Sex after a Heart Attack

As I am sure most people realize, sex can be a very aerobic cardiovascular activity (blood pressure and heart rate rise) and many people have heard stories about older men dying while having sexual intercourse. There is definitely a small risk of a heart attack while having sex, but the risk is low. However, in patients who have recently suffered a heart attack, the risk of sudden cardiac death early after a heart attack is higher in patients who do not refrain from sexual activity.

So, given this frightening news, how long should one wait? Well, there is good news. Not too long, but it depends on the situation. For example, if a patient suffered a heart attack and needs bypass surgery, then he or she should wait 2-3 weeks before engaging in sexual activity. If the patients is going for an elective stent placement, he or she should wait 2-3 days before having sexual activity.

One thing that should also be concerned in patients who are having problems having sex after a heart attack is that in men, erectile dysfunction can be a marker for cardiovascular and peripheral artery disease, that is, if there is disease in the arteries surrounding the heart, there is likely to be disease in the blood vessels in the abdomen, the neck, and even the perineal area, which supplies blood to the sexual organs. This lack of blood supply leads to the erectile dysfunction and the treatment for that is not always viagra or levitra, rather their coronary arteries should be investigated either noninvasively through an exercise stress test or through an invasive procedure such as a angiogram/catherization of the heart, other ways to assess the heart is a nuclear stress test, cardiac MRI stress test, or a CTA-a CAT scan of the heart and the coronary arteries of the heart.

Another question patients always ask is what should I do if I develop chest pain during or after sex. First, you should always call your doctor or EMS, but if this becomes a chronic problem and the likelihood is that this is not a new heart attack, you should stand up or sit down to reduce the workload on the heart. One should in most situations take a sublingual nitroglycerin if he or she develops chest pain during or after sex as they would in most situations, however, if a patient is on viagra or levitra, he should not take a nitroglycerin becomes this may lead to a significant decrease in blood pressure and vasodilate the arteries around the heart, which could also provoke a heart attack.

Many patients are anxious and nervous about having sex after a heart attack because of their fear of death, this may manifest in the bedroom where they no longer are able to perform prior to the heart attack, at times, this may be more of a psychological problem rather than a physiological problem and should be addressed in this manner either by a psychologist, a psychiatrist, their primary care doctor or cardiologist.

In conclusion, patients can return to sexual activity very quickly after suffering a heart attack, one should wait at least 2-3 weeks if bypass surgery was performed and less time if only a stent is placed. One must be careful not to use nitroglycerin with viagra and levitra. Finally, erectile dysfunction should be thought of as a possible cardiovascular disease marker in certain patients.

www.americanheart.org

Why Vitamin D and Calcium Matter

Everyone knows that getting enough vitamin D and calcium is important for bone strength in order to prevent bone loss and osteoporosis in the elderly and rickets in children, however, there is a growing body of evidence to suggest that vitamin D and calcium are more important than previously realized to prevent other disorders including obesity, certain types of cancers, and overall healthy living. 


This paper will highlight some of the benefits of vitamin D and calcium, some of the proposed mechanisms of function and what one needs to do to insure an adequate supply of vitamin D and calcium. Vitamin D is needed for the purpose of allowing calcium to be absorbed into the body. Without vitamin D, one can eat all the calcium without absorbing much of the calcium, thus it is important to have sufficient amounts of vitamin D, which is mainly produced through sun exposure (about 10 minutes per day). Although, we have become programmed to the negative effects of UV exposure, which is valid, there needs to be a balance where one can attain some exposure and not feel that they are causing detriment to their health and in fact one is actually allowing the conversion of vitamin D to its active formthus allowing more calcium absorption. The leading expert on this topic recently published a book on this subject titled: The UV advantage (http://www.uvadvantage.com). Dr. Holick is quoted as saying:“Your overall well-being depends in part on developing an appropriate relationship with the sun." Michael Holick, M.D., PhD is one of the world's foremost authorities on vitamin D and a full Professor of medicine, dermatology, biophysics and physiology at the Boston University School of Medicine.


He is also the director of the Bone Health Care Clinic in Boston. Dr. Holick believes that the body requires 1000 IU (international units) of vitamin D per day, and most vitamin supplements contain 400 IU, thus one would have to take 2.5 pills to attain the RDA (recommended daily allowance). He argues that 10 minutes of sunshine will provide the necessary amount of vitamin D for the day. One must also keep in mind that sunblock prevents and being in your car both prevent vitamin D production. In fact, it is estimated that SPF 8 and 15 reduce vitamin D production by 95 and 99% respectively. Not all people are able to absorb vitamin D equally, that is the darker ones skin, the more difficult it is to absorb vitamin D. 

Why Green and White Tea are Good for You

I first was introduced to green tea in 1998 when I heard a lecture by an epidemiologist about his research on Green Tea.  This talk mentioned the benefit of green tea in reducing cancer rates.  I did not start drinking green tea though until I was completing medical school and now in my fellowship, I drink green tea two to three times a day and have recently switched to white tea.


The goal of this article is to highlight the benefits of green and white tea in regards to the scientific data to demonstrate the benefits, to list the benefits of green tea and how much one would need to consume to acquire benefit.  

Green Tea is made from the dried leaves of the camellia sinensis plant, originated in China between 4,000- 5,000 years ago.    A Chinese and medical leader named Sheng Nong discovered green tea as a medicinal herb in 2737 B.C.  While boiling water under a tea tree, some tea leaves fell into Sheng's pot of boiling water. After drinking some tea, he discovered its healing powers and immediately placed tea on his list of medicinal herbs.

Benefits of Green Tea:



1. Researchers at the University of Arizona showed that cigarette smokers who drank four cups a day of decaffeinated green tea for four months cut the cellular damage caused by cigarettes.  They tested 140 smokers to see if drinking green tea reduces the risks of cancer.  They examined whether green tea helped repair damage to cells caused by smoking. For four months, volunteers drank either green tea, black tea or water."They were asked to eat whatever they were eating and just add tea totheir diet," said Dr Iman Hakim who was the principal investigator ofthe study.  Researchers tested the participants' urine for levels of 8-OHdG, which is found in higher amounts in individuals with lung cancer. "What we found was a 25% decrease in the green tea group," she said.   However, no changes were seen in the people who drank black tea or water. "We think green tea, in our group of smokers, is associated with a reduction of oxidative stress (associated with lung cancer) in their urine," Dr Hakim said.   "What we found was significant," Dr. Hakim said, referring to tests done on the urine of the 118 smokers in the study.  However, it is still unclear whether green tea changes genes damaged from smoking.


2. Reduce Skin Cancer/Melanoma:  At Case Medical School, a study on green and white tea showed a benefit in decreasing skin damage.  More skin products now contain green tea and white tea extracts.


3. Reduce Cavities:  Pace University researchers have shown that White Tea Extract (WTE) may have applications in retarding growth of bacteria that cause Staphylococcus infections, Streptococcus infections, pneumonia and dental cavities.  "Past studies have shown that green tea stimulates the immune system to fight disease," says Milton Schiffenbauer, Ph.D., a microbiologist and professor in the Department of Biology at Pace University's Dyson College of Arts & Sciences and primary author of the research. "Our research shows White Tea Extract can actually destroy in vitro the organisms that cause disease. Study after study with tea extract proves that it has many healing properties. This is not an old wives tale, it's a fact."  This research was presented at the 104th General Meeting of the American Society for Microbiology.


4. Weight Loss:    Research from Geneva found that drinking green tea led to an additional 70 calories burned in one day, which for one week this equals about 500 calories.  As a background, it takes about 3000 calories of exercise to lose one pound of weight.Newer research has focused on white tea.  In one study by Linus Pauling Institute at Oregon State University found that white tea reduced colon cancer in rats.  In this study, they recommended 3 cups of white tea per day.   Consumption of green tea reduced the number of tumors in the mice from an average of 30 to 17 and of white tea from an average of 30 to 13 tumors.  Furthermore, mice given a combination of sulindac ( a type of nsaid: non-steroidal anti-inflammatory drug)  and white tea saw a tumor reduction of about 80 percent, from 30 tumors to six.  White tea, the least processed of all teas, has the highest levels of polyphenols and antioxidants.  Green and white teas that have high levels of the protective polyphenols called catechins.   Recommendations:

You should always consult a physician when starting any new herbal products and although I am not supporting other herbal teas and products, I am a fan of green and white tea and do believe that it health benefits.  

However, to truly attain protective benefits from the green and white tea, research shows that one needs to drink 4 glasses a day, it should be hot tea and not on ice, but it can be tea that has been placed in the refrigerator to cool.

Why Gambling Can be Painful

There is an epidemic of gamblers in the US, who have become trapped into an endless cycle where they attempt to win back money they have lost. What many may not realize is not only an addiction, but it is associated with many negative health behaviors.  In an article in the American Journal of Family Practice, the authors cite that "...depression, drinking and taking drugs often go along with pathologic gambling and that they are more likely to commit suicide."  They also report that about 75% of all pathologic gamblers have been depressed at least once in their lifetimes and 25% have recurrent episodes of depression. The authors also report that Las Vegas and Atlantic Cityhave some of the highest suicide rates in the US. 

Many addiction experts believe that pathologic gambling is an addiction and that there are specific personality types that are more likely to succumb to addictive properties of gambling. This personality would include business people who like to take risks as well as physicians, lawyers, and the like. 

The diagnosis of pathological gambler includes the following criteria (according to the major psychiatric source, the DSM: diagnostic and statistical manual of mental disorders, one has to meet 5 of the 10 following criteria) 

- Preoccupation with gambling (i.e. preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble). 

- Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 

- Has repeated unsuccessful efforts to control, cut back or stop gambling. 

- Is restless or irritable when attempting to cut down or stop gambling. 

- Gambles as a way of escaping from problems or of relieving a dysphoric mood (i.e. feelings of helplessness, guilt, anxiety, or depression). 

- After losing money while gambling, often returns another day to get even (a.ka. chasing one's losses). 

- Lies to family members, therapist, or others to conceal the extent of involvement with gambling. 

- Has committed illegal acts such as forgery, fraud, theft or embezzlement to finance gambling. Has jeopardized or lost a significant relationship, job, or educational/career opportunity because of gambling. 

- Relies on others to provide money to relieve a desperate financial situation caused by gambling. 

For help, one should call the National Council on Problem 
Gambling at 1-800-522-4700; also can check out the website:  http://www.ncpgambling.org 


Gamblers Anonymous can be reached by calling: 213-386-8789 
in order to find a local group.

Why Do Athletes Drop Dead?

Many people may recall the sudden deaths of basketball greats such as Hank Gathers and Reggie Lewis who both suddenly died while playing basketball and recall that the cause of death was related to an enlargement of the left side of the heart, which is a disease entity called Hypertrophic Obstructive Cardiomyopathy (a.k.a. HOCM).  Usually, but not always, a doctor will hear a murmur to suggest the diagnosis, especially if the murmur gets louder when a patient goes from a squatting to a standing position.  However, in many instances the murmur is not heard and the disease is missed.  This is the most common cause of sudden death in young athletes (less than 30 years old).  However, there are other causes of sudden cardiac death, including coronary artery disease, sickle cell trait, hyponatremia, and commotion cordis (sudden blow to chest/heart causing an arrhythmia).

Another famous athlete who died of sudden cardiac death while running a marathon. Jim Fixx, who made running a popular sport in the US with his 1977 best seller: The Complete Book of Running, also died suddenly at age 52, but not from Hypertrophic Cardiomyopathy (a.k.a Hypertrophic Obstructive Cardiomyopathy-HOCM), rather he died of a heart attack (myocardial infarction).  What is interesting about his tragic death and story is that he in fact was a world class athlete who despite his endurance, had severe coronary artery disease.  Ironically, he was a former smoker who quit smoking at the age of 35 and began to jog then run and lost 50 pounds.  His autopsy revealed that three of his main coronary arteries were severly stenosed (clogged) and was also known to have dyslipidemia (alsoknown as hypercholesterolemia).  Apparently, his total cholesterol was about 250 and he had refused a stress test.  Interestingly, his father also died of a heart attack at age 42. This story may cause some to become even more fatalistic and not see much use in prevention considering the fact that a marathon runner withsignificant family history died suddenly, however this death could have possibly been prevented if his lipid levels were enhanced.


What is interesting about these two stories is that despite the fact that HOCM is a common cause of death in athletes (especially in younger athletes-less than 30 years old), as one ages, there is an increasedlikelihood that sudden cardiac death is due to coronary artery disease and in those with dyslipidemia and a family history of heart disease, risk of sudden death is very high.  


In conclusion, individuals should see a physician before starting a rigorous exercise program and to reconsider the weekend “warriormentality” that many businessmen/women have adopted.  Also, individuals need to take seriously their family history of cardiac disease.  The studies on the negative effects of dyslipidemia have been well demonstrated and the effects of statins on reducing this effect are well established.  

Jim Fixx should have been on a statin, which were not even on the market until the early 1990s.  As mentioned above, he also should have had a stress test done or perhaps with his significant family history a catherization to assess for coronary artery disease.  

The Problem with Elevated Cholesterol

There has been a great deal of interest in raising awareness about the risk for heart disease in women. Heart disease is women's No. 1 killer ” (see www.americanheart.org). Indeed, although cardiovascular disease is the most common cause of death in men and women, many may not realize that more women than men actually die of cardiovascular disease. The fact of the matter is more women die from cardiovascular disease than any other disease. For example, in the year 2000, 440,175 men died of heart disease compared to 505,661 women died of heart disease .

One of the major contributors to cardiovascular disease is dyslipidemia or what is commonly known as hyperlipidemia. In general, it used to be thought that most women did not have as severe lipid disorders as men because the protective effect of estrogen, however, post-menopausal women tend to have equivalent rates of dyslipidemia as men. Much of the research on dyspidemia has sought to identify the risky lipid parameters that increase risk for heart disease, which entails a low HDL (good cholesterol), and high LDL and cholesterol level, without much talk of hypertriglyceridemia. However, recent research in women has found that there are different lipid parameters that increase their risk for heart disease, which is a low HDL and high triglycerides with less impact from high LDL . This discrepancy is not always noticed by physicians because most of the research was conducted on men.

The benefits of statins such as Lipitor and Zocor have been well documented in many old and new studies in reducing the risk of cardiovascular disease. These medications had previously thought to decrease heart disease and cardiovascular mortality directly by decreasing bad cholesterol levels (such as total cholesterol and LDL) and increasing good cholesterol (such as HDL), however, there is new evidence to suggest that statins play an anti-inflammatory role in reducing death from heart attacks. This has been confirmed in the fact that patients who take statins have lower levels of CRP (C-reactive protein), which is a marker of inflammation in the body in general. In fact, some cardiologist now recommend checking hs-CRP (high sensitivity CRP) in patients with risk factors for cardiovascular disease to be able to identify the highest risk patients.

Diabetes in women has a more negative effect on women heart health than on men. In fact, it is estimated that women with diabetes have a three to seven times higher risk of cardiovascular disease compared to men’s two to three times higher risk when compared to the general population . Once again, statin therapy in patients withdiabetes has been a crucial medication in reducing cardiovascular disease in all diabetics with dyslipidemia. In fact, in an even more convincing study, which was recently published, a more aggressive approach to diabetics was taken where all diabetics regardless of their cholesterol levels were treated with low dose therapy without any major side effects and a significant decrease in cardiovascular disease .

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