DEAR READERS: In yesterday's column, a reader asked why a friend had undergone both bypass surgery and an angioplasty to restore blood flow to the heart. The reader had thought that a person had either one or the other, but not both. I replied that this has been the case until recently: When one or more blocked arteries were discovered, cardiologists and cardiac surgeons had traditionally decided whether to do one procedure or the other. However, a new hybrid approach is gaining favor. It makes sense only for some patients -- and it sounds as if the reader's friend is one of those patients. In yesterday's column, I explained both angioplasty with stenting and coronary artery bypass graft (CABG) surgery.
DEAR DOCTOR K: My friend said he had bypass surgery and angioplasty at the same time. Isn't it usually one or the other?
DEAR READER: It is usually one or the other, but your friend may have been treated at one of a few select medical centers in the United States currently offering a new hybrid approach. If so, he may have had both bypass surgery and angioplasty during the same surgery. To answer your question, I need to explain both the traditional approach and then the new hybrid approach. The hybrid approach cannot be used in all patients. However, when it is used, the goal is to make the surgery less grueling, and the beneficial results of surgery more long-lasting.
DEAR DOCTOR K: I take ibuprofen every morning for my arthritis. My doctor wants me to take low-dose aspirin every day to reduce my heart attack risk. Ibuprofen and aspirin are both NSAIDs, right? So will the ibuprofen help my arthritis and my heart? Or should I take both?
DEAR READER: When joints ache, many people turn to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Aspirin is a type of NSAID. So are ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). NSAIDs are widely used because they perform double duty. They relieve pain and also reduce inflammation.
DEAR DOCTOR K: The results of a recent stress test showed that I have "silent ischemia." I haven't felt any pain or discomfort. I wouldn't even have known about it if not for the stress test. Does it need to be treated if it's not causing any symptoms?
DEAR READER: The word "ischemia" comes from a Latin term that means "stopping blood." If a stress test shows you have cardiac ischemia, blood flow to a part of your heart muscle is less than the heart muscle needs when you exercise. The most likely culprit is a coronary artery narrowed by cholesterol-laden plaque.
DEAR READERS: Yesterday, I answered a question about treatments for heart failure. It's a big topic, and so today I'm talking about the medicines that are typically used to treat heart failure. As we discussed, heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs throughout the body don't get enough oxygen. Also, fluid builds up in the lungs and other body tissues. Taking heart failure medicines as prescribed is perhaps the single most important thing you can do to feel better and live longer. The medicines available today are dramatically more potent than the medicines that were available when I was in medical school.
DEAR DOCTOR K: I've been diagnosed with heart failure. Thankfully, it is still in the early stages. What can I do to keep it from getting worse?
DEAR READER: The function of the blood is to carry nutrition to every cell in the body and to carry away waste from the cell. The function of the heart is to keep pumping blood so that the blood reaches every cell in the body. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs don't get enough nutrition, and fluid builds up in the lungs and tissues.
DEAR DOCTOR K: You mention atherosclerosis in many of your columns. Could you explain what this word means?
DEAR READER: My readers ask me many questions about atherosclerosis, and for good reason: It is the No. 1 cause of premature death in developed nations, including the United States. Atherosclerosis is a narrowing of the arteries. Arteries are blood vessels that supply fresh, oxygen-rich blood to the heart, brain, intestines and other organs. The narrowing is caused by the buildup of plaques in artery walls. The plaques are filled with LDL cholesterol -- so-called "bad" cholesterol.
DEAR DOCTOR K: I've heard that coffee is good for your health -- but I've also heard that it increases your blood pressure and heart rate. What's true?
DEAR READER: Right now, the evidence I'm aware of points to health benefits for most people from regularly drinking coffee. I'm talking about straight coffee -- minus the cream and sugar. Straight coffee is a nearly calorie-free beverage brimming with antioxidants. There's evidence that drinking coffee might help prevent Type 2 diabetes and reduce the risk of heart disease and stroke. And studies show lower rates of gout and liver disease among regular coffee drinkers.
DEAR DOCTOR K: I have a clogged carotid artery. My doctor wants me to have an endarterectomy. Is this the best treatment option for my condition?
DEAR READER: It's impossible to answer your question without a lot more information. What I can do is describe what a clogged artery is, and what some of your treatment options are. The carotid arteries of the neck carry oxygen- and nutrient-rich blood from the heart to the brain. Deposits of fat and cholesterol -- plaque -- on the walls of the carotid arteries increase the risk of a stroke. Plaque can block blood flow to part of the brain. Or, a piece of it can break loose and completely block a smaller vessel in the brain.
DEAR DOCTOR K: I had a heart attack several years ago. I have been taking low-dose aspirin ever since to prevent a second one. Do I need to worry about bleeding risks?
DEAR READER: Every medicine contains risks as well as benefits. The question with any medicine is: Do the benefits outweigh the risks? Aspirin helps prevent repeat heart attacks in two ways. A heart attack occurs when the flow of blood through one of the heart's arteries is blocked.