UPDATE March 20, 2019:  The results of the “Apple Heart Study” were just released at the annual meeting of the American College of Cardiology.  Read my comment at the end of this post for an update.

Today, Apple released its ECG app and irregular heart rhythm notification feature.

The announcement about the technology was made with great fanfare a couple of months ago, when Apple also revealed that the device had received approval by the FDA.  This raised some eyebrows because—according to some—the technology was being approved and released to the public without evidence of effectiveness or harm.

What is so unique and novel about the product is that it claims to be able to detect atrial fibrillation, or “a.fib,” which is a common irregularity of the heart rhythm.  A.fib is not usually fatal but it can be a problem for two reasons.

First, the arrhythmia causes and irregularity and rapidity of the pulse that can provoke palpitations and also impair the pumping capacity of the heart.  This typically causes symptoms, so that people who develop a.fib typically become aware of the problem and seek medical attention relatively promptly.

But not everybody is necessarily aware that they have a.fib.Read more

As some of you may know, a new definition of hypertension (high blood pressure) was recently proposed by the American Heart Association, the American College of Cardiology, and 9 other sponsoring organizations.

According to the new definition, if one’s resting blood pressure (measured properly) is more than 120/80, it should be considered “elevated.”  And if one’s BP is more than 130/80, then the person with that blood pressure should receive a diagnosis of hypertension.

Needless to say, the proposed definition has generated a lot of controversy.  If all doctors adopted the new definition, that would create millions of new patients overnight, and a third of American adults would be considered to have a chronic disease!

What’s more, anyone with a blood pressure over 120/80 would be advised to have close medical follow-ups: repeat visits every 3-6 months, according to the new guidelines.Read more

As you may recall, in a previous video I addressed the topic of statin drugs, and whether these drugs are over-prescribed.  In that video, I criticized the approach of treating people’s cholesterol without any regard to the patient’s cardiovascular health or to other considerations.

Recently, Dr. Steve Nissen, chairman of cardiovascular medicine at the famed Cleveland Clinic and a very vocal proponent of statins, wrote an editorial in which he rebukes those who question the use of statins as “an internet-driven cult with deadly consequences,” a cult he calls “statin denial.”

Those are pretty strong words.  In fact, I think these are smearing words, meant to stifle any debate.

Am I a statin-denialist?  I’m not sure.  Dr. Nissen defines the problem as he sees it in 2 ways:  1) statin denial is “the proposition that cholesterol is not related to heart disease” and 2) statin fear is the notion that lowering serum cholesterol levels will cause serious adverse effects, such as muscle or hepatic toxicity—or even worse, dementia.”

Now, it’s true that some people hold an extreme position regarding statin drugs and, in my opinion, exaggerate their risk.  But it is undeniable that thousands, if not millions of healthy people are prescribed statin drugs—and therefore turned into patients, who need to worry and undergo constant monitoring.  The risk of being healthy yet turned into a patient is, in my opinion, very serious.Read more

Your Heart Health in a Heartbeat – Episode 5

Transcript:

Hello everyone and thank you for joining me.

I’m Dr. Accad, medical director of Athletic Heart of San Francisco, and today I would like to talk about high blood pressure in relationship to exercise.  I am doing this in light of a document recently published jointly by the American College of Cardiology and American Heart Association that makes some recommendations for competitive athletes who have blood pressure concerns.Read more

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.

TRANSCRIPT:

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

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

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

Image attribution: www.volganet.ru 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

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

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