The Widowmaker



Anyone out there concerned about heart disease in yourself or a loved one?

Do me a favor and watch The Widowmaker.  This is the best piece of medical investigative journalism I have ever watched.  It will make you understand what is wrong with heart disease prevention in our broken health care system.


The movie also has great drama, both in the personal testimonies of ordinary folks who have lost a loved one to heart disease, and in the depiction of the political power plays at the highest levels of the cardiology community.

The trailer is below, but it doesn’t begin to give justice to the richness of the movie.  To see the film, click on this link.  You can download it as a rental for $4.99 or buy it for $9.99.  You won’t regret it and I agree with their tag line:  IT COULD SAVE YOUR LIFE.Read more

Demystifying the cardiac stress test


For most people, the cardiac stress test is the epitome of modern cardiology.  For some, the thought of undergoing one may also cause cold sweats…Perhaps a little introduction can help clarify what it is and what it does, and will minimize any misplaced fear about this helpful diagnostic tool.Read more

What should your pulse rate be?

Image attribution: "MF-180" by Pascal. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

Image attribution: “MF-180” by Pascal. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

The topic of the pulse rate is one that our patients and healthy athletes frequently like to discuss with us.

With the increased availability and ease of use of wearable monitors, the optimal exercise heart rate has become an almost universal subject of conversation, not only in the athletic community but also among those who are just embarking on an exercise program.

In general, athletes are interested in the pulse rate in 2 situations:  the resting pulse rate, best measured upon waking in the morning, and the pulse rate during sustained aerobic exercise, such as running or cycling.  Today we will address the pulse rate during exercise and leave the resting pulse rate for a separate article.

So what is the physiologic meaning of the exercise pulse rate?  Is there a pulse rate one should aim for?  What if the rate falls outside the target zone?  Can the pulse rate ever be a clue to a cardiovascular problem?  Let’s take these questions one by one.Read more

Q&A about high blood pressure during exercise


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.

Image attribution: CC.BY.SA.3.0

The adverse effect of lack of exercise on the blood pressure is well known.  A sedentary life frequently leads to chronic hypertension, and in turn, high blood pressure can lead to heart, brain, and kidney damage.

We will address the topic of chronic hypertension in a separate article.  Today, we will discuss a phenomenon called “hypertensive response to exercise” which can occur in seemingly healthy subjects who have no history of hypertension but whose blood pressure during exercise seems to increase “too much.”Read more

Is your job affecting your heart?



Image attribution: Iconshock CC BY-SA 3.0

Is your job putting you at risk of a heart attack?

As you can imagine, this question has preoccupied epidemiologists and public health specialists for decades.  But despite years of research, straightforward or clear answers are not always available for specific job descriptions.  The medical literature is usually guarded in its assessment of occupational factors leading to heart disease.

Also, if a certain job is linked to an increased risk of heart disease, the job itself may not be the cause of the problem.  For example, risk factors for heart disease (such as smoking) may be more common in certain occupations than in others, making it seem like the job itself imparts the risk.

With this in mind, below are 8 findings that have emerged from years of research:


Read more

Can you ever exercise too much?

Can you exercise too much

Image attribution: Julian Mason/Flickr.

Professional athletic trainer and sports journalist Ian MacMahan asked us that question as part of an article he published in The Atlantic Monthly magazine.

McMahan reported on recent research that raises concerns about ultra-endurance sports carried to an extreme level for many years.  Such an exercise regimen increases one’s chance of having arrhythmia, such as atrial fibrillation, and may also cause scarring in the ventricle of the heart.

Some cardiologists have sounded alarm bells, comparing such exercise regimens to a “toxin.”  In my opinion, it is not yet clear if long-term, high-intensity exercise alone is the cause of the problem, or if those affected have other factors that come into play.  Nevertheless, the research should not be dismissed.   Here are some highlights:Read more

Outside Magazine highlights value of cardiac screening for athletes


In his excellent article on the debate regarding cardiac screening for athletes, Peter Vigneron remarks:

Advanced cardiac screening can reduce the likelihood of sudden cardiac arrest, the most common cause of death among athletes. So why is it so controversial?

We wonder as much!

The key to the controversy has to do with what perspective one adopts.

If one looks at the issue from a public health or population perspective, recommending mass screening for every athlete is logistically daunting, and potential problems (such as false positives and false negative test results) are likely to occur.  There is also an important socioeconomic dimension to the recommendation: who would pay for this?

Running man in forest woods training and exercising for trail ruOn the other hand, if an individual athlete wishes to reduce his or her own risk of sudden cardiac arrest, there is no question that comprehensive, individualized testing is feasible and can avoid or greatly reduce the pitfalls of false positives and false negatives, because multiple tests are applied at once.  When performed by competent staff and interpreted by an experienced physician, these tests are extremely helpful to detect or exclude any underlying cardiovascular problem.

Furthermore, the cost of comprehensive screening does not have to be as onerous as Vigneron states.  He warns that an echocardiogram (ultrasound study of the heart) can cost up to $2000.  We provide the entire battery of tests for a fraction of that amount!Read more

Wishing you…NOT a “Holiday Heart!”

Heart Ornament

We don’t mean to be Scrooges here!  While we certainly wish you a festive and wonderful Holiday Season, we also want to remind you that more of a good thing is not always better.  We are referring here to the effect that “large” quantities of alcohol ingestion may have on the heart, even on a healthy heart.

The term “holiday heart” was coined in the late 1970’s by doctors who studied patients admitted to the hospital for arrhythmia and who were also intoxicated with alcohol.  The admissions occurred more frequently on Sundays and Mondays, and there was a peak in incidence during the week between December 24 and January 1.  None of these patients had evidence of other heart problems, and the arrhythmia—usually atrial fibrillation—typically resolved as the alcohol intoxication resolved.  The doctors therefore suspected that the cause of the arrhythmia was binge-drinking on weekends or during Christmas week.Read more

Demystifying the ECG


ECG pulse trace

Image attribution: via Pixabay Creative Commons CC0 Public Domain

The electrocardiogram (ECG) is by far the most commonly performed cardiac test.  You may have seen a picture of one in a book or a magazine, or you may have been drawn into the drama of this mysterious waveform, flashing periodically on a monitor during a tense moment of  “E.R.” or “House.”

Have you wondered what the ECG is truly about?

The following Q&A will demystify the test as we begin to reflect on how the heartbeat comes about.Read more



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.

Cardiomyopathies are very common causes of exercise-related cardiac arrest in youth and young adults, but can occur to anyone at any age.  An unfortunate example is the case of a 45-year-old seasoned runner who collapsed during a marathon last November in Tennessee.  The autopsy revealed an unsuspected cardiomyopathy.Read more