Dr. Starling shares the actions a woman should take after she is officially diagnosed with heart disease. Dr. Starling was the Associate Professor of Medicine in the Departments of Internal Medicine and Cardiology Division at both the University of Texas and the University of Michigan and now works at Banner Heart Hospital in Mesa, Arizona.
When I talk to women or other patients in my office and relate to them that they do have some structural heart disease or their ejection fraction instead of being 55% or 60%, where it should be, remember it’s percent blood ejected each beat, that’s the normal kind of thing, if it’s diminished – 45%, 50%, 40% - that kind of thing, this will be called systolic dysfunction of the heart. It’s a structural problem. The heart is not pumping as strongly as it should.
In this case, even though you do not have… a patient may not have any symptoms whatsoever, so there may not be any fatigue. There is no shortness of breath. Nevertheless, there are well-studied therapies that a patient like that should be on and ask their physician to make sure there are.
For example, it is very clear that under that set of circumstances that having taking what we call an ace inhibitor, it’s called the angiotensin-converting enzyme inhibitor, it blocks a certain metabolic pathway in the body. It’s there kind of for your defense really, but it blocks it partially, and what it does is prevent changes in the heart. It actually prevents the heart muscle from getting worse. So it actually, while it’s protecting you on one side, it can, if it’s heightened in activity, have an effect that’s negative on the other side and so these ACE inhibitors kind of block that negative effect and restore that balance that allows your heart to be more effective and have better strength, more repair, more defense, that kind of thing. It doesn’t deteriorate. So that’s one drug that patients should be on.
If they can’t take that medication, which patients not uncommonly can’t because of cough and those kinds of things, there’s another class that does exactly the same thing and it’s called an angiotensin receptor blocker but it does exactly the same thing. It protects the heart and so the heart doesn’t deteriorate. The muscle is protected. All of the different parts that keep the heart muscle together are protected and so you don’t deteriorate and longevity is improved, symptom status remains probably neutral or not present or improved if you are mild. So it can have really positive benefits for people.
Again, even though symptoms of heart failure, obvious symptoms have not occurred as of yet. So this is again, kind of like an ounce of prevention while you may have a little structural heart disease but you are taking the medication to prevent deterioration and prevent the symptom decay if it is expressed as heart failure – key.
There’s another class of drugs that we know also protects the heart and those are called beta blockers. They kind of block another neurohumoral system or another system that’s innate in our bodies all over it. But that system can, when its activity is heightened and remains heightened, can cause deterioration of the heart muscle’s performance. So putting beta blockers on or taking beta blockers at reasonably low doses can really protect the heart muscle from further deterioration.
So, even though you have structural heart disease, but in the absence of obvious symptoms heart failure or the fatigue we were talking about earlier, the patient should be on those two medications to prevent further deterioration and obviously developing obvious symptoms of heart failure and survival goes up. You live longer. You live better and you live longer. What’s not to like?
About Dr. Mark Starling, M.D.:
Dr. Mark Starling graduated from the University of Washington, B.A. Degrees, cum laude, History and Literature. After a studying French Language and Literature at the University of Paris in France, Starling returned to Washington to study medicine at the University of Washington School of Medicine. He graduated in 1974 with honors. Over the years, Dr. Starling has been that Associate Professor of Medicine in the Departments of Internal Medicine and Cardiology Division at both the University of Texas and the University of Michigan.
Conditions: Heart Failure, Heart Disease, High Blood Pressure,
Related Terms: Shortness of Breath, Ejection Fraction, Edema, Exercise Intolerance, Fatigue, Echocardiogram, Electrocardiogram, Weak Heart Muscle
Expert: Dr. Mark Starling, Dr. Mark Starling, M.D., Doctor Starling, Chief Medical Officer Mark Starling, Women's Heart Health Specialist Cardiologist Dr. Mark Starling
Expertise: Peripheral Artery Disease, Heart Disease Risks, Heart Disease Management, Cardiac Metabolic Syndrome, Heart Disease Prevention, Blood Pressure Testing, Cholesterol Testing, Robotic Catheter Ablation, Coronary Artery Disease, Heart Failure Warning Signs, Heart Failure Prevention