Three Top of Utah cardiologists weigh in on heart health

Story by Jamie Lampros
(Standard-Examiner correspondent)
Tue, May 21, 2013
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If you could sit down with a cardiologist, what questions might you ask about your heart health?

Three local cardiologists agreed to answer several questions on the subject.

Dr. Yuri Khodakov is a cardiologist at the Cardiology Clinic at McKay-Dee Hospital. Dr. Bhavananda Reddy is a heart failure, heart transplant, peripheral vascular and interventional cardiologist at Davis Hospital and Medical Center. Dr. Scott West is a physician specializing in internal medicine, cardiovascular disease and interventional cardiology at Utah Cardiology at Lakeview Hospital.

• Can too much exercise be as harmful as none at all?

“Athletic heart is a known entity with endurance exercise,” Reddy said. “It is nothing but thickening of heart muscle and slight enlargement of chambers. It usually reverses within a few months once a person stops exercising.”

Currently, the only known association is a slight increase in atrial fibrillation, or an irregular rapid heartbeat, in long-distance runners.

“I myself am a long-distance runner and I am not worried about this mild risk,” Reddy said.

Khodakov said excessive exercise, such as marathon running, has been shown to increase risk in certain cardiac arrhythmias. It was suggested that the stretching of certain areas of the heart is a cause, but that is a speculative explanation.

For heart benefits, Khodakov recommends 150 minutes of aerobic exercise a week, spread out over most days of the week. In practical terms, that means about 30 to 40 minutes a day, four to five times a week.

“One should not feel that exercise is too strenuous, but it also should feel like exercise. Not recreation,” he said. “Mild breathlessness is a good gauge.”

Reddy said multiple studies have confirmed the importance of exercise, and West emphasized that exercise doesn’t need to be high intensity. There is great benefit from regular, modest levels of aerobic exercise, and adding some weight training increases metabolism and helps stabilize or reduce weight, said West.

• Should we stop jumping out and surprising people at parties?

“The science behind this notion is fascinating,” said Khodakov. “There are some potentially lethal cardiac electric abnormalities that can be triggered by a startle reaction.”

However, Khodakov said, there is often a family history of unexplained death in these cases.

Still, Dr. Martin Samuels, one of the nation’s eminent neurologists from Harvard University, collected a wealth of data on neurogenic cardiac disease and the response of the heart and brain to stress and startle reaction — and he says it can happen.

• Can waking up before 5 a.m. cause your stress hormones to surge, putting you at risk of heart attack?

“It is a well-known fact that most of the acute heart attacks happen during early hours because of hormonal changes, but to wake up before 5 a.m. has nothing to do with coronary artery disease or heart attack,” Reddy said.

More specifically, sleep deprivation is the concern, because it is associated with a number of cardiovascular problems, including high blood pressure and coronary disease.

“Most research suggests that less than five hours of sleep is too little and seven hours is enough,” Khodakov said. “Heart attacks are more common in early morning hours, but there is no association whether the patient is awake or asleep. There is no credible data on specific wake-up time, only on total sleep duration.”

• How important is it for people to take vacations?

Khodakov said heart risks attributable to psychological factors are low.

Although there are no studies directly linked to heart benefits and vacations, Reddy said, one study did show heart attacks during vacations were highest during the first two days, due to adverse driving conditions and less luxurious accommodations.

West said God rested on the seventh day, so we should take some time to rest as well. One or two days a week is reasonable enough, he said.

• Should women avoid the birth-control pill?

Oral contraceptives may be associated with an increased risk of heart attack, Khodakov said. However, heart attacks are rare in otherwise healthy women of reproductive age.

If a woman older than 35 smokes, she should avoid taking birth control.

• If something doesn’t feel right, should I wait to see if it will go away?

Absolutely not, the physicians said. Only half of patients with heart attacks have the classic chest pain radiating to the left shoulder and arm. Most patients will have upper back pain, chest pain radiating to the lower neck, upper abdominal pain, vague shoulder pain and shortness of breath with activity.

Other signs to watch for include unusual sweating, weakness or faintness, and palpitations that include a rapid heartbeat.

Health, heart health
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