Quwestions for the Cardiologist

I've got my annual appointment with the cardiologist on Wednesday. He's the one who referred me to the sleep clinic. My BP is still high, but I've only been around 30% compliant and I realize that these things can take time. Anyway, I know he's going to ask me if I'm using my CPAP. Is there anything specific I can tell him? Can anybody give me advice on questions I should ask him or things I should tell him or things he should know?

Yes, I realize this is an intensely individualized issue. I'm just wondering if there are general issues somebody can point me to that I can raise, so that I can get any questions answered in my brief 15 minutes with him.

Doug.

My opinion:

1. You need to work on improving your compliance more towards 100%. 100% compliance is only 4-hours use every day. You have to eliminate the hypoxia associated with OSA before you can even begin to address the effects of cardiovascular disease.

2. Once the main cause of that inflammation is under control, your Cardiologist can best recommend ways of further reducing the inflammation (if you remove the source of that inflammation it should immediately begin to reduce on its own).

3. Sometimes Cardiologist suggest a aspirin regiment (enteric coated 91-325mg) if you are at risk of cardiovascular disease. The reason is two-fold, one it helps thin your blood and/or prevents platelets from sticking together just like Plavix does in the prevention of thrombus/clots (in fact some studies show it more effective than Plavix alone), in addition it also helps to reduce arterial inflammation. Your level of inflammation can now be measured with the CRP test.

My Cardiologist is part of the well respected Cardiovascular Consultants Group in the Bay Area, he is a D.O and doesn't believe in prescribing drugs to control your cholesterol. His thought process is like mine that believe higher cholesterol levels seen (if not from food) are there as a result of arterial inflammation. That higher level is there because it was produced by the liver as a result of a condition (arterial inflammation). Get rid of the inflammation and those levels should go down on their own.

4. Hypertension always remains a risk to your vital organs and tissues. If you are having difficulty controlling your Hypertension thru medication, then you have what is called Essential Hypertension. The only thing I've seen to address that is CPAP (again goes back to #1 with better CPAP compliance). It is really simple when you think about it, if your brain is not getting enough oxygenated blood thru the dialation of the cerebral blood vessels it tells the heart to beat faster, the faster it beats the more oxygen rich blood reaches the brain. Only problem with that is it overworks your heart. If your airway is blocked how is the lungs going to exhange oxygen?

Why do you think so many people with untreated OSA have so many migraines? It is because their brain has dilated the cerebral blood vessels in an effort to get more oxygenated blood destined to the brain. Attached to those cerebral blood vessels is nerves, nerves don't like to stretch very much, they like staying stiff and rigid. Why is it they include caffeine in migraine medications like ExcedrinMigraine? It is because caffeine constricts blood vessels (so does nicotine from smoking) and migraines go away once those blood vessels have constricted.

But if you continually overwork your heart during sleep at night you should see a faster resting heart rate during the day. You can see that with any blood pressure monitor. Let's hope you haven't overworked that heart muscle so much to where one side has now become larger than the other because then has the effect to cause the heart to beat irregularly, sorta throws off its normal rhythm when it does that it doesn't pump blood as efficiently as it once did.

Essential Hypertension & OSA:
http://www.aafp.org/afp/20020115/229.html

If you have had any heart scans like a treadmill color nuclear test or one of the new ultra fast CT scans they can sometimes estimate your level of cardiovascular disease. They can get a better picture with an angiography, but I don't recommend that procedure to anyone unless you have already had failure.

If you ask good questions of your Cardiologist they will give good answers. You might want to let your Cardiologist know you are having difficulty controlling your hypertension, maybe they can change dose or switch medications for something that is better. I've had good luck with Lisinopril, it is an ACE inhibitor it works by dialating or relaxing your blood vessels. I used to take DiovanHCT and that stuff made every muscle in my body ache.

http://www.lisinopril.com/

I pay more attention to controlling cardiovascular disease than the avg. person, for me it is all about reducing the risk factors for stroke. I've had 2 already the first at age 45 (I was 6'1" 177lbs.) my father died in my arms at age 51 from sudden heart attack, my mom who is now 90 has had at least a dozen heart attacks since 60, so I think it runs in the family. I've been on the hose now about 7 years after the first stroke and made it past my dad's benchmark.

There is a reason your Cardiologist sent you for a sleep study. You can be tired from not getting enough sleep or a failing heart (or both).

My opinion is you have a pretty smart Cardiologist, but you have to understand the concept behind what they want you to do and why, once you understand that process you won't have any problems putting that mask on every night, all of a sudden that mask discomfort goes away.

Snoredog -- excellent piece!!

Thanks.

Thanks, Snoredog! I'm very aware that I need to get my compliance up. FWIW, I've been keeping track of my BP for at least six months now. It's high (140s over 90s). The RN I talked to on the phone when I faxed over my chart said that the good news is my BP is pretty stable. Also, I'm on a low dosage of Norvasc -- 10 mg/day. I'm thinking that we can talk about upping that at least until I've reached 100% compliance with the cpap.

Doug.

Snoredog - you rock ! However, I do want to comment on one thing - taking ASA as a cardiopreventative. So many of us have GERD and/or related issues and while we wish we could take ASA (even the baby kind every two days), we can't or shouldn't, certainly not without an MD's help, as it can do a serious number on your tummy. That's all.

Snoredog...

WOW! You can pack a whollop when you get going...All true and all needed. That helps to remind all of us why we do what we do. I am one of those who had a right sided enlarged heart and was sent for the sleep test. Struggled with high BP. To Dr. Thur. BP down from 200/100 to 140/98 .I'm getting there. On Cpap 1 1/2 years

Julie wrote:Snoredog - you rock ! However, I do want to comment on one thing - taking ASA as a cardiopreventative. So many of us have GERD and/or related issues and while we wish we could take ASA (even the baby kind every two days), we can't or shouldn't, certainly not without an MD's help, as it can do a serious number on your tummy. That's all.

like anything you have to weigh the good with the bad. It is like I told my GI specialist when I went to see him about my GERD, oh you have had it for 5 years? That can put you at risk for stomach cancer so you should have a endoscopy exam.

Next, his internist hands me a pamplet and says after reading my medical history (2 strokes, TIA's once a week for a year and a half) that I need to stop taking the Aspirin and Plavix 10-days before the procedure which I was taking at the time so they can do the endoscopy.

I said WHY? .....well he says we may nick your esophagaus and cause bleeding. I said I don't think so, as I pick up my jacket readying myself to leave this quack. I said there is no way in hell that was going to happen. He says I'll be right back.

By this time the actual doctor comes back in the exam room and just as the intern stated he says the same thing. This guy is like the top GI specialist in the bay area.

So I said to him, well, can you guarantee me that I won't stroke out during that procedure or the 10 days prior?

Can you guarantee me that if I can no longer walk from the effects of the stroke (if I survive it) you can fix it so I can walk again?

He says yeah you are right, stay on the aspirin and plavix and if you start to bleed we'll just take the laser and fix it right then and there.

I spent a couple years studying the efficacy of ASA, Plavix, warfin and other anticoagulants and antiplatelet agents. Not one of those studies ever revealed that GERD was caused from NSAIDS or ASA. Not a single one.

Having GERD has nothing to do with it. Taking ASA puts you at greater risk of ulcers, it doesn't contribute to GERD. The problem with taking ASA long term is it erodes the delicate mucus lining on the stomach wall which then allows stomach acid to erode the lining of the stomach which can contribute or be the cause of the ulcer.

And that is the reason I take enteric coated aspirin, it doesn't dissolve in the stomach it dissolves in the intestine so it gets past the the stomach where the damage can occur.

Sure ASA puts you at greater risk of bleeding if you cut yourself but so does Plavix, warfrin, coumadin and other antiplatelet therapies.

Once you have a stroke you don't care if you bleed a little bit, a little bleed is a good thing it helps get rid of those excess platelets. The fewer those I have the better off I'll be.