Dr. Garrick Stewart, MD

Heart failure is a common clinical syndrome, but it can be prevented by screening for and treating high blood pressure, encouraging physical activity and a heart-healthy diet, discouraging smoking, and moderating alcohol consumption.
 
Transcript: "Thanks for this question. Is heart failure? Preventable. Well, first of all, heart failure is an all too common clinical syndrome. Where the Hearts either too weak or too stiff to pump blood efficiently to the body. It can lead to breathlessness fatigue hospitalization and a higher risk of death. So we want to do everything in our power to prevent its development. We know from Myriad studies that there are factors that can be present years or even decades in advance of the development of heart failure, that can be mitigated. And thus, The development of heart failure. What are those factors that can put you at risk? Well, high blood pressure obesity, atherosclerosis diabetes excess, use of alcohol and even a family history of inherited, heart muscle disorders, like cardiomyopathy. So what do we do to prevent heart failure? Well, we want to screen for high blood pressure and treat it. When we see it, we want to encourage physical activity and a heart-healthy diet to reduce the risk of diabetes and obesity. We have To absolutely discourage smoking and help people quit. And also moderate alcohol, intake. This is such an important point that the American Heart Association over a decade ago developed stages of heart failure and Stage a heart failure or pre. Heart failure is simply the presence of any one of those risk factors that underscores the importance of identifying them and treating them when we see it. So yes, in many cases heart failure is preventable with public health measures and with diligence to our own health habits, thank you for this great question."

Exercise is safe for people with heart failure, although it's important to talk to your health care provider before starting an exercise program. Generally aerobic exercise should be done 4-5 days a week for 30 minutes and can be divided into 5 and 10 minute sessions throughout the day. Heavy weight training is not recommended because of the strain it puts on the heart. Lower weights and higher repetitions are best.
 
Transcript: "Thanks so much for this really important question on whether exercise is safe in heart, failure. Before I begin, let me just say that it's important before embarking on any kind of exercise program to talk about it with your health care team, to make sure that it's safe and sustainable for you and that you won't be overdoing it. I know it used to be in days gone by that we thought when the heart was weak or not working, well that rest and recuperation was the most important thing to avoid putting the heart under strain. But that thinking has really Family changed. We now know that exercise is really important, not only to preventing heart failure from developing in the first place. But once heart, failure is established exercise can promote well-being, functional capacity can improve quality of life. And in particular, for those heart failure patients, who are particularly frail exercise may have the most benefit. We now recommend a structured program of cardiac Rehabilitation which is medically supervised exercise and anybody who's been hospitalized Used with congestive heart failure, when the heart is weak with an ejection fraction, less than 40 percent, it's recommended often lasts around 3 months. Several days a week and is usually covered by Insurance exercise is really important. Prognostic marker for congestive heart failure as well. So much so that your health care team may have you do an exercise test not only to test your limits and give you a safe exercise prescription but also to help refine and establish your prognosis with Heart failure in general. We say that aerobic exercise should be performed about 30 minutes, four to five days a week. Those sessions can be divided up into 5 and 10 minute sessions. Several times a day. You should still be able to carry on a conversation when you're exercising. It shouldn't feel like a strain if you are significantly breathless or dizzy, that's when you know you're overdoing it in addition. In general, heavy weight training is frowned, upon that isometric load is a real strain on the heart. If Going to lift weights, which is recommended. Lower, weights, and higher repetitions or the weighted go. So, if you have heart, failure, exercise can be safe in the overwhelming. Number of cases, please talk about it with your health care provider before, embarking on? Any new exercise program. Thank you."

Lipoprotein A is a type of bad cholesterol linked to coronary artery disease, peripheral vascular disease, stroke, and aortic stenosis. It is usually screened in those with a personal or family history of premature atherosclerosis, vascular disease under the age of 55 for men, and 65 for women. Treatment includes lowering bad cholesterol through statin therapy, ezetimibe, and injectable medication, and there is also a new type of treatment called an all ago. Nucleotide anti-sense therapy which directly lowers LP, little A lipoprotein, a production in the body.
 
Transcript: "Thanks for this question. What is the significance of lipoprotein? A so lipoprotein. A is a type of bad cholesterol. It's a component of LDL or low density lipoprotein, cholesterol, the type of cholesterol, we know causes heart disease, however, this particularly nasty fragment can cause blood vessel inflammation, blood clot formation and stress to the walls of blood vessels, which leads to premature atherosclerosis, vascular disease, and heart disease. Who gets elevated LP little a? Well, it's all genetically determined. It's not related to diet or exercise or any other bad behavior. When should we get concerned lipoprotein? A levels are considered concerning, if it's more than about 50 milligrams per deciliter or more than 120 NM per liter. The units are a little different based on the type of asset. We use to measure lipoprotein. A in the blood. We have convincing evidence that elevated lipoprotein a is linked to coronary artery. He's to peripheral vascular disease, a higher risk of stroke and even of aortic stenosis and narrowing of a blood vessel within the heart. Who should we screen for an elevated lipoprotein? A well, it's generally agreed upon that anybody with a personal, or a family history of premature atherosclerosis, vascular disease, that's less than 55. If you're a man, and less than 65 years old. If you were a woman reasonable to screen for elevations in LP, little a, what do we do to treat an elevation in Life or protein? A, and what the Cornerstone of treatment is to lower the bad cholesterol, the LDL cholesterol by traditional Means that includes Statin therapy for not getting to the Target. We sometimes add a medication called ezetimibe and even an injectable medicine called a pcsk9 inhibitor or not reaching Target. Help is on the way though. There are ongoing clinical trials of a new type of therapy called an all ago. Nucleotide anti-sense therapy which directly lowers LP, little A lipoprotein, a production in the body. So we have a lot of promising treatments along the way. Thank you for this very interesting question."

If you have heart disease, it may be beneficial to take antibiotics before going to the dentist. Those who are at high risk include those with artificial heart valves, those who have repaired or unrepaired congenital heart disease, and those who have more advanced heart failure with a mechanical heart pump in place. The primary regimen is with Amoxicillin, which is very well tolerated. Antibiotics should only be considered for those who are at high risk.
 
Transcript: "Thanks for this question. This comes up a lot. If you have heart disease, should you take antibiotics before going to the dentist? Well, the specific condition that we're trying to prevent is a serious infection of the heart called endocarditis, that's infection of either a heart valve or other heart structure. It can be very difficult to treat and can even be deadly and sometimes even require surgery to treat. So, why dental work? Well, all of our mouths have bacteria in them. And when you have dental work, whether it's a tooth extraction or treatment of an abscess, or even a routine, dental cleaning, some of that bacteria can enter the bloodstream. Once it's in the bloodstream, it can stick to artificial material in the heart and it stands to reason that if you get in a biotics before going to the dentist, maybe you could prevent that bacteria from taking hold in the bloodstream and eradicate it before it ever reaches the heart. But that has to be weighed against indiscriminate, use of antibiotics, which can lead to resistance, or even disruption of your normal bacterial Flora. That's so important in our body. And so who's really at risk? Well, there are four primary categories of risk and the First is anybody who's had an artificial heart valve, whether it's metal or biologic, the second is anybody who's had any type of repair on the heart, whether it's a ring repair of a valve, a clip, or even a minimally invasive heart valve, put in through the leg, the third category or folks who have repaired or unrepaired congenital heart disease, particularly if there is artificial material used in the repair and then the last or those patients who have more advanced heart failure and have a mechanical heart pump in place. Place where even those who've had a heart transplant with significant, residual valve disease. In those people, we think that antibiotics can be beneficial to prevent a bacterial infection of the heart. When undergoing dental work, typically, antibiotics are administered about an hour before the dental work and the primary regimen is with Amoxicillin, which is a penicillin derivative that's very common and usually really. Well, tolerated for those who have a penicillin allergy, there are plenty of alternatives. It's available. So dental work is a very rare cause of bacterial infection of the heart. And in, folks, only those who are at high risk, antibiotics should be considered. Thank you."

T-waves on an EKG can be normal but must be placed in context with what else is going on. Abnormalities can indicate an underlying heart problem or ischemia and may require additional investigations.
 
Transcript: "Thanks for this question Ruth. So, what's the significance of a dip in a T? Wave on an EKG. So, an EKG, one of the most commonly performed tests. In all of medicine, small, electrodes are put on the chest and read the electrical activity of the heart. From many different perspectives. Comedy can she has 12 different leads and has a wealth of information. The electrical activity of the heart is commonly represented as a p, q r s, t sequence and the wave is the last part of that sequence and represents the electrical recovery or repolarization of The ventricle, a t-waves can have dips or inversions that are sometimes abnormal and sometimes not in general, the T wave goes in the same direction as the QRS complex, that's the depolarization of the heart and if it's in a different direction, we have to put our thinking caps on on What that might be from, could be from several things, if you're having symptoms that are representative of low blood flow in the heart or ischemia such as chest, discomfort or breathlessness, sometimes the T wave abnormalities are in versions, can be due to that. People who have had a recent stroke or injury to the brain, can sometimes Heaven versions of the T waves. By the same token, if there's an increase in the amplitude of the QRS complex that depolarization, complex of the EKG, sometimes the T waves can be abnormal and that's sometimes referred to as a strange pattern can sometimes be seen in a thick heart muscle with hypertrophic cardiomyopathy or even just thickening of the heart due to high blood pressure. Even more rarely to wave abnormalities can be indicative of an underlying. He or structural heart problem, particularly if those t-wave abnormalities extend across the leads, going across the front of the chest. So in short T, waves can be completely normal with little dips, but must be placed in context with what else is going on with symptoms. And sometimes will spur on additional investigations, including pictures of the heart blood tests and additional consultation with Specialists. I hope that helps"

Riddick stenosis is a narrowing of the aortic valve, which can lead to symptoms such as breathlessness, chest tightness, and dizziness. It is typically caused by calcium buildup on the leaflets of the valve, and can be picked up by a murmur detected by a doctor. Treatment usually involves surgery or transcatheter aortic valve replacement.
 
Transcript: "What is a Riddick stenosis? Well, the aortic valve is the valve, that separates the main pumping chamber of the heart. The left ventricle from the aorta, which is the main blood vessel in the body. When the heart pumps out. Blood through that valve, the valve closes to prevent backwash of blood into the heart and stenosis is a narrowing of that valve. So that valve is unable to open fully as the heart, ejects blood into the body. And in turn can put the Under a fair bit of stream by far, the most common cause of aortic stenosis is calcium. Buildup on the leaflets of the valve, which is an age-related process. Particularly after the age of 65, the American Heart Association estimates that as many as twenty percent of older Americans have some form of aortic stenosis. Other potential causes are congenital abnormalities, with either a one or two leaflet valve, it's normally supposed to have three leaflets on the L've or rheumatic heart disease, which is fortunately becoming more rare aortic. Stenosis is a progressive condition but can have a very long asymptomatic period for many years where the valve can be modestly narrowed. But without any symptoms when symptoms do arise, the valve is typically severely narrowed with a reduced orifice, for the heart to eject blood through the most common symptoms. Of aortic stenosis include breathlessness chest, tightness and occasionally, dizziness or even passing out when the aortic valve is severely narrowed and symptoms are present. Usually surgery is required to fix the valve in recent years. We have a less invasive way of replacing the aortic valve something called transcatheter aortic valve replacement. So aortic stenosis can be picked up either because of symptoms or more typically Because of a murmur that's detected by your doctor. When it is identified monitoring with echocardiography and ultrasound of the heart, which is the gold standard for measuring severity of the valve is needed, and careful conversation with your medical team is required to, determine when the right time to fix the valve might be. Thank you for this question."