Do NOT Rely on AF Detect Smartphone App To Diagnose Atrial fibrillation

I’m writing this brief post as a warning to any individuals who have purchased the  smartphone app AF Detect (screen shot below from Apple app store.) It is not a reliable detector of atrial fibrillation (AF).

screen-shot-2017-02-19-at-11-25-56-am

 

A patient of mine with AF recently  purchased this app unbeknownst to me. He  relied on its faulty information which  reassured hm he was not in AF when in fact he was in AF. Such misinformation has the potential to lead to dangerous delays in diagnosis.

There are multiple reviews on the Apple and Google app sites which confirm the total lack of reliability of this app to diagnose AF with screen-shot-2017-02-19-at-9-18-10-ammultiple instances of both failure to detect known AF and inappropriate diagnosis of AF when rhythm was not AF.

In the description of the app the company says the app will “transform you rmobile device into a personal heart rate monitor and atrial fibrillation detector”.

However after purchasing the app and before using it you see this disclaimer which img_8348states it is not to be used for any medical diagnosis.

 

 

 

 

 

 

I will be performing a more detailed analysis of this app’s performance in the future and contacting the FDA about the danger such inaccurate medical testing confers on victims.

In the meantime if you have any experience with this app or other apps claiming to detect AF reliably using detection of the pulse from finger application to the camera lens please share them with me (via email  DRP@theskepticalcardiologist.com or via comments below.)

-ACP

The Impact of Organic Foods On Human Health: European Perspective

The skeptical cardiologist obtains most of his groceries from Whole Foods, something the eternal fiancée insists on.  At least part of my preference is related to Whole Foods’ focus on organic produce and part to their focus on sustainable and healthier meat and fish.

A recent report from the European Parliament reviews the existing scientific evidence regarding the impact of organic food on human health. I think this document, (eu-organic-food) is a reasonable summary of the science in this area. The summary can be broken down into 4 key points:

  1. Very few studies have directly addressed the effect of organic food on human health. They indicate that organic food may reduce the risk of allergic disease and obesity, but this evidence is not conclusive. Consumers of organic food tend to have healthier dietary patterns overall. Animal experiments suggest that identically composed feed from organic or conventional production has different impacts on early development and physiology, but the significance of these findings for human health is unclear.

Meaning: We just don’t have good evidence to support routine use of organic foods.

2. In organic agriculture, the use of pesticides is restricted. Epidemiological studies point to the negative effects of certain insecticides on children’s cognitive development at current levels of exposure. Such risks can be minimised with organic food, especially during pregnancy and in infancy, and by introducing non-pesticidal plant protection in conventional agriculture. There are few known compositional differences between organic and conventional crops. Perhaps most importantly, there are indications that organic crops have a lower cadmium content than conventional crops due to differences in fertiliser usage and soil organic matter, an issue that is highly relevant to human health

My take. A 2014 review concluded that “the frequency of occurrence of pesticide residues was found to be four times higher in conventional crops, which also contained significantly higher concentrations of the toxic metal Cadmium

The review also concluded that ” the concentrations of a range of antioxidants such as polyphenolics were found to be substantially higher in organic crops/crop-based foods…… phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanin.

3. Organic milk, and probably also meat, have a higher content of omega-3 fatty acids compared to conventional products, but this is not likely to be nutritionally significant in light of other dietary sources.

My take. I disagree. I wrote about why I only consume full-fat dairy products that are “organic” and come from grass-fed cows here. There are a lot of benefits, beyond increased omega-3 fatty acids, in consuming dairy that comes from cows that eat grass versus corn and are treated properly.

4. The prevalent use of antibiotics in conventional animal production is a key driver of antibiotic resistance. The prevention of animal disease and more restrictive use of antibiotics, as practiced in organic production, could minimise this risk, with potentially considerable benefits for public health.

My take. I agree. Cut out the antibiotics. Other countries seem to be able to do this.

I would also agree with the conclusion of  The Lancet’s editorial comment (Organic Food: Panacea for Health?)  on the EU paper:

Large, prospective, long-term studies are needed as well as deeper examination of agricultural policy and health. Much still rests on the provision of robust multidisciplinary research to guide future food choices for health.

Until we get such studies, I will be erring on the side of caution and consuming food with the least amount of pesticides, cadmium and antibiotics possible.

EUingly Yours,

-ACP

Sustained Atrial Fibrillation or Not: The Vagaries and Inaccuracies of AliveCor/Kardia and Computer Interpretation of ECG Rhythm

The skeptical cardiologist has often sung the praises of the AliveCor Mobile ECG for home and office heart rhythm monitoring (see  here and here.) However, there is a significant rate of failure of the device to accurately identify atrial fibrillation.  I’ve seen numerous cases where the device read afib as  “unclassified” and normal sinus rhythm (usually with PVCs or PACs) called afib both in my office and with my patient’s home monitors.

In such  cases it is easy for me to review my patient’s  recordings and clarify the rhythm for them.

For those individuals who do not have a img_8322cardiologist available to review the recordings, AliveCor offers a service which gives an option of having either a cardiac technician or cardiologist review the tracing. The “cardiac technician assessment” costs $9 and response time is one hour. The “Clinical Analysis and Report by a U.S. Board Certified Cardiologist” costs $19 with 24 hour response time.

Obviously, I have no need for this service but I’ve had several readers provide me with their anecdotal experiences with it and it hasn’t been good.

One reader who has a familial form of hypertrophic cardiomyopathy utilizes his AliveCor device to monitor for PVCs. One day he made the following recording which AliveCor could not classify:
screen-shot-2017-02-14-at-5-37-42-am
screen-shot-2017-02-14-at-5-43-51-am screen-shot-2017-02-14-at-5-41-41-am

He then requested a technician read which was interpreted as “atrial fibrillation sustained.”

He then had requested the cardiologist reading which came back as Normal Sinus Rhythm.

Finally, he againscreen-shot-2017-02-14-at-5-44-09-am requested the technician
read and got the correct reading this time which is normal sinus rhythm with PACs

When my reader protested to Kardia customer service about this marked inconsistency: three different readings in a 24 hour period, a Kardia  customer service rep responded :

 I was able to review this with our Chief Medical Officer who advised that the recording shows Sinus Rhythm with PACs. The Compumed report seldom provides identification of PACs and PVCs as most cardiologists believe they are not significant findings. The sustained AFib finding was incorrect, so I have refunded the $5 fee you had paid.

Please let us know if you have any other questions.

As I pointed out in my post on palpitations, most PVCS are benign but some are not and patients with palpitation would like to know if they are having PVCS and/or PACs when they feel palpitations.

More importantly, the misdiagnosis of afib when the rhythm is NSR with PACs or PVCs can lead to extreme anxiety.

sr-pvcs-with-annotations
This tracing clearly (to me) shows regular and similar upward deflections (red arrow, p waves) which are a similar distance from the QRS complexes which follow (QRS complexes). The green arrows point to irregular deflections due to noise which can confuse computer algorithms (and non-cardiologists.) The distance between the QRS complexes is very regular (black arrow, RR interval). Thus, this is clearly normal sinus rhythm (NSR). Later in the recording PVCs (green arrows) are noted occurring every other beat. The distance between the QRS complexes on either side of the PVC is still the same as two RR intervals. This is clearly ventricular bigeminy.

Heres a recording
I made in my office this morning on a patient with cardiomyopathy and a defibrillator.

This is very clearly NSR with PVCs yet AliveCor diagnosed it as “possible atrial fibrillation.”

The AliveCor algorithm  is not alone in  making frequent errors in the diagnosis of atrial fibrillation.

The vast majority of ECGs performed in the US come with an interpretation provided by a computerized algorithm and medical personnel rely on this interpretation until it can be verified or corrected by an overreading cardiologist.

One study demonstrated that computerized ECG interpration (ECG-C) is correct only 54% of the time when dealing with a rhythm other than sinus rhythm

Another study found that 19% of ECG-C misinterpreted normal rhythm as atrial fibrillation. Failure of the physician ordering the ECG to correct the inaccurate interpretation resulted in change in management and initiation of inappropriate treatment, including antiarrhytmic medications and anticoagulation, in 10% of patients. Additional unnecessary diagnostic testing was performed based on the misinterpreted ECGs in 24% of patients.

When lives or peace of mind are at risk you want your ECG interpreted by a cardiologist.

I would like to take this opportunity to personally issue a challenge to IBM’s Watson.

Hey, Watson, I bet $1,000 I can Interpret cardiac rhythm from an ECG with more accuracy than you can!

Are you listening, IBM?

Do you copy, Watson?

-ACP

Saguaro National Park: Hidden Gem Among The National Treasures

There are 56 National Parks (NPs) in the  U.S. and prior to last week, the skeptical cardiologist had visited 13 of them,  none of which were plant-based. Only 4 NPs as far as I can tell are created specifically to preserve a plant species. Three of them are in California, two of which are concerned with really large redwood trees. I haven’t visited Sequoia  or Redwood National Park in California but I’ve been to Muir Woods National Monument north of San Francisco and apparently (per the eternal fiancee’) I wasn’t suitably impressed by the immensity of the coastal redwoods (Sequoia Sempervirens) that grow in their enormity there. Perhaps if I had seen the giant sequoias (Sequoiadendron Giganteum) which grow on the western slopes of the Sierra Nevada mountains my jaw would still be dropped.

The skeptical cardiologist is more impressed by the intrinsic beauty, joshua-treecolors, and complexity of the shapes and textures of the branches and leaves of trees rather than their giganticness. I am enthralled just watching trees blown by the winds.

The third  California plant-based NP is based on an odd looking but not terribly tall tree called the Joshua Tree which grows in the Mojave desert in Southern California.

I’ve always wanted to visit Joshua Tree  National Park because one grand_theft_parsons-3472of my musical heroes, Gram Parsons, died from a morphine overdose in room 8 of the Joshua Tree Inn near there. After he died, his body was stolen at Los Angeles International  airport by his  road manager and his assistant and taken to the Nationa Park and set on fire. There is an interesting (if you are a Gram Parsons fan) movie entitled Grand Theft Parsons based on this adventure.

The only non-California plant-based NP is Saguaro (pronounced sa wah roo)  NP (SNP) unknownwhich exists on either side of Tucson, Arizona. Since no famous rock stars were cremated in SNP and no best-selling albums by U2 feature the saguaro cactus on the cover, the park remains relatively unknown.

 

However, after hiking at SNP last week I can attest to the dscn0252photogenicity of the saguaro,  the largest cactus in the U.S. and the beauty of the Sonoran desert, the only location where they grow. The saguaro (Carnegiae Gigantea)  reaches sixty feet in height and can live for 200 years. They only sprout arms when they are 50-75 years old.

Since my kids became old enough to appreciate hiking and nature I have tried to focus family vacations on visits to National parks. I can’t think of any more valuable experience for them than hiking in some of the most beautiful places on earth and experiencing diverse and fascinating flora and fauna.  And all of this comes at a ridiculously low price for the user.

For example, because I’m 62 years old I qualify for a Lifetime senior pass to all National parks and monuments. Cost? 10$!!!! I’m finally seeing the perquisites of becoming a senior citizen.

Since the National Park Service was created in 1916 it has grown to protect 88 million acres, 43,000 miles of shoreline, 85,000 miles of rivers and streams, 12,000 miles of trail and 8,500 miles of road in more than 400 national parks, sites and monuments.

I sure hope the vision of prior Presidents, Congressman and ardent conservationists (all praise be to Teddy Roosevelt!) who established the federal system that protects these national treasures continues.

Gigantically Yours,

-ACP

 

Nutella: Healthy and Natural Spread or Highly Processed, Slickly Marketed Junk Food?

It’s World Nutella day according to Ferrero, the Italian confectonery company and manufacturer of the globally beloved hazelnut-based spread.screen-shot-2017-02-05-at-6-28-42-am

“With Nutella we spread positive energy to families to bring more happiness to the world” we are informed. On this day, apparently, the world should be spreading Nutella on as many food products as possible, ramping up positive energy levels to unprecedented levels.

Here are some of the other products Ferrero sells:screen-shot-2017-02-05-at-9-08-21-am

Three of them are clearly recognized by consumers as candy.

Should Nutella be in the same category as tic-tacs?

 

 

Nutella Ingredients

Perhaps in anticipation of World Nutella Day, a graphic has been appearing on Twitter:

nutella-englisy

detailing the ingredients of Nutella. The English version of this was posted on Reddit on a subreddit that I can’t mention on my family-friendly blog. It is a translation of a graphic that was published in German originally.

screen-shot-2017-02-05-at-8-18-31-am
If you thought you were getting mostly hazelnuts under the lid as this Nutella website graphic implies, you will be disappointed.

I’m not sure where the original data for the graphic came from but it seems to be a reasonable illustration of how much of Nutella is made up of palm oil and sugar. A 2 tbsp serving of Nutella (37 grams) contains 12 grams of fat, 21 grams of sugar and 2 grams of protein. Only about 12% of Nutella comes from actual hazelnuts.

I don’t have any concerns from a cardiovascular risk standpoint with the fat content of either the palm oil or the hazelnuts in Nutella.

But the 5 teaspoons of sugar per serving screen-shot-2017-02-05-at-8-44-16-am

are just still another source of empty
sugar calories adding to the daily dietary glut of sugar consumers face when consuming highly processed foods.

Nutella definitely is a highly processed, highly sugared product that shouldn’t be a regular part of a healthy Mediterranean diet. Most of the ingredients have gone through  complex sourcing and factory processing although their marketing material strains to emphasize the freshness and naturalness of these ingredients.

screen-shot-2017-02-05-at-6-30-27-am

One ingredient not depicted on the now viral graphic of Nutella is vanillin. From Nutella’s ingredient graphic one might think the screen-shot-2017-02-05-at-6-34-38-amvanillin is being extracted from (per wikipedia)

“the seed pods of Vanilla planifolia, a vining orchid native to Mexico, but now grown in tropical areas around the globe.”

In reality, however, the Nutella people,  ” use synthetic vanillin, an aroma identical to the one naturally present in the vanilla pod.”

Is the Palm OIl In Nutella Carcinogenic?

Some question the healthiness of the palm oil in nutella, either due to its high saturated fat content or its carcinogenic potential. A european food safety authority paper in May, 2016 declared certain toxins found in palm oil in particular to be “genotoxic and carcinogenic”

EFSA assessed the risks for public health of the substances: glycidyl fatty acid esters (GE), 3-monochloropropanediol (3-MCPD), and 2-monochloropropanediol (2-MCPD) and their fatty acid esters. The substances form during food processing, in particular, when refining vegetable oils at high temperatures (approx. 200°C)

The highest levels of GE, as well as 3-MCPD and 2-MCPD (including esters) were found in palm oils and palm fats, followed by other oils and fats. For consumers aged three and above, margarines and ‘pastries and cakes’ were the main sources of exposure to all substances.

As a result, According to Reuters, In Italy, some products containing palm oil have been removed from grocer’s shelves and one pastry company has eliminated palm oil from it products, labeling them as “palm oil free.”

High temperatures are used to remove palm oil’s natural red color and neutralize its smell, but Ferrero says it uses an industrial process that combines a temperature of just below 200C and extremely low pressure to minimize contaminants.

Nutella has fought back, defending its use of palm oil, with television and print advertisements.

Healthier Alternatives To Nutella

Conner Middleman, nutritionist , cooking instructor and author of Zest For Life, has shared with me her recipe for Nutritella, a healthier version of Nutella you can make at home. She points out in her intro to the recipe:

Nutella was invented in the 1940s in the Piedmont region of northern Italy, where hazelnuts grow plentifully. Alas, modern, store-bought Nutella contains a mere 13% hazelnut and only a hint of cocoa; the rest is made up of sugar, palm oil and artificial vanilla flavoring. My home-made version of Nutella, on the other hand, contains very little sweetener (in the form of raw honey), 3 tablespoons of flavonoid-rich dark cocoa, and about 90% hazelnuts, which boast a particularly high concentration of antioxidants and healthy fats (mostly monounsaturated). This is not to say that you should eat this spread by the tablespoonful; its high fat content means it’s high in calories and it should be enjoyed in sensible amounts (1-2 tbsp/day). The good news is that a high-fat food such as this one keeps you sated for longer, and because it is made from whole, real foods, it’s not only rich in calories, but also in nutrients! 

Here’s the recipe:

1 cup/125g toasted hazelnuts (Trader Joe’s roasted Oregon hazelnuts work great here; alternatively buy plain, raw hazelnuts and roast them yourself as described below)

½ oz/2 tbsp/15g unsweetened cocoa

3 tbsp hazelnut oil (La Tourangelle is my favorite brand – available in the oils section of good supermarkets or online)

3 tbsp honey or maple syrup

2 tsp alcohol-free vanilla extract (e.g., Trader Joe’s)

6-8 tbsp milk/plant milk/water

If you are roasting the hazelnuts from scratch, preheat oven to 350F. Place nuts on a dry, clean baking sheet and roast for 8 minutes (set timer). Remove and tip hot nuts onto a clean kitchen towel (pictured here).

As they cool, the skins will loosen, crack and flake off. Gather up the towel by its corners and scoop together into a tight bundle. Hold the bundle with one hand and knead the nuts with the other through the cloth to rub the skins off them. Place bundle back on a flat surface and open; lift out the nuts and lightly shake off the skins. (Leave some skin on the nuts – it’s where most of the antioxidants reside.)

If using pre-roasted nuts, start here.

Place the hazelnuts in an electric blender with the cocoa, oil, honey/maple syrup and vanilla extract. Process on “high” for about 30-40 seconds until all the ingredients come together in a coarse paste.

With the motor running, add milk or water (whichever using), a tablespoon at a time, and keep processing until the mixture reaches the desired consistency.

Transfer to a clean glass jar and refrigerate. Keeps for at least 2 weeks.

You can check out Conner’s excellent website, Modern Mediterranean, replete with more recipes and information on the cancer-fighting benefits of the Mediterranean diet,  here. and her You-tube channel here.

Of course, the skeptical cardiologist Heart Nuts project advocates just eating  heartnutsunadulterated hazelnuts along with other healthy drupes, nuts and legumes for snacking and soon we will be distributing these to you using our trademark-pending walnut-auscultating squirrel, Sparky.

Notnutellingly Yours,

-ACP

 

Are Your Palpitations Due to Benign PVCs?

If you feel your heart flip-flopping, then you are experiencing palpitations: a sensation that the heart is racing, fluttering, pounding, skipping beats or beating irregularly.

Often, this common symptom is due to an abnormal heart rhythm or arrhythmia.

The arrhythmias that cause palpitations range from common and benign to rare and lethal, and since most individuals cannot easily sort out whether they have a dangerous or a benign problem, they often end up getting cardiac testing or cardiology consultation.

The most common cause of palpitations, in my experience, is the premature ventricular contraction, or PVC (less commonly known as the ventricular ectopic beat or VEB).

Premature Ventricular Contractions-Electrical Tissue Gone Rogue

The PVC occurs when the ventricles of the heart (the muscular chambers responsible for pumping blood out to the body) are activated prematurely.

This video shows the normal sequence of electrical and subsequent mechanical activation of the chambers of the heart.

To get an efficient contraction, the electrical signal and contraction begins in the upper chambers, the atria, and then proceeds through special electrical fibers to activate the left and right ventricles.

Sometimes this normal sequence is disrupted because a rogue cell in one of the ventricles becomes electrically activated prior to getting orders from above. In this situation, the electrical signal spreads out from the rogue cell and the ventricles contract out of sequence or prematurely.

This results in a Premature Ventricle Contraction.

labeled-pvc
p waves represent depolarization and activation of the atria which are followed normally after120 to 200 milliseconds by the QRS complex which represents activation of the ventricles. The PVC (inside red circle) is wider and weirder and disrupts the regular interval between beats (green lines).

I recorded the above AliveCor tracing in my office on a patient who suffers palpitations due to PVCs (we’ll call her Janet).

The wider, earlier beat (circled in red) in the sequence is the PVC. The prematurity of the PVC means that the heart has not had the appropriate time to fill up properly. As a result, the PVC beat pumps very little blood and may not even be felt in the peripheral pulse. Patients with a lot of PVCs, say ocurring every other beat in what is termed a bigeminal pattern, often record an abnormally slow heart rate because only one-half of the heart’s contractions are being counted.

While recording this, every time Janet felt one of her typical “flip-flops,” we could see that she had a corresponding PVC and the cause of her symptoms was made clear.

There is a pause after the PVC because the normal pacemaker of the heart up in the right  atrium (the sinus node) is reset by electrical impulses triggered by the PVC.. The beat after the PVC is more forceful due to a more prolonged time for the ventricles to fill and  Consequently, most  patients feel this pause after the PVC rather than the PVC itself,

PVCs are common and most often benign. I have patients who have

ECG from 70 year very vigrous man who had 20 thousand PVCs in 24 hours. Every third beat is a PVC (green arrow)
ECG from 70 year old very vigorous man who had 20 thousand PVCs in 24 hours. Every third beat is a PVC (green arrow PVC, blue arrow normal QRS.)This patient feels nothing with his frequent PVCs. He has had them probably lifelong and definitely for the last 10 years without any adverse consequences.

thousands of them in a 24-hour period and feel nothing. On the other hand, some of my patients suffer disabling palpitations from very infrequent PVCs. From an electrical or physiologic standpoint, there seems to be neither rhyme nor reason to why some patients are exquisitely sensitive to premature beats.

How Do I Know If My PVCs Are Benign?

My patient, Janet, is a great example of how PVCs can present and how inappropriate or inaccurate heart tests done to evaluate PVCs can lead to anxiety and unnecessary and dangerous subsequent testing.

A year ago,  Janet began experiencing a sensation of fluttering in her chest that appeared to be random. Her general practitioner noted an irregular pulse and obtained an ECG, which showed PVCS. He ordered two cardiac tests for evaluation of the palpitations: a Holter monitor and a stress echo.

A Holter monitor consists of a device the size of a cell phone connected to two sensors or electrodes that are stuck to the skin of the chest area. The electrical activity of the heart is recorded for 24 or 48 hours, and a technician then scans the entire recording looking for arrhythmias while trying to correlate any symptoms the patient recorded with arrhythmias. The Holter allows us to quantitate the PVCs and calculate the total number of PVCs occurring either singly or strung together as couplets (two  in a row), or triplets (three in a row.)

Janet’s Holter monitor showed that over 24 hours her heart beat  around 100,000 times with around 2500 PVCs during the recording.  Unfortunately, the report did not mention symptoms, so it was not possible to tell from the Holter if the PVCs were the cause of her palpitations.

A stress echocardiogram combines ultrasound imaging of the heart before and after exercise with a standard treadmill ECG. It is a very reasonable test to order in a patient with palpitations and PVCs, as it allows us to assess for any significant problems with the heart muscle, valves or blood supply and to see if any more dangerous rhythms like ventricular tachycardia occur with exercise. If it is normal, we can state with high certainty that the PVCs are benign.

Benign, in this context, means the patient is not at increased risk of stroke, heart attack, or death due to the PVCs.

In the right hands, a stress echocardiogram is superior to a stress nuclear test for these kinds of assessments for three reasons:

-Reduced rate of false positives (test is called abnormal, but the coronary arteries have no significant blockages)

-No radiation involved (which adds to costs and cancer risk)

-The echocardiogram allows assessment of the entire anatomy of the heart, thus detecting any thickening (hypertrophy), enlargement  or weakness of the heart muscle, that would mean the PVCs are potentially dangerous.

Unfortunately, my patient’s stress echo (done at another medical center) was botched and read as showing evidence for a blockage when there was none.  An invasive and potentially life-threatening procedure, a cardiac catheterization was recommended.  Similar to the situation I’ve pointed out with the performance and interpretation of echocardiograms (see here),  there is no guarantee that your stress echo will be performed or interpreted by someone who actually knows what they are doing.  So, although the stress echo in published studies or in the hands of someone who is truly expert in interpretation, has a low yield of false positives, in clinical practice the situation is not always the same.

Given that Janet was very active without any symptoms, she balked at getting the catheterization and came to me for a second opinion. I felt the stress echo was a false positive and did not feel the catheterization was warranted. We discussed alternatives, and because Janet needed more reassurance of the normality of her heart (partially because her father had died suddenly in his sixties) and thus the benignity of her palpitations/PVCs, she underwent a coronary CT angiogram instead. This noninvasive exam (which involves IV contrast administration, and is different from a coronary calcium scan), showed that her coronary arteries were totally normal.

lad-ccta
Images from Janet’s coronary CT angiogram showing the left anterior descending (LAD) coronary artery coming off the aorta. The LAD (and her other coronaries) were totally free of any plaque build-up.)

Benign PVCs-Treatment Options

Once we have demonstrated that the heart is structurally normal, reassurance is often the only treatment that is needed.  Now that the patient understands exactly what is going on with the heart and that it is common and not dangerous, they are less likely to become anxious when the PVCs come on.

PVCS can create a vicious cycle because the anxiety they provoke can cause  an increase in neurohormonal factors (catecholamines/adrenalin) that may increase heart rate , make the heart beat stronger and increase the  frequency of the PVCs.

Some patients, find their PVCs are triggered by caffeine (tea, soda, coffee, chocolate) or stress, and reducing or eliminating those triggers helps greatly. Others, like Janet, have already eliminated caffeine, and are not under significant stress.

Since I’m already over a thousand words in this post, I’ll discuss treatment options for these patients with benign PVCs who continue to have troubling symptoms after reassurance and caffeine reduction in a subsequent post.

Prematurely Yours,

-ACP

 

Longevity: Lifespan, Healthspan and Swimming Underwater At Age 98

img_7056
Eugene and Naomi.

The skeptical cardiologist has a few nonagenarian patients who seemingly defy the ravages of aging and remain vibrant and active into their late 90’s.

Eugene, for example, still ballroom
dances regularly with his wife, Naomi and swims underwater significant distances.

In this video, recorded when he was 97, you can see him swim the length of a swimming pool underwater

As life expectancy at birth has increased  from 35 years in 1900 to over 80 years now, we see more and more individuals reaching their nineties. Ongoing research seeks to further extend our lifespan.

But just as important as increasing lifespan is increasing healthspan, the portion of the life span during which function is sufficient to maintain autonomy, control, independence, productivity and well-being.

Eugene is an example of someone with a long lifespan and healthspan and this is what we truly seek, the combination of living well and living long.

Peter Attila writes that lifespan is driven by how long one can avoid the onset of diseases caused by atherosclerosis such heart attacks and strokes (see my  discussions on subclinical atherosclerosis here), cancer and neurodegenerative disease.

Healthspan,  Attila writes, is about preserving three elements of life as long as possible:

  1. Brain—namely, how long can you preserve cognition and executive function

  2. Body—specifically, how long can you maintain muscle mass, functional strength, flexibility, and freedom from pain

  3. “Spirit”—how robust is your social support network and your sense of purpose.

Problems with the body result in frailty, recognized as a major cause of disability and related falls, hospitalizations and death in the elderly.

The single best tool for warding off frailty appears to be physical exercise.

img_7051
Eugene and Noami tripping the light fantastic in our exam room

So, if you want to life a long life with lots of quality years at the
end of that life be like Eugene: swim and dance with your loved ones. Keep moving, stretch and exercise in some manner regularly.

Gerontologically Yours,

-ACP

Say Hello To Heart Nuts

The skeptical cardiologist nut project (aka the nutty cardiologist project) now has a logo. Say hello toheartnuts  the world’s only walnut-auscultating promoter of nut consumption. Soon you will see his smiling face on the packets of nuts I’ll be handing out to help defeat cardiovascular disease.

Special thanks to my wonderful Washington University computer-science major and  bass guitar wiz daughter, Gwyneth, for creating the squirrel doctor during her winter break.

I promised 10 bags of nuts and “oodles of glory” to the reader whose name I selected but I can’t identify who proposed Heart Nuts. Let me know who you are and I’ll get the nuts to you.

Now I need a name for the squirrel.

Squirrelly Yours,

-ACP

See here for my post on KIND bars versus Simply Nuts and here for my review of nuts, drupes and legumes and reduced mortality.

N.B. Nuts are recognized as promoting reduced cholesterol, oxidative stress, and insulin resistance thereby reducing the risk of cardiovascular disease.

I’ve focused on their cardiovascular benefits (perhaps mediated by dietary fiber, magnesium, polyunsaturated fats, vitamin E, and antioxidants)  but recent studies suggest  other health benefits that could contribute to improved longevity.

Nuts contain bioactive compounds both known (ellagic acid, anacardic acid, genistein, resveratrol, and inositol phosphates) and unknown which may reduce the risk of cancer or other chronic diseases.

A recent meta-analysis found that consuming one serving of nuts per day was associated with a 15% lower  risk of any cancer and a 22% lower risk of dying from any cause.

Embrace the nuts I say!

 

Sheepshead Fish: Vulnerable and Gender Fluid Yet Mighty Tasty

The skeptical cardiologist and his Eternal Fiancee’ have escaped dreary and oceanopenic St. Louis and are spending a week in allegedly sunny and definitely beachy San Diego.

Upon arrival we took in a Farmer’s Market in Little Italy and stumbled into Ironside Fish and Oyster.screen-shot-2017-01-22-at-9-07-04-am
Always in search of heart-healthy, unique and local fish dishes, I spotted on the menu a luncheon special of sheepshead fish.

Kelly Fukushima is the local fisherman who caught my fish
Kelly Fukushima is the local fisherman who caught my fish.

California sheepshead (Semicossyphus pulcher), the existence of which I was previously unaware, turned out to be a fascinating and most delicious fish.

casheepshead

Before I could order it, I had to verify that I wasn’t contributing to the extinction of a species.  The IUCN Red List of Threatened species lists the CS as “vulnerable” because:

“The natural history of this species, including its limited geographic range along inshore habitat, the likely increasing interest in the fishery and the currently unsustainable fishing levels (according to the models of Alonzo et al. 2004), together with the difficulties in enforcing existing regulations strongly suggest that this species will continue to decline if stronger protective action is not put into place. “

After learning the CS was vulnerable, I had to make a critical decision: should I eat it before it disappeared, robbing me of a chance to ever taste it, or should I order something that wasn’t vulnerable, thus contributing to the preservation of the continuing biodiversity of the planet. I elected to taste it.

Gender Fluid Fish

Further research revealed that the CS transitions from a reproductively functional female at birth, to a functional male during the course of a lifespan in response to social factors (?reverse Bruce Jenner).

According to evolution.berkeley.edu this is termed sequential hermaphroditism:

In some sequentially hermaphroditic fish species, animals develop first as male and then switch to female (a condition called protandry), and in others, the individuals develop first as female and then switch to male (protogyny).

Clownfish (as in Finding Nemo) do the opposite of the sheepshead and are protandrous:

This species lives within sea anemones in groups of two large fish and many small fish. The two large fish are the only sexually mature fish and are a male and female breeding pair. All of the smaller fish are male. If the large breeding female is removed, her male mate changes sex to female and the next largest fish in the group rapidly increases in size and takes over the role as the sexually mature male.

While waiting for the vulnerable and sequentially hermaphroditic sheepshead to arrive, I sampled an equally

img_8160stupendous and heart-healthy side of cannelloni bean cassoulet. Chock full of Mediterranean diet essentials including kale, beans and mustard seeds, it worked really well as an appetizer.

 

Do not make the mistake of looking at this youtube video while waiting for your sheepshead entree’ as I did. The disturbing human-like teeth will not be part of your meal.

Finally, the 4 ounces of CS arrived, perfectly prepared a la plancha,

img_8162with an accompanying lemon butter sauce that was divine. Although butter is not officially a big part of the Mediterranean diet, frequent readers of the skepcard know that dairy fat does not make you fat or promote heart disease, and is fine (in moderation of course) as part of a heart-healthy diet.

Speaking of lingering bad dietary advice, if you investigate the nutritional content of sheepshead at a site like SELF Nutrition, the screen-shot-2017-01-22-at-10-18-54-amold canard that we should be limiting our dietary cholesterol raises its ugly head. Because sheepshead contain significant amounts of cholesterol (presumably from carnivorously munching on shellfish with its scary human-like choppers), the misguided nutritionists at SELF Nutrition and other would-be nutritionistas pronounce it as not optimally healthy.

Semiccossyphusilly Yours

-ACP

PS. If you’d really like to get your nerd on about sequential hermaphroditism check out this graphic showing the independent evolution of this feature across different phylogenetic lineages!

hermaphroditismtree

 

 

 

 

How To Spot a Quack Health Site: Red Flag #1, Primary Goal Is Selling Supplements

During the process of compiling the Cardiology Quackery Hall of Shame, the skeptical cardiologist has recognized that the #1 red flag of quackery is the constant promotion of useless supplements.

Such supplements typically:

-consist of “natural” ingredients

-are a proprietary blend of ingredients or a uniquely prepared single ingredient, and are only available through the quack

screen-shot-2017-01-15-at-11-11-44-am
And you thought Vital Red referred to Putin! *Individual results will vary according to the strength of the placebo effect

-have thousands of individuals who have had dramatic improvement on the supplement and enthusiastically record their testimonial to its power

-have no scientific support of efficacy or safety

-despite the lack of scientific data, the quack is able to list a series of seemingly valid supportive “studies”

-aren’t checked by the FDA

-apparently cure everything from heart disease to lassitude

I received an email today purportedly from a reader complimenting me on my post on the lack of science behind Dr. Esselstyn’s plant-based diet. The writer thought I would be interested in the work of a Dr. Gundry.

I clicked on the one of the numerous links that were provided andscreen-shot-2017-01-15-at-10-59-10-am based on the appearance of the home page of Dr. Gundry’s website, I feel confident that he is a quack.

Yes, there it is. Red Flag #1: an immediate and aggressive attempt to sell lots of useless supplements.

I didn’t spend a lot of time perusing Gundry’s website, but I read enough to enter him into my contest for America’s Greatest Quack Cardiologist.

Sadly, Dr. Gundry used to be a well-respected cardiac surgeon.screen-shot-2017-01-15-at-11-12-06-am (what is it about cardiac surgery that makes so many turn to quackery?)

Gundry’s life story is typical of the physician who has given up actually helping patients with real medicine and resorted to shilling untested snake oil to gullible people.

“I left my former position at California’s Loma Linda University Medical Center, and founded The Center for Restorative Medicine. I have spent the last 14 years studying the human microbiome – and developing the principles of Holobiotics that have since changed the lives of countless men and women.”

Need I mention that “holobiotics” is (?are) not real.

If any readers have more candidates to nominate for the soon-to-be-announced honor of America’s #1 Quack Cardiologist please forward their names to me.

Bonohibotically Yours,

-ACP

After writing this, I googled “red flag of quackery” images in the foolish hope that I might find a useable image. Lo and behold the image I featured in this post turned up courtesy of sci-ence.org. Here it is in all its glory, courtesy of Maki

2012-01-09-redflags2-682x1024

 

 

Unbiased, evidence-based discussion of the effects of diet, drugs, and procedures on heart disease

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