5 ways to help a parent with heart disease

As more people survive and live longer with heart disease, adult children are increasingly becoming involved in their parent’s health care. They support their parents in making diet and lifestyle changes, taking multiple medications, recognizing side effects or new symptoms, figuring out health insurance claims – the list goes on.

Having a parent with a chronic health condition is one many people can relate to – including myself. I know it sometimes can be difficult to know how to help – or how much to help – but your care and support can make an enormous difference in managing their health, as well as retaining their independence.

Some of the most successful outcomes I’ve seen in patients came in large part because an adult child was keeping tabs on how the patient was feeling, managing medications and, in some cases, making key medical decisions for them.

Helping a parent with #heartdisease can range from watching for symptoms to ultimately making medical decisions for them. via @MedStarWHC

Let’s discuss five ways you can assist in the care and support of an aging parent – and what you can do if you don’t live nearby. These suggestions can be scaled up or down depending on your parent’s health. And while I may be talking specifically about heart disease, these tips could be modified to work with any chronic health condition.

1. Learn about their heart condition

Heart disease can seem overwhelming – for the patient and their loved ones. If your parent agrees, accompany them to doctor appointments. It can help to have a second person in the room while a doctor explains things. You can take notes and ask questions. The information is more likely to stick if there’s more than one person listening in the room.

You know your parent and their needs better than the doctor. This insight can be especially valuable as health care continues to move toward a shared decision-making model, in which the doctor and patient work together to make decisions based on best practices and patient preferences and values.

It also may be a good idea to schedule an appointment in which there will be no physical exam or tests, but to simply get you up to speed on your loved one’s condition. Explain that you’re Mom’s or Dad’s helper and while they will join you, the appointment is for you.

Along with asking about what symptoms to watch for and what role you can play in their recovery and health, ask what the future looks like. This topic may be uncomfortable to discuss, but can be useful for planning if the condition progresses.

If you care for an ill parent, ask the doctor what the future may hold. It can help with planning if the condition worsens. via @MedStarWHC

2. Watch for signs of heart problems

Providing a second set of eyes and ears may be the best way you can help a parent who has heart disease. Catching problems early can mean the potential for a better outcome.  

Symptoms of heart problems may not be as obvious in older people. They may be subtler than chest pain. But if you know your parent’s health baseline, you may notice changes before a doctor – or in some cases – even your parent does.  

Signs to be aware of, particularly if they appear suddenly, include:

  • Do they seem fatigued? Are they sleeping more or longer?
  • Does their breathing seem labored or “off”?
  • Has their appetite declined?
  • Is there increased swelling in the legs or ankles?  

Your parent may not mention changes in their health. We often see in this in the “Greatest Generation.” They don’t want to be a bother. “It was just a little chest pain. I didn’t want to worry you.” Ask them direct questions about their health. For example, when I talk to my father, I ask, “How are you feeling, Dad? Anything bothering you?” And, include even more specific questions that relate to their personal health problems. For example, “How is your breathing today?”  

3. Address potential heart problems

Don’t ignore warning signs. Encourage your parent to seek help, even if the symptom seems minor. Doing so could prevent a more dangerous situation.  

Create a plan with your parent’s doctor to address potential problems. Ask the doctor:

  • How can we reach you during the day or after hours?
  • Do you offer same-day appointments?
  • When should we go straight to the emergency room?  

Knowing these answers can result in more streamlined and effective treatment. For example, a patient’s daughter may call and say, “Mom’s having some of the same symptoms she had previously when she was admitted to the hospital. But I think it’s too early to go to the ER. Can I bring her to the clinic?” We may be able to prevent an unnecessary hospital admission.  

4. Assist with treatment, recovery and prevention efforts

Your parent’s doctor likely will send them home with a treatment and prevention plan. But there are all kinds of ways that a plan can be derailed. You can plan an important role in keeping their health plan on track.  

  • Track doctor appointments: Add your parent’s doctors’ appointments – or reminders to schedule appointments – to your personal calendar. This way you can help them remember and ensure they have transportation. If your parent agrees, join them at appointments as a second set of eyes and ears.  
  • Manage medications: Medication adherence is crucial in preventing secondary events. Your parent may get frustrated or confused if they are taking multiple medications. Make sure you understand the drug’s purpose, how and when to take it, the potential side effects, and when it needs to be refilled. And, don’t be afraid to ask if any medications can be safely stopped.  This can help in several ways including helping control the number of pills your family member takes, and ensuring that each pill provides a meaningful health benefit. Find more tips to improve medication management.
  • Monitor blood pressure: Blood pressure is a vital measurement we use to assess heart health. But sometimes, the readings may not be accurate during a doctor’s visit. The stress of being in a doctor’s office can cause blood pressure to rise, a condition we call “white-coat hypertension.” The doctor may recommend regular blood pressure monitoring at home. Learn how to monitor your blood pressure at home.
  • Support lifestyle changes: Your parent may be asked to make significant changes in diet and exercise. Offer to help with grocery shopping or cooking. When possible, join them in diet changes or physical activity. The American Heart Association says people are 76 percent more likely to follow a walking program if someone is counting on them to show up.  

5. Organize health-related records such as insurance, advance directives

Navigating health insurance plans can be confusing for anyone. But it may be especially difficult for your 85-year-old mother or father. Look at their plan and know what benefits are included. This can become useful, for example, to ensure they don’t defer care they should be getting.  

Discuss your parent’s preferences regarding end-of-life-care. Who would they like to make medical decisions for them should they be unable, and which treatments would they want and not want? Although these conversations can be painful, they’re important decisions that will help ease the burden on the family should your parent’s condition worsen. Prepare an advance directive and make their wishes known to close family. 

End-of-life planning discussions can be painful, but the decisions made can help ease the burden on family later. via @MedStarWHC

What if you don’t live near your parent?

There are all sorts of creative ways to communicate and keep tabs on someone in our tech-enabled world. Many jokes are made about older generations not being able to use technology, but I’ve found my elderly patients remarkably adaptable when it comes to learning how to use some of these devices, especially if it allows them to see and talk with their children and grandchildren.

Make use of apps such as FaceTime, WhatsApp or Skype to not only talk with your parent, but also to physically check for symptoms. You could set up a standing time to talk each day to make sure they have taken their medication or completed their physical therapy.

Wearable healthcare monitoring devices, which are constantly evolving and growing in use, may allow you to remotely track your parent’s blood pressure, pulse and heart rhythm. I’ve even seen one that alerts you to someone’s body position, so if it’s noon and Mom is lying down, you can check on her. One note of caution about these devices and apps: Check out the privacy policy and be sure your parent is willing to share their healthcare information with the company.

You also could use video monitoring for some details. This may sound spooky, but it could be as simple as mounting a camera over the pill organizer to ensure that your parent is taking their medication every day.

Finally, don’t forget to look after yourself as well. Surround yourself with a support system that can give you a break from caring for a parent when you need it and to help you manage the emotions you may face from day to day. Also, heart disease can run in families, so talk to your doctor about your own heart risks and what you can do to prevent future problems.

Request an appointment to discuss your heart health or to learn more about a parent’s heart condition and treatment.

Cardiogenetics: Detecting and Preventing Heart Disease Before it Strikes

Tune in to the full podcast with Dr. Susan O’Donoghue.

A relatively new sub-specialty of cardiology is helping people with a family history of certain serious heart problems understand their risk of developing the same conditions and how to prevent them.  Called cardiogenetics, the service is usually only available at advanced heart centers like MedStar Washington Hospital Center, which opened the first program in the Washington metropolitan area. But during the field’s short history, cardiogenetics has already demonstrated its value in identifying some inherited heart syndromes and improving, even saving, the lives of individuals with genetic-based heart disease.  

That’s because some very specific and dangerous heart problems are known to have strong genetic components. Yet until now, we’ve had to rely on clinical findings, EKGs and imaging to diagnose and treat such conditions—most often, after symptoms have surfaced and the damage has already begun. In contrast, cardiogenetics gives us a new type of tool that can actually help predict the likelihood of developing the disease, allowing us to make pre-emptive strikes before problems arise.  

Cardiogenetic Testing—When and Why  

Despite the prevalence of cardiovascular disease in the United States, cardiogenetic testing is only used for a subset of conditions. Testing is most often recommended because of a suspicious finding on a patient’s EKG or other test, his or her symptoms, or personal or family history. Red flags include fainting or palpitations during exercise, a diagnosis of heart failure at age 40 or younger, multiple family members with the same heart condition, or an incidence of sudden, unexpected death in the family.  

To date, the conditions most suitable for cardiogenetic testing are a few specific structural and electrical abnormalities that can produce fatal irregularities in the heart’s rhythm, including hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS). Anyone with an inherited heart disease like HCM or LQTS may face a 50/50 chance of passing this genetic error on to their children.  

Hypertrophic cardiomyopathy, an abnormal thickening in the walls of the heart muscle that restricts blood flow and weakens the heart, may result in ventricular fibrillation, a fatal arrhythmia. Quite common, HCM occurs in roughly 1 out of every 500 people and is the leading cause of sudden cardiac death in people 30 and younger, in which the heart suddenly stops beating, without warning.  

If an individual is found to have a defective HCM gene, we can then screen family members to determine who, if anyone, is at increased risk for the condition and needs close follow-up for early identification of disease and intervention. If the genetic error is discovered in a child, for instance, precautions might include frequent monitoring, an echocardiogram every few years and other safety measures, such as avoiding competitive sports. Conversely, a negative finding frees parents and kids from increased vigilance, life-style restrictions, and worry…at least for HCM.  

How it Works

Cardiogenetic testing is extremely simple for the patient, as it only involves collection of blood or saliva samples. Then the tricky part begins, as specialists work to find potential molecular changes that indicate—or, more often, suggest—the presence of the genetic material responsible for the disease.  

There are three possible outcomes:

  • Positive: a genetic error is causing the patient’s disease or symptoms.
  • Negative: there is no evidence of a genetic mutation.    
  • Inconclusive: something genetically unusual is discovered, but science does not yet understand the relationship between the mutation and the disease; i.e., the genetic variation could be harmless or harmful.

If tests identify a genetic disorder, recommendations range from avoiding certain things (like some common medications, strenuous exercise or excessive alcohol consumption) to watchful waiting to the prompt initiation of medical, electrophysiological or surgical treatment.

Fortunately, we have the full array of proven and promising treatments available, multiple experts in every aspect of cardiac care and a certified genetic counselor in cardiology who can help guide patients and families in their decisions.

Knowledge is Power

As scientists continue to learn more about the genetic basis for heart disease, the field of cardiogenetic testing will evolve as well. Until then, interpretation is often as much art as science.

Because of the field’s newness and complexity, current consensus guidelines advise that cardiogenetic testing only be carried out by dedicated centers, like ours, that offer genetic counseling before and after testing. That assures that patients and family members understand the various implications of results and options so they can make fully informed decisions.    

Meanwhile, a patient’s best bet to defeat or minimize hereditary disease, of any type, is to be aware of his or her family’s medical history. In the presence of arrhythmias, congestive heart failure or cardiac arrest, ask your physician whether cardiogenetics testing might be appropriate for you. Results can help you eliminate, postpone or reduce the effects of genetic conditions or, if negative, reassure you that you’re not following in your family’s footsteps. Either way, knowledge is power!

Listen to Dr. O’Donoghue’s podcast interview about cardiogenetics.



Stress: As dangerous as high cholesterol and blood pressure

According to a study released in January 2017 by the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. Many of my patients know they’re at risk for heart disease, and we work together to lower their risk by controlling their risk factors, including high blood pressure and high cholesterol.

But these aren’t the only risk factors to watch out for. People with constantly high levels of stress double their risk of heart disease. That’s equal to the risk from high cholesterol and high blood pressure. And according to real estate blog Movoto, Washington, D.C., is the most stressed-out city in the nation.

How stress may affect the heart

We’ve known about the link between stress and heart health for some time. Experts at the American Heart Association note the importance of managing stress to prevent heart disease. And in 2015, an international group of researchers identified emotional shocks as the second leading cause of stress cardiomyopathy, or broken-heart syndrome. This condition is a special kind of heart attack that isn’t caused by blockages in the heart arteries. Instead, broken-heart syndrome can happen when someone sees or learns of something traumatic, such as the death of their child.

Though we’ve known that stress can affect heart health for some time, we haven’t understood the mechanics behind how this happens. But we may be close to a breakthrough in that area of research. In January 2017, researchers showed the area of the brain called the amygdala is associated with the risk of heart disease and stroke. The amygdala contributes to the brain’s processing of emotions and helps communicate with the rest of the body on whether to get away from stress or handle it head-on. This is what many people know as the “fight or flight” response.

So we know stress is dangerous, and we have an idea of why. The question then becomes: What do we do about it? I wish I could say that we should just not have any stress. The reality is that sort of advice isn’t practical. We can’t avoid all stress in our lives.

But when it comes to your heart’s long-term health, not all stress is created equal. Some types of stress are much worse than others. It’s important to recognize these different types of stress so you can get help from your doctor before your heart is at risk.

Types of stress

I think most people would agree with me that stress is bad for you. And I think most people also would agree that stress is a part of life we simply can’t avoid. Stressors like a bad commute, a rough day at work or an argument with your spouse are part of what life throws at us.

Most sources of stress are like these. They pop up, we deal with them, and we move on. These short, intermittent episodes of stress aren’t really a problem for your heart. Even stress that comes up on a regular basis, such as rushing to get the kids to soccer practice every Tuesday, isn’t that bad for you.

The main danger of stress to your heart is when you’re constantly in a stressful situation you can’t control or get away from. We call this uncontrolled, unrelieved stress. Some examples of these types of uncontrolled stress include:

  • A terrible work environment
  • An abusive relationship
  • Ongoing depression
  • Ongoing serious financial trouble

Though these are very different causes of stress, your body can’t tell the difference. In these situations, all your body knows is that you’re under severe chronic stress that you don’t feel you can escape. And that’s a major red flag for your heart health. You need to talk to your doctor if you’re in these or similar types of stressful situations.

Get help to find stress relief

Patients don’t talk to their doctors enough about stress. A lot of patients don’t like to talk about stress with their doctors—certainly not doctors who aren’t psychiatrists or psychologists. There’s not enough time in the course of a normal visit, or they don’t think it’s a medical problem. But stress absolutely is a medical problem!

And just as patients should be willing to talk to their doctors about stress, we doctors should be asking our patients about stress. That should be part of our care for people’s overall heart risk.

When a patient brings up a source of severe stress with me, I’m always grateful. I try to point them toward resources or come up with strategies for stress management. That’s part of my job as their doctor.

It might be tempting to think, “But you can’t help me get out of my debt. You can’t fix the stress. Why bother?” And no, we can’t remove sources of stress that way, but if we identify it as a problem for your heart, it might be something you can focus on to find a solution.

We also can refer patients to get professional help for their stress from mental health professionals, if necessary, or find other ways to resolve these sources of anxiety and worry. But if it’s really to that level that you feel like you can’t control this stress, you probably need to get some help.

Recognize and address stress

Some people are more aware of stress than others. Just like beauty, stress is in the eye of the beholder. What one person might think of as no big deal could be a source of extreme stress for another person.

But some people who think they’re handling their stress might just be ignoring or suppressing it. That’s a big problem, because those people aren’t recognizing the effects of their stressors on their lives or doing enough to address it.

Whether or not you think you’re stressed, use these simple assessments to measure the stress levels in your life. You might be surprised by what you find. If your stress levels are high, talk to your doctor about it, especially if you’re already being seen by a cardiologist for a heart condition.

Stress isn’t just in your head. It’s a real, physical, medical problem. And leaving severe stress untreated could lead to your heart paying the price.


Know your heart-healthy numbers – including CRP

“Know your numbers.” It’s a common theme surrounding heart health. Most doctors agree you should know your blood pressure, blood sugar and cholesterol so you can make changes to improve your health and reduce your risk of heart problems.

But there’s one more number people should be aware of: C-reactive protein (CRP).

CRP is a marker for inflammation in the body. It’s been shown that, when used in conjunction with cholesterol levels, it can help us better understand a person’s risk for heart disease. In fact, one analysis showed that the risk of a future heart event was more than 50 percent higher when CRP levels were over 3 mg/L.

Unfortunately, people often emphasize their cholesterol levels without considering any other factors. They think if their cholesterol is low, they are at low risk for heart disease. That may not always be the case. Knowing both your CRP and cholesterol levels is more powerful than knowing one alone.

Let’s take a closer look at how your CRP affects your heart risk. That way, the next time your doctor prepares to test your cholesterol, you can also ask about your CRP level.

What is CRP, and what does it tell us about heart health?

CRP is a ring-shaped protein produced in the liver in response to inflammation in the body. Inflammation is part of the body’s response to fighting infection. We all have a low level of inflammation at any given time. That’s normal and healthy.

While the exact role inflammation plays in heart disease is a topic of ongoing research, we do know that having a high level of inflammation over a long period of time creates heart risk. And we know we can measure inflammation in the body by testing CRP levels.

Checking your CRP involves a simple blood test. If you’re getting your cholesterol tested, we can use the same tube of blood. No extra needle sticks are necessary.

Your CRP level puts you in one of three categories:

  • Low risk: Less than 1 mg/L
  • Average risk: 1 to 3 mg/L
  • High risk: Greater than 3 mg/L

However, your CRP can’t tell us everything. It’s important to look at it in relation to your cholesterol, specifically low-density lipoprotein (LDL). LDL is considered the bad cholesterol because it collects in your arteries and can cause blockages. Your CRP modifies your LDL level.

Here’s how it works: If you have a low LDL but a high CRP, the high CRP reduces the benefit of a low LDL. You’re at increased risk. And it’s the same in reverse: If you have a high LDL but a very low CRP, that low CRP reduces the risk from the high LDL.

In fact, the American Heart Association and the Centers for Disease Control and Prevention say it’s reasonable to measure CRP as a part of heart disease risk assessment. It’s not considered mandatory, but patients and their doctors should discuss its potential benefits.

Once you know your numbers, there is a very simple online scoring tool you can use to predict your heart risk over the next 10 years.

How can you lower your CRP?

What causes a high CRP? It’s a combination of genetics, health and lifestyle factors, including:

  • Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis and gum disease
  • Excess body fat
  • Low physical activity
  • Smoking

The good news is that there are many ways to lower your CRP. Most are the same things you should be doing to live a heart-healthy lifestyle: eat a healthy diet, exercise and quit smoking. If you have a chronic inflammatory condition, work with your doctor to manage it effectively.

Studies, including one I authored, have shown statins also can reduce CRP. Statins are a class of drugs typically prescribed to lower cholesterol levels and reduce the risk of heart attack and stroke. Current guidelines advise the use of statins for people with:

  • Known heart disease
  • Elevated levels of LDL cholesterol
  • Diabetes
  • An estimated 10-year risk of a heart event greater than 7.5 percent

And the JUPITER study showed statins could benefit otherwise healthy people with high CRP levels by cutting their risk of heart disease and death from heart disease by almost half. This would indicate we should take CRP into effect when assessing a person’s heart risk.

Who should get their CRP tested?

I recommend anyone who has their cholesterol checked to also have their CRP tested. As I said earlier, we can use the same blood draw; we simply check one more box for the lab to test.

Just like with cholesterol, the earlier we identify a high CRP levels, the more time we have to prevent potential heart problems through lifestyle changes and, if necessary, medical treatments.

CRP is simply one more way to optimize our understanding of someone’s heart risk. And high CRP is treatable! So the next time you’re in the doctor’s office, ask about your numbers. All of them.

Request an appointment to test your heart-health numbers.

The surprising heart risks of too much sleep and exercise

You’ve probably heard a lot about how getting exercise and sleep can help you avoid heart troubles in the future. But getting too much of either can actually increase your risk of heart disease.

It seems counterintuitive. After all, we’re constantly told that exercising regularly and getting enough sleep are vital to staving off obesity, high blood pressure, stroke and, of course, heart disease. And it’s true. Exercise and sleep are important components of a healthy lifestyle. So, wouldn’t exercising even more and getting lots of sleep make us healthier and less prone to heart disease?

Surprisingly, the answer is no. Excessive sleep and over-exercising can increase your risk for heart disease, just like not getting enough sleep or exercise can. In many disciplines, from economics to communication, this phenomenon is known as the “Goldilocks effect,” referring to the children’s story of “Goldilocks and the Three Bears.”

Here’s how can you balance your sleep and exercise to find the amount that isn’t too much or too little, but instead “just right” for your heart health.     

How sleep affects the heart

There is still some debate about the exact amount of sleep that’s ideal for adults. However, researchers have reached a consensus on the optimum range. Almost everyone needs between seven and nine hours of sleep every day. And no, you can’t “catch up” on the weekends. It’s much better for your body’s circadian rhythm–the natural sleeping and waking cycle–to go to bed and wake up at a relatively consistent time each day.

Some people are naturally long sleepers, about two percent of the population. These people need 10 to 12 hours of sleep, or they feel tired and groggy throughout the day. However, most people should not be sleeping more than nine hours per day.  

Oversleeping has been linked to increased inflammation–in which the body’s immune system attacks healthy tissue. Chronic inflammation, or inflammation that occurs over months or even years, can put you at greater risk for cancer, diabetes, heart disease and many other health problems.

Getting too little sleep or too much sleep can increase inflammation levels. But considering that fewer people are aware of the dangers of oversleeping compared to undersleeping, it’s important to emphasize that both can lead to heart problems in the future. A study of the National Health and Nutrition Examination Survey found that, compared to people who get six to eight hours of sleep, those who slept:

  • Less than six hours: Had a doubled risk of stroke or heart attack
  • More than eight hours: Had a doubled risk of angina – chest pain due to reduced blood flow – and 10 percent higher risk of coronary artery disease

If you’re having trouble getting between seven and nine hours of sleep each night, bring it up to your doctor at your next physical. While short-term sleep problems aren’t likely to cause lasting damage, developing poor sleep habits can put you at higher risk for heart trouble as well as other problems later in life.

How exercise affects the heart

On the whole, Americans don’t exercise nearly enough. About half of U.S. adults don’t get enough aerobic physical activity – the heart-strengthening exercises known as “cardio.” Aerobic exercise is one of the best ways to safeguard against future heart disease and improve your overall health. However, too much vigorous aerobic exercise can also be detrimental to your heart health.

Like a few days of getting too little sleep, brief bouts of high-intensity cardio followed by periods of rest won’t do lasting damage. In fact, it can make your heart stronger. Problems arise when extreme athletes – such as long-distance runners, rowers, swimmers and cyclists – perform vigorous exercise regularly.

Intense aerobic physical activity puts a strain on your heart. Over time, repeated strain changes the very structure of the heart, enlarging the arteries and right ventricle and causing thick scar tissue to form in the heart’s two atria. These adaptations have been linked to heart problems in some people, though more research is needed for us to draw definitive conclusions.

There are many misconceptions about how intense exercise needs to be to achieve the best results. I find that many people believe they have to be totally out of breath and drenched in sweat to get a “good workout,” but the reality is that, as far as your heart is concerned, you’ll maximize your exercise benefits with regular moderate exercise, like a brisk walk. What defines “moderate” exercise? You should sweat a little and be able to carry on a conversation with someone without too much difficulty.

The American Heart Association recommends 150 minutes of moderate physical activity per week, or 75 minutes of vigorous exercise, or some combination of both. I suggest doing 30 to 60 minutes of moderate exercise on most days of the week. That’s a healthy habit that you can continue through your whole life. 

This doesn’t mean you shouldn’t give that marathon or triathlon you’ve always wanted to do a try. I’ve finished 11 marathons and a 50-mile race, so I know the allure of such events. The positives of endurance training are many: fitness, strength, even psychological. But we need to remember that more isn’t always better. Talk to your doctor before beginning to train for such endurance events. As for me, I still enjoy running and believe strongly in the benefits of exercise, although I’ve moderated my distance over the years, opting for a morning jog on the C&O canal as my favorite run!

Most people don’t have to worry about exercising too much or oversleeping. In fact, they should be concerned about too little exercise and sleep! But for extreme athletes and chronic sleepers, these issues can lead to heart problems in the future. The trick to the Goldilocks effect of sleep and exercise is finding a balance that makes you feel “just right.”


Request an appointment online or call 202-877-3627 to talk to a doctor about how your sleep and exercise routine affects your heart.


How to monitor your blood pressure at home

Your blood pressure can lie. It changes throughout the day, but too often, we rely on one blood pressure measurement taken in a doctor’s office.

There often isn’t time to take an accurate blood pressure measurement during a doctor’s visit. To properly take a blood pressure measurement, you need to be relaxed and seated for five minutes. If the measurement is high, you need to wait five minutes and take it again.

It’s often the “relaxed” part that is most difficult. Doctor’s visits can be stressful. This can cause your blood pressure to rise. The phenomenon of blood pressure readings that are higher in a doctor’s office compared to at home is known as “white-coat hypertension,” and it can occur in 15 to 30 percent of patients.

So how do we get a more accurate blood pressure reading? By supplementing office measurements with those taken during your daily routine. There are two ways to do this: manual home blood pressure monitoring and a more formal test known as ambulatory blood pressure monitoring.

Who benefits from home blood pressure monitoring?

I’ve had many patients come to me thinking they had high blood pressure (also known as hypertension) due to measurements taken in a doctor’s office. But after home blood pressure monitoring, I can give them the good news that their blood pressure is, in fact, normal. This monitoring can save them from unnecessary treatment.

Home blood pressure monitoring also can validate high office measurements and allow us to use office time more productively, such as searching for the cause of the hypertension. This could be as simple as your favorite snack food. I once had a patient who loved a certain salty cracker. Once she eliminated the culprit, her blood pressure went back to normal.

Not everyone needs to monitor their blood pressure from home. I recommend it for people who:

  • Have borderline high blood pressure (between 120/80 mm Hg and 140/90 mm Hg)
  • Have high blood pressure (140/90 mm Hg)
  • Take medication for high blood pressure

Along with more accurately diagnosing hypertension, home blood pressure monitoring can track treatment and empower you to take an active role in your health care. With regular monitoring at home, you can see in real time how medication and lifestyle changes affect your blood pressure. And it can help us optimize your care, such as determining whether we need to alter your medication or dosage.

How to monitor your blood pressure at home

Home blood pressure monitoring is easy, but it only works if you do it correctly.

How to choose a home blood pressure monitor

Patients often ask which home blood pressure monitor is best. It doesn’t matter whether you use an arm cuff, wrist cuff or finger measurement. They all work. I tend to find that the wrist and finger monitors are easiest for people to handle because they can do it with one hand and don’t need a helper. Use what’s comfortable for you.

Once you’ve chosen a home blood pressure monitor, bring it to your doctor’s office to make sure you’re using it correctly and to check its accuracy against the doctor’s equipment.

How to check your blood pressure

Timing is everything when checking your blood pressure. If you’re rushing around, that’s not the time to take it. Wait 30 minutes before taking your blood pressure if you:

  • Are about to eat
  • Have just eaten
  • Have exercised recently
  • Have had a caffeinated drink

When you’re ready, sit quietly with your feet flat on the floor. Don’t cross your legs. After five minutes, take your blood pressure. Wait five minutes and do it again to check the accuracy. You can do this three times to get an average of the readings.

How often to measure your blood pressure

You don’t need to do go through this process three or four times a day. When you start, do it on a regular basis so you understand what your blood pressure normally is at different times of the day. Try taking it once in the morning and once in the evening. After that, you can do it periodically. Talk to your doctor about how often to measure your blood pressure.

Home blood pressure monitoring is not a substitute for a doctor’s visit. Keep a journal of your home measurements to show your doctor. Some home blood pressure monitors digitally record your measurements, so you can print them out or send them to your doctor.

How ambulatory blood pressure monitoring works

If there’s uncertainty about the accuracy of your blood pressure readings, we can do a more formal test called ambulatory blood pressure monitoring. We consider this the gold standard to diagnose high blood pressure.

We’ll send you home with an arm cuff to wear. The device measures your blood pressure at regular intervals over 24 hours. This gives us a nice visual chart of your blood pressure throughout the day.

 The information we get from ambulatory blood pressure monitoring and manual monitoring allows you and your doctor to make more effective use of your time together. For example, if your blood pressure is high in my office, but your home readings are normal, we can move on to the next thing. We don’t need to waste time focusing on something that isn’t wrong.

Don’t let one blood pressure measurement lie to you. Request an appointment online or call 202-877-3627 to talk to a doctor about whether you might benefit from home blood pressure monitoring

Absorb™ Stent: New Dissolvable Stent Shows Promise

Some 600,000 Americans undergo a cardiac stent procedure each year. For people having a heart attack or at risk for a heart event, stents (metal mesh devices inserted during a cardiac angioplasty procedure to open or maintain the artery pathways) can be life-saving, as they keep blood flowing to the heart.  Stents are used where a patient’s coronary arteries are fully or partially blocked due to build up of fatty deposits called plaque. Traditionally, stents are permanent installations. But recently, the MedStar Heart & Vascular Institute became the first in the Baltimore-Washington area to offer the Absorb™ Stent, a bioresorbable stent.

How the Absorb™ Stent Benefits Patients

“The Absorb scaffold is a major advancement in the treatment of coronary artery disease that has the potential to affect quality of life and address patients’ desire to leave no metallic stent behind,” said Ron Waksman, MD, director of Cardiovascular Research at MedStar Heart & Vascular Institute, and the principal investigator of the ABSORB III trial.

Similar to dissolving sutures, the Absorb™ Stent dissolves gradually over a 12-month period and disappears entirely after three years. Only four small metallic markers are left behind, as an identifier of the prior location of the stent within the artery.

But why does a fully-dissolving stent help patients?

Dr. Waksman explains, “The fact that no metal material is left in the body allows the vessel to heal itself and reduces adverse side effects of permanent implants.” 

Who Is the Absorb™ Stent for?

It’s important to note that the Absorb™ Stent isn’t for everyone. In a recent study, patients who had the Absorb™ Stent had similar outcomes after one year to those who had the more conventional metal stent. In that same study, however, heart-related complications were slightly elevated for those with the Absorb™ Stent.

Moreover, patients who are unable to take blood thinners for long periods of time or possess smaller vessels are not good candidates for this new breed of stent.

Dr. Waksman says the MedStar interventional cardiology team will continue to provide traditional stents for most of their coronary heart disease patients, as the safety assessment of the Absorb™ Stent continues.

The Front Line of Innovation for Heart Patients

Currently, MedStar Washington Hospital Center and MedStar Union Memorial Hospital in Baltimore offer the new stent. At the Hospital Center, a man in his 80's became the first patient to receive the dissolvable stent a month after the FDA approval.

“Once again MedStar is on the front line of medical technology the first to offer new innovation to Mid-Atlantic and DC patients, this time it is a bioresorbable scaffold that perform similar to a metallic stent but disappears from the body overtime and leave nothing behind, said Dr. Waksman.


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Are Symptoms of Heart Disease in Women Different than in Men?

More than half of the 500,000 individuals who die each year from a heart attack are women. Unfortunately, heart conditions are often stereotyped as a primarily male health concern, and symptoms of heart disease in women go unchecked because they differ than those found in men.

For example, in a 2005 survey cited by the Centers for Disease Control and Prevention (CDC), 92 percent of people were able to recognize chest pain as a sign of a heart attack. But symptoms such as chronic fatigue, anxiety and sleep disturbances can also be warning signs of a heart event for women.

If you are a woman of any age, it's critical that you know and understand the different women's heart disease symptoms, so you know how to take control of your health and potentially save your life.

Know the Symptoms

Heart disease is a leading cause of death in the United States, causing approximately one in every four fatalities each year. Educational programs have made great strides in alerting people to the warning signs of heart disease, as well as heart events such as heart attacks. But only in recent years has the medical community taken greater steps to ensure women and men are aware of the gender-specific signs of heart issues.

While many women think they are at little risk for heart disease - either due to age, history or lifestyle - the reality is that even young, relatively healthy women may find themselves experiencing a heart incident. That is why it is so important to know symptoms of heart disease in women.

Signs of Heart Issues in Women

The term "heart disease" actually refers to a collection of different conditions and coronary events, rather than a singular diagnosis. Each one has distinct symptoms, although they may be closely related in terms of your overall health. Remember these are all possible signs of heart issues, but you may experience only one or a few. For example, some women have a heart attack without experiencing chest pain.

Coronary heart disease - which can lead to a heart attack - is a condition characterized by reduced blood flow to the heart. Over time, the major blood vessels (coronary arteries) that provide oxygen-rich blood and nutrients to the heart may narrow due to a buildup of cholesterol and other waste deposits.

You can have coronary heart disease for many years and not know it. Common symptoms of CHD in women include angina (chest pain) and pain in the neck, jaw, upper abdomen, or back.

With a heart attack, women may experience the following symptoms, in addition to chest pain:

  • Upper back pain
  • Neck pain
  • Indigestion
  • Heartburn
  • Nausea and vomiting
  • Extreme fatigue
  • Shortness of breath

Symptoms of heart failure include shortness of breath and fatigue, as well as swelling of the abdomen, feet, ankles, and legs.

Another relatively common condition is arrhythmia, which is characterized by an irregular or abnormal heartbeat. You may experience heart palpitations or a fluttering sensation. This becomes more serious when it leads to other symptoms, including:

  • Fatigue
  • Dizziness
  • Lightheadedness
  • Fainting
  • Rapid heart rate
  • Shortness of breath
  • Chest pain

Heart events of any kind are a serious medical emergency. So if you or someone you know is experiencing symptoms, contact 9-1-1 services immediately.

Taking Control of Your Health

Heart disease is a serious concern for women. But knowing the signs and symptoms of chronic disease or a coronary event can help you to get long-term treatment and life-saving assistance in an emergency.

Take steps to help yourself and the other women in your community. Discuss the symptoms of heart disease in women with your family members so they know what to look for and be vigilant to protect those around you by spotting the signs in others. Heart disease can affect women of all ages, so make women's heart disease symptoms a family conversation that includes all generations.

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Women and Heart Disease: What you Need to Know

Eighty percent of all heart disease is preventable – and heart disease does affect women. In fact, it is the leading cause of death among women in the U.S. So it is very important for women of all ages to learn the facts about heart disease and know the symptoms, because there are steps you can take to reduce your risk and get treatment when you most need it.

What are the risk factors for heart disease?

Many different factors can put women at risk for developing heart disease.  Some things are out of your control. However, it is important to understand how the following risk factors contribute to your chances of developing heart disease:

  • Age - Research indicates that about 6 out of 100 women in their 40’s will develop coronary heart disease growing to nearly 1 out of 5 women in their 80’s.
  • Family History of Heart Disease - You are at greater risk if a close family member, a parent, brother, sister or grandparent developed heart disease before age 59.
  • Race – African–American women are at higher risk of developing heart disease as compared to women of other races.

Risk factors more under your control include:

  • Smoking – Smoking increases the risk of heart disease and stroke by 2 to 4 times and women who smoke have a 25 percent higher risk of developing heart disease than men who smoke.
  • Obesity - Excess body weight puts a strain on your heart, raising your blood pressure, LDL (bad) cholesterol and triglyceride levels, and lowering your HDL (good) cholesterol. Obesity also increases your risk for developing diabetes.
  • Diabetes- Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without the condition.
  • High Blood Pressure (HBP) - Elevated blood pressure makes the heart work harder. Chronic HBP scars and damages your arteries and can lead to heart attack, stroke, heart failure and
  • Lack of Physical Activity - A lack of physical activity comes with great risks as a sedentary lifestyle has been linked to an increased risk for blood clots, high blood pressure, heart attack, stroke and other heart related problems.
  • High Cholesterol - Cholesterol hardens over time into plaque which can narrow the artery walls and reduce blood flow leading to blood clots, heart attacks or strokes.

The ABCs of Women’s Heart Disease Symptoms

Heart disease symptoms can be different for women than men. They are sometimes subtler in nature and harder to identify. Because women tend to dismiss their symptoms as not significant, they are more likely to have a silent heart attack or die during their first heart attack.

The following is an ABC listing of heart disease symptoms to help guide you.

  • Angina:  pain, discomfort or fullness in the chest. (Women also report pain in the jaw, right arm or abdomen.)
  • Breathlessness: experienced during activities or waking up breathless at night
  • Blackouts: fainting
  • Chronic fatigue: an inability to complete routine activities and a constant feeling of tiredness
  • Dizziness: this can indicate irregular heartbeats, or arrhythmias
  • Edema: swelling, particularly of the lower legs and ankles
  • Fluttering heartbeats: palpations, rapid heartbeats that may cause pain or difficulty breathing
  • Gastric upset: nausea or vomiting, unrelated to diet, indigestion or abdominal pain

If you experience any of these symptoms frequently (about once a day), see a physician—the symptoms are serious and should not be ignored. Keep notes about when the symptoms occur, what triggers them, and what, if anything, relieves them. It is also helpful to make a list of past treatment and all medications you are currently taking.

How can I prevent heart disease?

There are steps you can take today to prevent heart disease. Here are some ways you can stay healthy:

  • Identify behaviors that contribute to your risk (smoking, unhealthy diet, lack of exercise)
  • Ask your physician about your numbers (blood pressure, cholesterol, glucose, body mass index or BMI
  • Learn about your family history
  • Discuss all of the above with your physician

We urge you to start on the road to become heart healthy today.  Learn more about heart disease.  Seek out guidance and support from medical professionals. Heart disease can be treated, prevented and even ended.

Have Any Questions?

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29 Things You Should Do for a Healthy Heart

You’re heard it many times before -- follow a healthy lifestyle for a healthy heart. Sounds simple, right?  But it’s not always so easy to pull off. A heart healthy lifestyle can reduce the risk for heart disease by as much as 80%!  But what is a “heart healthy lifestyle”?  It’s a commitment to many habits in our daily lives centered on our activity, diets, mindset and awareness.  There is no one “magic” thing. When lifestyle isn’t enough, talk with your doctor to set goals you can realistically achieve, such as losing weight or lowering your cholesterol or blood pressure levels. Sometimes, it takes medications that can be very helpful to optimizing your heart risk.

So, commit to making the many small lifestyle changes that make a healthy heart a snap! The key to success is to make small changes in many areas. No matter what you do, remember to take it day by day, and work to sustain your gains.

With that in mind, we’ve compiled 29 heart health tips. Knowledge is power!  Read on to find out what you can do to keep your heart healthy. Only you can love your heart. So start today!

1. Make time for exercise: Exercising 30 to 60 minutes on most days will cut your heart risk in half.

2. Know your heart disease risk: Calculate your risk by plugging your numbers into an online calculator.

3. Never ignore your chest pain:  Pain can be felt anywhere in the chest area, arms, your back and neck.

4. Check your blood pressure: Let the healthy blood pressure number be below 140/90. Both numbers matter!

5. No smoking: Don’t smoke, and ask your loved ones to quit.

6. Aspirin: Should you take aspirin? If you have heart disease, yes! If you don’t have heart disease, then maybe not! Ask your doctor.

7. Moderate exercise: How do you know whether you are exercising moderately? You should able to carry on a light conversation

8. Stress: Is it bad for your heart? Yes, sustained stress is, no matter the source. Learn to control your stress to prevent heart disease.

9. Second hand smoke is dangerous! Public smoking bans in the community have reduced heart attack risk by 20%.

10. Sex: Is your heart healthy enough for sex? Sex has a “heart workload” like climbing two flights of stairs.

11. Dark chocolate: Give your loved ones chocolate as a gift on Valentine’s day! Regular chocolate eaters have less heart and stroke risk!

12. Order wine with your dinner! Moderate intake is associated with lower heart risk. (Consume wisely!)

13. Red or white wine? Is one better for your heart? Wine, beer or spirits all show a similar relationship to lower heart risk.

14. The “Mediterranean diet” is the most heart healthy way to eat. Studies show this diet reduces heart attack risk up to 30%.

15. Mediterranean diet = veggies, fruits, nuts, seeds, grains, herbs, spices, fish, seafood, olive oil, poultry, eggs, cheese, yogurt and wine.

16. Take your heart meds fully and faithfully! It’s the only way to get the full benefit of the treatments!

17. Stairs burn twice as many calories as walking. Regular stair climbing reduces your risk of premature death by 15%!

18. The quantified self. Keep moving! Steps per day: Very active >10,000, active >7500, sedentary <5000.

19. Fish eaters have less heart disease! Think about fish as a first choice when eating out- let somebody else do the cooking!

20. Did you know that people who are optimistic have less heart disease? See the bright side- it is truly good for your heart!

21. If you snore, tell your doctor. Snoring can be treated, and could signal risks for your blood pressure and heart rhythm.

22. Want to really know your risk of heart attack? Get a calcium scan of your heart. Accurate, safe, and costs less than dinner for 2!

23. Do you know CPR? Simple! Learn it here and double somebody’s chance of surviving cardiac arrest. http://www.cpr.heart.org

24. Ditch the soda and energy drinks. Please.

25. Coffee lover? For your heart’s sake, it is OK! (But, skip the donut!)

26. Like music? So does your heart! Music listening lowers your heart rate, and blood pressure!

27. Are statin cholesterol drugs safe? For most patients, yes! Unfortunately, over the counter supplements aren’t very helpful.

28. Heart attack or stroke symptoms? Don’t delay! Call 911 immediately. Minutes matter to save lives!

29. Taking vitamins or other supplements for heart disease risk? Be careful- few have little, if any, proven benefit.

Have any questions?

We are here to help! Contact us for more information about heart health or to schedule an appointment. Call us at 202-877-3627.

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