The proper management of high blood pressure


If you have a high blood pressure concern, or you are on treatment for hypertension, you may wish to watch this video.  The transcripts are below, but let me also point you to this medical journal article, called On Redefining Hypertension.   I wrote it with my colleague Dr. Herbert Fred and you may find it informative.



Hello everyone

Today I’d like to talk about high blood pressure management, because I think this is one area where there is a lot of confusion, even among doctors.  Just in the last couple of years, there have been studies and recommendations that conflict with each other about what constitutes high blood pressure, how to treat it, and so forth.

I will talk briefly about what high blood pressure is, why there is confusion about it, and what I think is the proper way to deal with people who have blood pressure concerns.Read more

Water intoxication during exercise and athletic activities

Your heart health in a heartbeat _ Episode 3


Hello Everyone,

Today I’d like to talk about a topic that has nothing to do with heart disease, but one which I think should be of interest to athletes and to people who do intense exercise and sports.  The topic is “water intoxication.”

I bring that up because a young man came to Athletic Heart SF just the other day to be evaluated. He had had really bad symptoms during an intense workout, and there was a concern it might be his heart, but we figured out that the most likely cause of his symptoms was water intoxication.Read more

Why are screening tests controversial?

Your heart health in a heartbeat – Episode 2

Mammograms, PSA tests, heart scans, lung scans are all subject of debate and controversy.  Why is that?  Join me as I clarify the reason why screening should not be viewed only from the perspective of public health,


Today, I’d like to talk about screening tests in general and why there seems to be so much debate and confusion about them.  It seems that every other week there is a new report in the media raising doubt about the value of this screening test or that screening test, whether it’s mammography, the PSA test for prostate cancer, colonoscopy, heart scans, or what have you.  And you hear one group of people advising one way and another advising another way, and it’s very confusing.

So how do we make sense of that?Read more

Are statin drugs over-prescribed?

Your heart health in a heartbeat – Episode 1

If your cholesterol is high, should you immediately start lifelong medication?  Join me as I discuss a new study which addresses this important question.

Link to the study discussed in this episode:

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Related blog post about the heart scan:

The heart scan as a “mammogram of the heart”



Aortic aneurysms in simple terms


Please note: this article is for general information only and should not be taken as specific medical advice. Should you have any symptoms or concerns, please seek medical attention or contact us for further evaluation. If you feel you are having a medical emergency, contact 9-1-1 immediately.
Case report (part 1 – diagnosis)

A 57-tear-old man made an appointment for an Athletic Heart SF screening.  He was feeling well.  His exercise routine included lifting weights, but also doing some light treadmill activity at the gym several times a week.

He played competitive football and basketball in high school, and played various other sports throughout his life.  He played full court basketball until 4 years ago but had to stop due to mild knee arthritis.  He had been coaching sports for many years.  For the last 1-2 years, he had noted some mild shortness of breath walking uphill.

He had no prior history of heart disease.  He was advised by his primary care physician to take blood pressure and cholesterol-lowering medications, but he declined.  He had no other chronic illnesses except for mild knee arthritis and occasional tension headaches.  He considered himself in good overall health.

During the Athletic Heart SF screening, we confirmed that his blood pressure was elevated.  We also discovered a significant aneurysm of the ascending aorta.  Left undetected and unattended, this aneurysm could rupture and lead to very serious complications: stroke, heart attack, paralysis, kidney failure, or death.Read more

Podcast interview with Sami Karam


I had the pleasure of being interviewed by Sami Karam, the editor of Populyst, an economics and demographics blog and podcast.  Sami heard about Athletic Heart of San Francisco and decided to devote a show to the topic of heart screens.  We covered a lot of ground, but the focus was mainly on detection of coronary disease and on contrasting the early detection strategy to the strategy of managing risk factors.  I hope you will find our conversation informative.  To listen to the podcast, simply click on the play button below or on this link.


The echocardiogram: seeing with sounds!


Ultrasound technology is not exactly new, but it never ceases to amaze me.

First developed in the 1950’s, medical ultrasound technology uses the fact that different tissues and fluids in the body reflect sound waves differently.  If an ultrasound source is applied over the chest, the sound will be reflected back from different parts of the heart in a way that can be analyzed to reconstruct an image of the heart in real time.

"Ventricular Septal Defect". Licensed under Public Domain via Wikimedia Commons.

Licensed under Public Domain via Wikimedia Commons.

Because of the clarity and reliability of the image produced, echocardiography has become an indispensable tool of cardiac diagnosis and has allowed doctors to “see” directly what they previously had to imagine, deduce, or guess: the size of the heart chambers, the pumping strength of the heart muscle, the health and function of the heart valves, the presence of fluid build up around the heart, the size of the aorta and other major vessels, and many other important cardiovascular features.  Having all this information at the tip of our fingers would have been unimaginable to cardiologists of a generation or two ago.

What’s more, the procedure itself—as far as the patient is concerned—is completely safe and painless.  The technician applies some gel on the chest, which allows the ultrasound probe to have better contact with the skin.  The probe itself is like a speaker and microphone in one piece, transmitting and receiving the sound waves which are immediately analyzed and displayed on a monitor.

Of course, there is a great deal of skill involved in obtaining good images.  Because the heart is surrounded by ribs and lung tissue which interfere with the ultrasound images of the heart, one must find adequate “windows” to take a peak at the heart.

The procedure for a complete echocardiogram takes about 30 minutes or so.

Introducing the Coronary Health Starter Kit!


Dear Friends,

In an effort to make heart scans more widely available, I am delighted to introduce a new service:  AHSF’s Coronary Health Starter Kit.

This service consists of an affordable telephone consultation focused on a cardiac prevention.  As part of this service, I order the famed “mammogram of the heart“, the coronary heart scan that can detect the presence of coronary artery plaques in their early stage, before they cause complications such as heart attacks and sudden cardiac arrest.

I recommend this service for men over age 40 and for women over age 50 (or younger women  if they had premature menopause).  You may consider obtaining the service at an earlier age if you have strong risk factors, such as a family history of coronary disease at a young age. This is a screening service, so it assumes that you feel generally well and have no specific symptoms to report.

I cannot think of a better investment for your heart health than to take advantage of this service and obtain a heart scan.  Please do not delay.  It is as simple as picking up the phone and calling 1-415-567-1014 between 9a-3p to make time for a telephone consultation.Read more

The “mammogram of the heart”


The phrase “mammogram of the heart” refers to the heart scan that detects calcium build-up in the coronary arteries.  The phrase was coined by the pioneers in this technology to try to impress on the public and on the medical community the simplicity and value of this test.

Calcium in coronary artery detected by CT scan.Image attribution: Wikimedia Commons

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons


Just as a mammogram can identify cancer before it spreads, a heart scan can identify the presence of coronary artery disease before it causes symptoms.  And like the mammogram, the heart scan is easy to perform, uses a low amount of radiation, and is inexpensive.Read more

621 kids screened for heart disease!


Desta and I had the pleasure of participating in a heart screening day at Sequoia High School in Redwood City last Sunday.

Volunteer briefing at the start of the day

Volunteers obtaining 12-lead ECG’s

The event was organized by Via Heart Project, a non-profit organization that equips California public schools with AED’s.   Via Heart recently decided to organize heart screenings, and they put a lot of effort and talent into this first event.

They were assisted by the folks at the EP Save-a-Life Foundation, who have been organizing heart screens in the San Diego area for several years and who provided some of the equipment we used, such as the cardiac ultrasound machines.  In total, 203 volunteers helped out, not including the Redwood City Fire Department.Read more