Doctor, do I have to take this medication forever?
Some people have hypertension only at times of great stress. Monitoring your own blood pressure can help pinpoint when meds are needed, and when they re no longer necessary. (Fotolia.com / May 8, 2013)
4. Palpitations (rapid or irregular heart rate)
Persistent or episodic rapid heart rate or irregular heart rate can indicate the presence of serious disease or can be annoying, but harmless. Persistent or episodic heart rhythm problems usually should be assessed by a physician.
There are many different types of harmless but troublesome rhythm disturbances that cause palpitations. Among the most common is the sensation of the heart pounding. This often is associated with a somewhat elevated heart rate between 120 to 140/minute. These occur most often in young women.
The second most common complaint is episodes of "fluttering" lasting 3-4 seconds at a time, with no dizziness or shortness of breath. These usually occur when the person is lying quietly in bed or watching TV late at night. These seem to affect both men and women evenly.
These benign events can be controlled by medication, but these treat the symptoms. There are some things a person can do to manage this problem themselves: cut back on caffeine, or at least cut down. Coffee, tea, many soft drinks, "power" drinks, some sports rehydration drinks, some chocolate products, some ice creams, some chewing gums, some candies, and other commonly used foodstuffs contain caffeine.
Also, watch out for oral decongestants, such as pseudoephedrine, present in many over-the-counter allergy medications, and in some prescription allergy medications. Vasoconstrictor nasal sprays sometimes can cause palpitations. If you can't cut down, and the palpitations are found to be harmless, be prepared to ignore them.
5. Congestive heart failure:
When the heart is unable to pump blood efficiently, congestion builds up in the lungs, in the rest of the body, or both. Shortness of breath, decreased exercise tolerance, difficulty lying flat to sleep, and swelling of the ankles can be manifestations of heart failure.
Congestive heart failure can be mild, but is a potentially fatal problem. There are many causes and several medications that are known to be effective, depending on the cause and the individual's situation. Development of congestive heart failure should trigger careful assessment of possible causes or contributing factors, and careful assessment of the success of therapy.
The mainstay of treatment is diuretics, medications that help remove accumulated fluid from the body. We also can use medications such as ACE inhibitors (drugs that inhibit the angiotensin converting enzyme that generates angiotensin that in turn can have undesirable effects in heart failure patients) and beta blockers (drugs that block some actions of the body's own epinephrine and norepinephrine).
Diuretics, at least initially, cause increased amounts of urine in people with congestive heart failure and fluid accumulation. This can be disruptive day and night. Naturally this leads the person to ask, "Do I have to take these diuretics the rest of my life?" The answer might be yes, but in some patients avoiding excessive fluid intake, or fluid intake late in the day, can limit urinary frequency.
Low-dose aspirin therapy has been shown to reduce the risk of heart attacks and strokes in some patient groups. Your physician can assess the value of daily aspirin therapy based on family history, blood pressure, cholesterol levels, smoking history, diabetes, and other factors that influence the benefits and also the risks of low dose aspirin. If you do need aspirin, that means forever to decrease the risk of a heart attack or a stroke.
Aspirin is not for everyone. It increases the risk of bleeding, although the risk is small. At this time, there's not enough evidence to say the benefits outweigh the risks for every adult to take aspirin to guard against heart attacks or strokes.
There are many examples of medical situations in which daily medications may be crucially important. In some situations however, changes in lifestyle can minimize or eliminate the need for meds. Knowing when and how to modify lifestyle factors and/or medications under the care of a physician can help patients with these problems regain and maintain a healthier life
(Yale M. Samole, M.D., FACC, is board certified in cardiovascular disease, internal medicine and nuclear cardiology. He has been practicing for more than 40 years and is currently with Baptist Health South Miami Heart Center.)
(WhatDoctorsKnow is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at http://www.whatdoctorsknow.com.)