Dr. Cynthia Shelby Lane Answers Your Questions About Heart Disease

Lisa Nelson Health Pro
  • Last month I gave you the opportunity to submit the questions you'd like answered.  Many of you took advantage of the opportunity and asked a question - thank you!  You'll be very pleased with the results of this interview and the answers and insight Dr. Shelby-Lane has provided.


    Lisa Nelson RD #1:  What role does temperament/personality play in a person's heart disease risk? Does it have a direct affect on cholesterol levels or blood pressure?


    Dr. Shelby-Lane: Temperament and personality have a definite effect on blood pressure and on heart disease.  This is a great question and it has been studied by the experts, as you will note in the following excerpts.  Heart disease consists of congenital abnormalities, arrhythmias, lipid abnormalities acquired and congenital, functional and physiologic problems, risk factors such as diabetes and metabolic syndrome, structural disease and valvular problems, heart failure, acquired disease such as coronary artery disuse, and infectious diseases along with diseases related to blood vessel structure.  Again, anxiety, stress, and stress related disorders can have an effect on major hormones, heart rate and heart health and heart disease.  Nutritional abnormalities can also affect heart performance. 

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    Read on to learn more about the link between heart disease, panic attacks, and depression.


    Lisa Nelson RD #2: For women the signs of a heart attack are more subtle. What should women watch for?  If everyone responded to every arm/jaw/chest/indigestion/feeling "not quite right" symptom, they'd never leave the ER!


    Dr. Shelby-Lane: When it comes to women and heart disease, ignorance can be deadly. The misconception that heart disease is a "man's disease" is the main reason women are misdiagnosed, or receive delayed treatment, when experiencing symptoms of heart disease and even a heart attack.


    In a recent study at Weill Medical College of Cornell University/New York-Presbyterian Hospital, 230 physicians were given hypothetical cases of men and women with identical symptoms of heart disease. Half of the case studies included reports that the patient recently had a stressful experience or felt anxious. When this detail was included, doctors diagnosed heart disease in 56 percent of men compared with just 18 percent of women.


    Read on to learn more about this "gender bias" and the unique symptoms of heart disease in women.


    Lisa Nelson RD: Cynthia provided additional information related to heart disease and the signs of a heart attack specific to women.


    Dr. Shelby-Lane: Women do need to pay attention to symptoms that may be related to heart disease and hey need to be able to discern how it is different from stress related disorders and GI disorders. 


    What are the signs of a heart attack? Most people think it is the Hollywood version where the person grabs their chest and falls over. The truth of the matter is that many heart attacks start with vague and subtle symptoms that may come and go.


    Read on to learn more about when to take action and seek immediate help for heart attack or stroke.


    Lisa Nelson RD #3:  Please explain briefly what a leaking valve is and if someone chooses not to correct a "leaky valve" via surgery what's the long term prognosis?


    Dr. Shelby-Lane: A leaky valve is a condition in which the blood flow is altered by a valve that allows blood to flow backwards, otherwise known as "regurgitation".  Regurgitation can negatively impact the flow of blood across each of your four heart valves - aortic valve, pulmonary valve, mitral valve and tricuspid valve.

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    Ultimately, leaky heart valves force the heart to "work harder" as it re-pumps blood through a valve. Over time, this can lead to several leaking heart valve symptoms and an enlarged heart.


    Read on to learn the symptoms that may be indicative of a leaky valve and how to determine the right treatment option for you.


    Lisa Nelson RD #4: If you have a poor echo test indicating your heart does not effectively circulate blood, is it safe to donate blood?


    Dr. Shelby-Lane: Your entire medical history must be taken into consideration when it comes to donating blood or blood products.  A "poor or abnormal" result on an echocardiogram can have multiple implications.  A specific diagnosis is needed to make that judgment. If you have an abnormal result it is best to discuss this with your cardiologist.   Your cardiologist should be involved in any activity related to your cardiovascular system. 


    Lisa Nelson RD #5: Should individuals with low HDL levels receive treatment even if all other levels are normal?


    Dr. Shelby-Lane: According to Science Daily (May 29, 2005) - High circulating levels of the "good cholesterol" HDL are associated with decreased risk of cardiovascular disease. HDL helps the liver excrete extra cholesterol by binding to a receptor in the liver called scavenger receptor-BI (SR-BI). However, the signaling events between HDL and SR-BI that afforded heart healthy benefits were not known.


    A low HDL is an isolated risk factor and should be included in the overall health picture, and can be modified with diet, nutrition, and some newer drugs. 


    Read on to learn about a recent study that has identified the link between HDL and reduced heart disease risk.


    Lisa Nelson RD #6: If you have a patient with a high HDL level, let's say an HDL greater than 80; are you concerned if their LDL level is elevated?


    Dr. Shelby-Lane: New research has revealed that LDL or "bad" cholesterol inhibits the breakdown of fat in adipocytes, or fat cells, thus suggesting that it is a regulator of fat stores.

    This new knowledge gives you three important areas to work on, to not only boost your HDL number, but to also boost your HDL quality. It is interesting indeed that HDL-building nutrients like niacin and pantethine also help lower triglycerides and improve cardiovascular health, giving more proof to this new field of emerging HDL science.


    Read on to learn about the key nutrients that support a high HDL level and what is a desirable HDL level.

    Lisa Nelson #7: Are you concerned by unusually high HDL levels, such as greater than 100 mg/dl?


    Dr. Shelby-Lane: The main function of HDL is to help soak up excess cholesterol from the walls of blood vessels and carry it to the liver, where it breaks down and is removed from the body in the bile.


    Measuring for particle size and particle number is the best way to tell if HDL cholesterol levels are safe and healthy. This involves testing and it is usually measured under the guidelines of an "expanded lipid profile."  The usual range for HDL is low (40 for men and 50 for women).

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    Expanded lipid profiles are necessary to look at particle size.


    Read on to learn about laboratories that complete expanded lipid profiles, normal HDL levels, and new research identifying "good" and "bad" types of HDL cholesterol.


    Lisa Nelson RD #8: Please clear up the confusion about grapefruit and medication!  Is it safe for individuals taking medication for heart disease to eat grapefruit or drink grapefruit juice?  When is grapefruit not allowed?


    Dr. Shelby-Lane: I am including information that may help answer your question about grapefruit and a variety of nutritionals that affect statin drugs for the lowering of cholesterol.


    Grapefruit and grapefruit juice may increase the effects of HMG-CoA reductase inhibitors and should not be consumed at the same time. It is suggested that these medications be taken with water. Grapefruit contains substances that may inhibit the body's ability to break down statin drugs increasing the toxicity of the drug. Muscle pain, tenderness, or muscle weakness may be a result. If you begin to notice these symptoms, contact your doctor.


    Read on to learn about the relationship between pomegranate juice, niacin, magnesium, and additional vitamins/minerals and statin drugs.


    Lisa Nelson RD #9: Is there a connection between vitamin D and heart disease?  What level vitamin D should individuals maintain to prevent heart problems?


    Dr. Shelby-Lane: It is a known and documented fact that too little Vitamin D puts the heart at risk.  Yet many patients are not routinely tested, and if so, they do not take the proper steps to reach optimal Vitamin D levels between 50 to 100 ng/dL.  Most lab tests give 30 as a low normal, yet this is not optimal.  This can by done by diet, sun exposure (in most cases) or adequate supplementation.  But most of all, people are not tested.   Research suggests Vitamin D deficiency may be an unrecognized heart disease risk factor.


    Researchers say a growing body of evidence suggests that vitamin D deficiency increases the risk of heart disease and is linked to other, well-known heart disease risk factors such as high blood pressure, obesity, and diabetes.


    Read on to learn more about these studies and how to guard yourself against vitamin D deficiency.


    Lisa Nelson RD #10: Do you feel there is a link between heart disease and fibromyalgia?  I have noticed many individuals diagnosed with heart disease also diagnosed with fibromyalgia.  Could this be due to medications used to treat the heart conditions?


    Dr. Shelby-Lane: The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. The brain nerve chemical serotonin is also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia.

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    Read on to learn more about causes, symptoms, and recovery strategies for fibromyalgia.


    Lisa Nelson RD #11: How much coenzyme Q10, if any, should individuals with heart disease supplement to see benefits?


    Dr. Shelby-Lane: CoenzymeQ10-H2, also known as ubiquinol, is the reduced form of coenzymeQ10 (CoQ10) that is over five times more bioavailable than ordinary (standard) CoQ10. CoQ10 plays an essential role in providing energy to the body through the mitochondria, the energy-producing organelles found in all cells. There are between 100 and 300 mitochondria inside every cell, and they are responsible for over 90% of the body's energy production. Mitochondria can truly be described as the cell's ‘blast furnaces,' and CoQ10 plays a critical role in the utilization of oxygen inside these mitochondria. CoQ10 also acts as an antioxidant to protect the mitochondria against the massive free radical production that occurs during the cell's energy-producing respiratory cycle.


    Recommended Dosage: 50 mg to 300 mg standard CoQ10 per day with meals. Testing is the best way to know if you are getting adequate supplementation. Remember to consult with your physician before taking any new drugs or supplements.


    Read on to learn more about how CoQ10 works, when to expect results, and precautions.


    Lisa Nelson RD #12: Many individuals that visit The Health Central Network are confused about the relationship between blood pressure and heart rate.  Would you please explain if there is a connection between high or low blood pressure and someone's heart rate?  For example, if someone lowers their blood pressure, should they see a corresponding decrease in heart rate?  Also, should someone be concerned about a consistently high heart rate, such as 100 bpm?


    Dr. Shelby-Lane: Blood pressure and heart rate are interrelated components of the cardiovascular system and therefore, not mutually exclusively. One can affect the other.


    Persons with well controlled high blood pressure, with or without medication, can also have a cardiac arrhythmia or irregular heart beat.  This heart rhythm problem, if poorly controlled can then affect the blood pressure.


    Read on to learn more about the relationship between blood pressure and heart rate.


    Lisa Nelson RD #13: What is the difference between atrial fibrillation and an irregular heart beat?


    Dr. Shelby-Lane: Atrial fibrillation is a type of irregular heart rhythm.  During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly - out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness.

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    Atrial fibrillation can also cause fatigue and stroke. It's often caused by changes in your heart that occur as a result of heart disease or high blood pressure. Episodes of atrial fibrillation can come and go, or you may have chronic atrial fibrillation.


    Although atrial fibrillation itself usually isn't life-threatening, it is a medical emergency. It can lead to complications. Treatments for atrial fibrillation may include medications and other interventions to try to alter the heart's electrical system.


    Lisa Nelson RD #14: What do you recommend for individuals experiencing heart palpitations and what may be triggering the problem?


    Dr. Shelby-Lane: Arrhythmias are any deviations in the normal rhythm of the heart (heartbeat).  They usually occur as a result of interference with the electrical pathways that produce the heart's rhythmic muscular contractions.  The Parasympathetic Nervous System is responsible for slowing down the heartbeat rate.  The Beta-1 Adrenergic Receptors of the Beta-Adrenergic Nervous System are responsible for speeding up the heartbeat rate.


    If you experiencing symptoms, you may need to be evaluated for toxicity and consider a stress test, echocardiogram, holter monitor or a tilt table test for further evaluation and diagnosis.  A neurologic evaluation may also be indicated.


    Read on to learn the symptoms and possible causes of heart palpitations.


    Lisa Nelson RD #15: How is heart beat affected by body positioning?  For example, several individuals experience an irregular heart beat when laying on their side, but a return to normal when they roll to their back or stomach.


    Dr. Shelby-Lane: Irregular heart beats may be due to anatomic or physiologic problems and an evaluation by a cardiologist or an electrophysiologist (EP expert) is very useful in determining the underlying problem or cause.


    Lisa Nelson #16: If an individual experiences significant dizziness and/or lightheadedness, that requires grabbing an object to steady themselves, when moving from a squat position to standing followed by feelings of fatigue and weakness, should they consult their MD?  What may be a possible problem?


    Dr. Shelby-Lane: Vertigo is an ailment that involves a disturbed sense of balance in which the affected individual feels their surroundings are in a state of constant movement, especially through a spinning sensation.


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    Several causes for syncope include inner ear disturbances, cardiovascular problems, drugs and medication side effects, neurologic disorders, endocrine, infectious diseases, neurocardiogenic syncope, herbs, etc. All of these conditions require further evaluation and re-evaluation or tests such as an MRI, EEG, carotid ultrasound, EKG, Echocardiogram, a TILT test, hormone and blood tests, as indicated after a thorough exam and evaluation.  You may need an evaluation by multiple specialists including a cardiologist, neurologist or ENT specialist.


    Read on to learn more about ailments linked to vertigo.


    On behalf of myself and the users of The Health Central Network I want to send a heartfelt thank you to Dr. Shelby-Lane for taking the time to answer our questions and provide detailed insight into each issue.


    To learn more about Dr. Cynthia Shelby-Lane, you can check out the services she offers at www.elanantiaging.meta-ehealth.com.


    I would love to have you sign-up for The Heart of Health free ezine to receive regular heart health and weight loss tips.  Select the free e-course How to Lower Cholesterol in 8 Simple Steps or free report Stop Wasting Money - Take Control of Your Health when you subscribe.

Published On: February 25, 2009