How you can build a healthier heart and reduce your risk of a heart attack

Dear Phyllis:

Thanks for all the patient information you’ve written. At the risk of sounding crass (which is never a good idea for any doctor), I have to say that I’m recommending that a blood pressure reading should not be the entire criterion for your care. So give me some of your previous symptoms, followed by what a potential new medication might do for your heart.

An elderly patient I work with has had no more than mild pain in his legs and a quick reflex to return to sleep. I began to suspect a brain aneurysm. With his wife’s assistance, I performed several CT angiograms. The imaging proved inconclusive. But, two weeks later, during the visit, I ordered a second CT scan with a simple rapid assay for percutaneous coronary intervention, and the results confirmed the suspected aortic aneurysm.

Following a heart catheterization and an angioplasty, I referred the patient to a “systemic interventional cardiologist,” who performed a procedure to install a coronary stent with an artificial film to keep the aneurysm from bursting. After that all went well.

Another patient I’ve cared for recently came to me after what he described as severe heart attacks. He said he always felt achy, and the pain had made it difficult to sleep. He did not qualify for any medication to combat the symptoms, or recommended anything in particular for reducing my anxiety about his sudden illness.

So I explained that sometimes nonsurgical treatment can work wonders. I gave him a cystoscope (a small gadget that slides between the abdomen and groin) to be used on the right side of his chest and asked him to join me.

During the exam, he had trouble articulating words and I observed that his speech was slowed as he talked about a long-ago occurrence. I took this to mean that something was wrong with his right ventricle, so I urged him to rule out a heart attack. I took heart test results along with us, and he was cleared of any heart problem. No follow-up is needed.

I have had no other patient complain of similar symptoms, yet some have already suffered for years from just the usual fatigue.

And all of us die sooner than we would have.

I would request your advice on how to deal with that, as well as on other underappreciated symptoms. For example, how to respond to sudden fatigue in someone who has mild fever, sinusitis or pneumonia.

Thank you for your time and by the way, a special happy Thanksgiving to you and all of your readers.

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