Hypertension (High Blood Pressure)

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High blood pressure is a common condition that causes your blood to push against the walls of your arteries with more force than usual. When high blood pressure goes untreated or poorly treated for too long, it can cause significant damage to your circulatory system, substantially increasing your risk of stroke, coronary heart disease, kidney disease, and peripheral artery disease. At CardioHealth in Jacksonville, Florida, board-certified cardiologist Ramon Castello MD, FACC, FASE provides a complete range of effective and individualized treatment solutions for patients with high blood pressure. To learn more, call or book an appointment online today.

What is high blood pressure? 

Blood pressure refers to the amount of force your blood exerts against the walls of your arteries as it flows, both when your heart beats and when it rests.  Your blood pressure is at its highest when your heart contracts because that’s when it pumps blood through your arteries. That's known as systolic pressure. When your heart relaxes, your blood pressure goes down. That's known as diastolic pressure. 

Your blood pressure measurement uses these two numbers, with the systolic number coming before the diastolic number. High blood pressure, or hypertension, occurs when your systolic blood pressure is greater than 130 mmHg or the diastolic blood pressure is greater than 80 mmHg.

How common is high blood pressure?

About one in three adults in the United States have high blood pressure. Roughly half of all people with high blood pressure are not aware of their condition. Also, only half of those aware of their condition have it adequately managed and controlled.

Am I at risk for high blood pressure? 

High blood pressure has been called a “silent killer” because you can live with the condition for years without having any noticeable signs or symptoms. That’s why Dr. Castello and his team always check your blood pressure in every visit. For the average person with high blood pressure, there isn’t usually one specific underlying cause. In most cases, a variety of factors contribute to its development, including:

Weight

Being overweight or obese puts extra stress on your blood vessels because it requires them to handle an increased blood volume to deliver enough oxygen and nutrients to your tissues.

Age

Getting older increases your risk of developing high blood pressure. Men are more likely to be diagnosed with hypertension before the age of 55, while women are more likely to develop the condition after the age of 55.

Family history

Having close family members with high blood pressure means you’re more likely to develop the condition, as it tends to run in families. 

Other factors

Other factors that may play a role in the development of hypertension include eating a high-sodium diet, leading an inactive lifestyle, drinking too much alcohol, smoking cigarettes, living with chronic stress, and obstructive sleep apnea. 

How is high blood pressure treated?

Hypertension tends to develop as a person ages. Hypertension typically responds well to specific lifestyle changes, such as eating a heart-healthy diet that’s low in sodium, staying physically active, losing excess body weight, quitting smoking, limiting alcohol, and managing stress levels. Younger individuals may also develop hypertension, which requires specific investigations to find the cause.

If such lifestyle interventions don’t work quickly enough, Dr. Castello may prescribe medication to help lower your blood pressure more effectively. Medical treatment with Dr. Castello is very individualized; at Cardiohealth, there’s a great emphasis on finding the appropriate treatment for the individual patient.

To learn all the ways you can keep high blood pressure in check, call or book an appointment with Dr. Castello today.

Cholesterol is an essential substance that your body uses to produce healthy cells. The waxy material is also present in the fats that circulate in your blood. The two different types of cholesterol that flow freely in your blood are categorized by how they behave:High-density lipoprotein (HDL)Also known as “good” cholesterol — or H for happy — HDL cholesterol picks up excess blood cholesterol and carries it back to your liver for processing.Low-density lipoprotein (LDL)Also known as “bad” cholesterol — or L for lousy — LDL carries cholesterol throughout your body, where it builds up on the walls of your arteries and makes them narrow and hard.    

What causes high cholesterol?Having high cholesterol means that Dr. Castello has diagnosed you with higher than normal levels of total (TC) cholesterol. For most people, high cholesterol is the result of unhealthy lifestyle choices combined with genetic factors that make them likely to develop the problem.

• Smoking is one of the worst things you can do. Besides increasing your LDL cholesterol level, tobacco use also decreases your HDL. 
• Eating a diet that’s high in saturated fats or trans fats can increase your LDL cholesterol levels while leading a sedentary lifestyle can decrease your HDL cholesterol levels.

If high cholesterol runs in your family, you may carry a genetic mutation that makes it harder for your body to clear LDL cholesterol from your blood.For some people, certain medical conditions may contribute to the problem: kidney disease, diabetes, hypothyroidism, and obesity, for example, are all associated with high cholesterol. 

How is high cholesterol diagnosed? The best way to diagnose it is by having a blood test. Your cholesterol levels are assessed with a lipid panel, which is a fasting blood test that requires you to avoid all food and liquids — other than water — for at least nine hours before your blood is drawn.Healthy cholesterol levels are:·  Total cholesterol levels below 200 mg/dL·  LDL cholesterol levels below 100 mg/dL for individuals without Coronary Disease or Diabetes, for individuals with Coronary Artery Disease and/or Diabetes LDL levels below 70 ·  HDL cholesterol levels above 60 mg/dLUnhealthy cholesterol levels are:·  Total cholesterol levels above 200 mg/dL·  LDL cholesterol levels above 190 mg/dL·  HDL cholesterol levels below 40 mg/dL for men, and 50 mg/dL for women How is high cholesterol treated?High cholesterol is a highly treatable problem that usually responds well to a combination of lifestyle changes and medications, preferably statins.The most current indications and guidelines to treat cholesterol are based on the percentage risk of developing coronary heart disease in 10 years, which depends on cholesterol levels and the presence or absence of clinical risk factors. Four patient groups have been defined, each of which requires a distinct treatment method:1. Secondary prevention: This is treatment needed for patients with proven cardiovascular disease2. Primary prevention: Treatment before there is proven cardiovascular disease; statins are indicated if LDL is>1903. Primary prevention: Diabetes, aged between 40-75yrs with LDL between 70 and 1894. Primary prevention: No diabetes with a 10yr risk of cardiovascular disease >7.5% who are 40-75 yrs and LDL between 70-189 

To learn more about how you can achieve healthy cholesterol levels, call or book an appointment online today.

What is atrial fibrillation?

Atrial fibrillation — which is also called Afib or AF — is one of the most common types of cardiac arrhythmia, or abnormal heartbeat. 

It occurs when the upper chambers of your heart contract erratically and rapidly (often more than 300 beats per minute), making your pulse either irregularly fast or slow. 

This may lead to palpitations or sensations of a racing heartbeat or a kind of flip-flop feeling in your chest. Quite often there are no symptoms, which becomes problematic since the risk for stroke is the same with or without symptoms. 

Common symptoms include:

·  Shortness of breath

·  Weakness and fatigue

·  Dizziness and fainting

·  Palpitations

·  Chest pressure

Are there different types of atrial fibrillation?

Atrial fibrillation is classified based on how long it lasts. The three main types of atrial fibrillation are:

Paroxysmal atrial fibrillation

Also called occasional atrial fibrillation, this form of the condition typically causes symptoms that may last for a few minutes or a few hours, but they subside on their own. You can have just one episode in your lifetime, or you can have daily episodes. 

The abnormal rhythm comes and goes and alternates with the normal rhythm.

• Persistent atrial fibrillation

With this condition, the irregular heartbeat can last as long as several weeks. Although it may eventually subside on its own, medication or electrical shocks can re-establish a normal heart rhythm.

• Permanent atrial fibrillation

Having permanent atrial fibrillation means that you require medication to control your heart rate, but the treatment can’t help you restore a normal heart rhythm. 

Both paroxysmal and persistent atrial fibrillation can eventually become permanent.   

What are the dangers of atrial fibrillation?

Nearly 3 million people in the United States have received an atrial fibrillation diagnosis. Unfortunately, many more people are unaware that they have the condition because it requires an EKG to make the diagnosis.

The primary danger in living with untreated atrial fibrillation is that it makes you up to five times more likely to have a stroke. In fact, atrial fibrillation causes 15-20% of all strokes.

Atrial fibrillation causes strokes by forming blood clots within the cardiac chambers, particularly in a small pouch called the left atrial appendage. 

How is atrial fibrillation treated?

There are two main aspects of treatment: symptom control and stroke prevention treatment. Therefore, treatment for atrial fibrillation typically includes taking medications to help prevent blood clots, control your heart rate, and restore a normal heart rhythm.

For patients with persistent atrial fibrillation, electrical cardioversion can restore a normal heart rhythm through low-energy electrical shocks.

Radiofrequency ablation destroys the abnormal heart tissues that are disrupting the electrical signals.

Patients with permanent atrial fibrillation may require a pacemaker in addition to medical treatment.

To learn more about atrial fibrillation, call Dr. Castello’s office today or book an appointment online anytime. 

What is valve disease? 

The heart contains four valves that ensure that blood can flow in the correct direction, thus preventing backward leakage.  

When one or more of these valves don’t function properly, blood flow is disrupted, which can cause a variety of symptoms.  

Two main problems occur with valve disease: 

• Regurgitation or “leaky valve”

When valves don’t close completely, they allow blood to leak backward into your heart. This results in volume overload to the heart that causes the heart to enlarge and to weaken.

• Stenosis or “narrow valve”

Occurs when valves become narrow and hard, thus reducing blood flow through them. A narrow valve imposes an excessive pressure load to the heart, which can cause a variety of symptoms depending on which valve is affected.

What are the symptoms of valve disease?

It is possible to have valve disease for years without experiencing any noticeable symptoms. For many people, being diagnosed with a heart murmur during a routine physical is one of the first signs that they have a valve problem. As valve disease progresses, it often causes symptoms that are similar to those caused by heart failure, such as:

· Shortness of breath at rest or with exertion

· Chest pain or pressure

· Heart palpitations, or skipped heartbeats

· Unusual feelings of fatigue or weakness

· Periodic episodes of dizziness or fainting spells

· Swelling of your ankles, feet, legs, or abdomen

Valve disease increases your chances of developing blood clots and heart rhythm abnormalities without treatment. Ultimately, it can lead to heart failure, stroke, and death.

How is valve disease treated?

If you have valve disease, your treatment depends on the underlying cause of the problem, the severity of your condition, and how quickly the disease seems to be progressing.

The first step in valve disease management is to obtain an accurate diagnosis. Valvular diseases are diagnosed using echocardiography, an ultrasound study of the heart that is performed in the office by a certified cardiac sonographer.

Sometimes, when more detail is required, a patient may need a transesophageal echocardiogram. This is a semi-invasive study that needs to be performed in a hospital.

Dr. Castello is a world-renowned authority in the field of echocardiography and has experience in tens of thousands of echocardiographic studies.

To learn more about valve disease, call or book an appointment online today. 

 What is congestive heart failure?

Congestive heart failure — or heart failure — occurs when your heart can no longer pump enough blood to meet your body’s needs. 

It can occur when the pumping chambers of your heart have stiffened and can no longer fill with enough blood, causing backflow. It can also happen when your heart muscles have become too weak to pump blood through your body sufficiently. 

Heart failure can affect either or both sides of your heart. In many cases, heart failure begins with the left ventricle, which is your heart’s main pumping chamber.

Although the term “heart failure” doesn’t mean that your heart has stopped or is about to stop, it’s important to seek medical care to keep the condition from progressing or causing severe complications like heart arrhythmias, kidney failure, or liver damage.

What are the symptoms of heart failure?

Heart failure symptoms can vary, depending on which side of your heart is affected. For example, when heart failure affects your left ventricle, you’re likely to experience shortness of breath as fluid backs up into your lungs. 

When heart failure affects your right ventricle, fluid may back up into your abdomen, legs, and feet, causing noticeable swelling. This is called edema. Most patients have a combination of these symptoms.

The most common warning signs of heart failure are:

· Shortness of breath at rest or with exertion

· Edema in the feet, ankles, legs, abdomen, or neck veins

· Chronic coughing or wheezing

· Fatigue, weakness, or lightheadedness

People with heart failure often experience shortness of breath either when they’re exerting themselves, or when they’re lying down. People who are affected by edema may also experience very rapid weight gain as their body retains more and more fluid. 

What are the underlying causes heart failure?

Congestive heart failure develops after another health condition either damages or overworks your heart muscle, weakening it or making it too stiff. Some of the most common causes of heart failure are:

· Coronary heart disease

· Diabetes

· High blood pressure

· Defective heart valves

· Cardiomyopathy (heart muscle damage)

· Myocarditis (inflammation of the heart)

· Heart arrhythmias

Heart failure is more common in older adults who are past the age of 65, both because the heart muscle weakens with age and because older people are more likely to have lived with the kinds of diseases that facilitate heart failure for many years.

People who have had a heart attack are more likely to develop heart failure due to muscle weakening. Hypertension is also one of the common causes of congestive heart failure: It makes the heart muscle stiff, which results in fluid retention.

How is heart failure treated?

When it comes to treating heart failure, early detection is vital. The sooner the problem is diagnosed, the sooner you can take action to address any contributing factors while protecting and supporting the long-term health of your heart.

The overriding goal for all heart failure patients at CardioHealth, no matter how advanced the condition, is to treat or manage the underlying cause. That helps reduce symptoms and prevent the condition from worsening. 

The key to appropriately treating congestive heart failure is performing an echocardiogram. The test measures your heart's pumping capabilities and helps Dr. Castello determine which treatment you need. 

Patients with heart failure either have stiff hearts or weak hearts. Depending on which type of heart failure you have, the medicines will help strengthen the heart to decrease the fluid overload.

If you have severe heart failure, multiple options are available, including medicines and cardiac devices. Dr. Castello can tell you which treatment is right for you and answer all of your questions.    

To learn more, call the office or schedule an appointment online today. 

What is angina?

Angina — also known as angina pectoris — is a symptom of an underlying cardiovascular condition that reduces the flow of oxygen-rich blood to your heart. It causes a feeling of intense pressure, squeezing, burning, tightness, discomfort, or pain in your chest, usually right behind your breastbone. 

For some people, angina causes pain that radiates through the arms, shoulders, back, neck, or jaw. Some patients experience no pain, but other symptoms, known as “angina equivalents” can occur, such as:

· Nausea or indigestion

· Weakness and fatigue

· Shortness of breath

· Dizziness or fainting

Although coronary microvascular disease, stenotic aortic valve, or a spasm of the coronary artery can cause angina, it’s most often the effect of atherosclerosis or coronary heart disease (CHD). 

CHD occurs when a waxy substance called “plaque” builds up inside the walls of your coronary arteries, causing them to narrow, stiffen, and reduce the amount of oxygen-rich blood that reaches your heart.  

Are there different types of angina?

Angina takes different forms, each with distinct hallmarks:

• Stable angina

Stable angina, the most common, predictable form of the condition, happens when angina is triggered by exercise. It usually lasts a few seconds to a few minutes, and typically disappears with rest or nitroglycerin.

• Unstable angina

This medical emergency — which may be a sign of an impending heart attack — can occur even at rest. Besides being unpredictable, unstable angina tends to be more severe and longer-lasting.

Unstable angina doesn’t usually respond to rest or medication and should be treated in a hospital. Recognizing the features of this severe condition can be life-saving. 

Am I at risk for angina?

Because CHD causes the vast majority of angina cases, anything that increases your risk of developing CHD also increases your risk of developing angina. Major risk factors include:

· Tobacco use

· High blood pressure

· Unhealthy cholesterol levels

· Family history of premature heart attacks

· Diabetes mellitus

You also have a higher chance of developing angina if you are a man older than 45, or a woman older than 55.

How is angina treated?

The primary goal of angina treatment is to decrease the incidence and severity of symptomatic episodes, while simultaneously reducing your chances of having a heart attack.

This may mean taking medications like aspirin (which promotes easier blood flow through narrowed vessels), beta-blockers (which reduce blood pressure and heart rate), and statins (which lower cholesterol levels and are potent vascular anti-inflammatories).

When an angina episode occurs, taking sublingual (under the tongue) nitroglycerin can be life-saving.

Making healthy lifestyle changes can also be very beneficial. As with all conditions that affect the heart, this includes quitting smoking, losing weight, safely increasing your activity levels, and switching to a heart-healthy diet.

For patients who can’t control angina with medications, Dr. Castello may recommend coronary interventions, which include angioplasty, stenting, and coronary artery bypass grafting. 

To learn more, call or book an appointment online today. 

What is syncope?

Commonly referred to as fainting or passing out, syncope is the temporary loss of consciousness brought on by insufficient blood flow to the brain.

When you’re about to faint, you may feel dizzy, lightheaded, or nauseous. Your skin may also feel cold and clammy. Just before you lose all muscle control and pass out, your field of vision may go completely white or black.

After fainting, you may be unconscious for a minute or two before you wake back up. It’s important to rest for 15-30 minutes after fainting, as standing up too soon can lead to another fainting spell. 

What is vasovagal syncope?

Vasovagal syncope (VVS), also known as neurocardiogenic syncope or reflex syncope, is the most common type of fainting. 

VVS occurs when the area of your autonomic nervous system that controls blood pressure and heart rate stops working as it should, usually in response to an outside trigger. Common triggers include:

· Heat exposure

· Dehydration

· Standing for too long

· Emotional stress

· Seeing blood or having blood drawn

· Drop in blood sugar

VVS is usually a benign condition that you can avoid once you know your triggers. Because you can’t always avoid your known triggers, however, it’s important to lie or sit down if you feel a fainting episode coming on.

What is cardiac syncope? 

When fainting spells happen regularly, or when they can’t be definitively linked to a trigger like dehydration, overheating, or a sudden positional change, they may be a symptom of a serious heart or vascular condition.

Unlike VVS, cardiac syncope usually occurs suddenly. It can also occur without the dizziness, nausea, clammy skin, and other pre-syncope symptoms that usually happen with VVS.

Common causes of cardiac syncope include:

• Heart arrhythmias

Heart arrhythmias, or abnormal heart rhythms, can make it harder for your heart to pump oxygen-rich blood to your brain efficiently.

Several types of cardiac arrhythmias can cause syncope, including bradyarrhythmias, which occur when your heart beats too slowly, and tachyarrhythmias, which occur when your heart beats too quickly.

• Aortic valve stenosis

Your aorta is the large artery that carries oxygen-rich blood from your heart to the rest of your body. When the valve between your heart and your aorta (aortic valve) becomes severely narrow, it can reduce the amount of oxygen that reaches your brain.  

Why is it important to diagnose unexplained syncope?

Losing consciousness is always a scary experience. It can compromise your life or that of others, depending on what you are doing (climbing a ladder, driving). Therefore, it’s vital for anyone who has experienced syncope to undergo a comprehensive cardiovascular evaluation.

Besides considering your medical history and assessing your blood pressure, heart rate, and overall condition, Dr. Castello may have you undergo an electrocardiogram (ECG), an echocardiogram, or a stress echocardiogram to get more information about your heart. 

A test called ANSAR is specifically designed to evaluate the autonomic nervous system. Many patients are referred to CardioHealth to undergo this test. Dr. Castello and his team have experience with thousands of ANSAR tests and results.

Treating the underlying cause of cardiac syncope is the best way to stop the problem. To learn more, call or book an appointment online today.

How does a stroke happen?

Although all strokes interrupt the blood supply to part of your brain, not all strokes occur in the same way. The three primary strokes are:

• Ischemic stroke

Four in five stroke patients have an ischemic stroke or one that occurs when a blood clot blocks an artery.

• A thrombotic ischemic stroke 

happens when a blood clot forms within one of the arteries that supply your brain with oxygen-rich blood, while an embolic ischemic stroke occurs when a blood clot that formed elsewhere moves through your bloodstream and gets lodged in a brain artery.

• Hemorrhagic stroke

This type of stroke occurs when a blood vessel in your brain leaks or bursts. Hemorrhagic strokes have few possible causes but are primarily due to either poorly controlled high blood pressure or weak blood vessel walls (aneurysms).

• Transient ischemic attack (TIA)

Besides ischemic strokes and hemorrhagic strokes, you might also suffer a transient ischemic attack (TIA). A TIA occurs when a clot temporarily decreases the flow of blood to part of your brain. Although TIA symptoms are similar to those of a full-blown stroke, they usually subside within a short amount of time (less than 24 hours). 

Having a TIA increases your risk of having a stroke later. In fact, one in three patients suffers a full stroke within a month after having a TIA. 

What are some common stroke symptoms?

If you notice any of the following signs of a stroke, either in yourself or someone else, seeking immediate emergency treatment is critical. Prompt care can not only be life-saving, but it can minimize brain tissue damage and potential post-stroke complications.

Common stroke symptoms include:

· Confusion, trouble speaking, or difficulty understanding speech

· Numbness/paralysis of an arm or a leg

· Facial drooping or numbness

· A sudden, severe headache that may be accompanied by dizziness

· Blurred or blackened vision in one or both eyes; double vision

Am I at risk of having a stroke?

Several factors can increase your risk of having a stroke, but poor blood pressure control is the most critical one: It’s responsible for more than 70% of strokes.

Unhealthy cholesterol levels also increase your stroke risk, as does having diabetes, obstructive sleep apnea, and cardiovascular disease. 

One of the most common underlying causes of a stroke is carotid artery disease. It occurs when the carotid arteries that supply your head and brain with blood get narrowed due to fatty plaque.

Plaque buildup in your carotid arteries may reduce blood flow to your brain, or it may cause small clots to form, break off, and travel to your brain, resulting in a minor or major stroke. 

Carotid artery disease is responsible for approximately one-third of all strokes that occur in the United States each year. 

What are some stroke prevention strategies?

Knowing your risk factors enables you to take appropriate steps to decrease your chances of having a stroke. In many cases, this means making healthy lifestyle changes and adopting many of the same strategies that are used to prevent or control heart disease. 

This may mean getting your blood pressure and cholesterol levels under control, maintaining a healthy body weight, or maintaining healthy blood sugar levels if you have diabetes. 

If you’ve had a stroke or TIA, Dr. Castello will look for potential causes of stroke, such as carotid stenosis or cardiac sources of traveling clots. The latter may include monitoring for atrial fibrillation or performing a special ultrasound test (TEE) that's done in a hospital.

Dr. Castello also provides interventional treatment solutions to prevent recurrent strokes. These treatments are performed in a hospital in collaboration with interventional cardiologists. Examples include carotid stents or closing small holes in the heart (PFO).

To find out more about stroke treatment or prevention, call the office or schedule an appointment online today.

Shortness of breath, also known as dyspnea, is a common symptom for a wide range of potentially severe health conditions, ranging from asthma to emphysema, obesity, and heart dysfunction.

Shortness of Breath Q & A

CardioHealth

What causes shortness of breath?

Although there’s no standard definition for dyspnea, most people who complain of shortness of breath either have difficulty breathing, find breathing uncomfortable, or feel as though they aren’t getting enough air.

Some people feel short of breath only when they exercise, while others feel it mostly when they’re resting or lying down.  

Shortness of breath has many potential causes. Breathing difficulties may be a result of a problem in your lungs or airways, such as chronic obstructive pulmonary disease (COPD) or pulmonary edema, which occurs when there’s excess fluid in your lungs.

Some of the conditions that can cause shortness of breath include:

· Anemia

· Asthma

· Low blood pressure

· Deconditioning

· Pneumonia

· Tuberculosis

· Hiatal hernia

Can heart problems cause shortness of breath?

Shortness of breath is a common warning sign for many different cardiovascular problems, including:

· Coronary heart disease (CHD)

· Cardiomyopathy

· Pericarditis, or inflammation around the heart

· Heart arrhythmias, such as atrial fibrillation

· Heart attack

· Congestive heart failure

Most of these conditions make it harder for your heart muscle to pump enough oxygen-rich blood to the rest of your body. When your brain, organs, and muscles don’t get enough oxygen, you may experience an ongoing sense of breathlessness.

How is shortness of breath diagnosed?

To discover the underlying cause of an ongoing breathing difficulty, Dr. Castello performs a comprehensive physical exam, which includes asking detailed questions about your symptoms and medical history.

Besides telling Dr. Castello how long you’ve had shortness of breath, you should tell him if you make any wheezing or grunting sounds when you’re short of breath and if there’s anything that makes your breathing worse.

Dr. Castello may measure your breathing and your blood oxygen levels, and he may order an electrocardiogram (ECG) or an echocardiogram to evaluate your heart. Cardiopulmonary exercise testing may also be helpful, in some cases.

When is shortness of breath a medical emergency?

If you experience sudden or severe shortness of breath that interferes with your ability to function, call 911 or have someone take you to the emergency room.

It’s especially important to seek immediate care if your shortness of breath is accompanied by chest pain, fainting, or nausea, as these may be signs that you’re having a heart attack or a pulmonary embolism.

If your shortness of breath is less severe but still concerning, make an appointment to see Dr. Castello as soon as possible.