Ask the Cardiologist

By Michael Massoomi, MD

Dr. Massoomi, the cardiologist, is an assistant professor of medicine within the division of cardiology at UF. His clinical interests include coronary artery disease, nutrition, preventive medicine and general health and well-being.

Can you really die of a broken heart?

There is a condition called “broken heart syndrome,” also known as Takatsubo cardiomyopathy or stress-induced cardiomyopathy. The heart function is affected in a way that results in part of the heart not pumping effectively while the rest of the heart contracts forcefully, resembling the shape of a Japanese octopus trap, or Takatsubo. This condition may be caused by physical or mental/emotional stress and it can occur in patients with no heart disease. We see this more in women than in men, and it can look like a heart attack based on symptoms and even lab tests. Severe cases can result in profound heart failure, which, if left untreated, could be fatal in rare cases. This condition is usually diagnosed when a patient presents with signs and symptoms of a heart attack/heart failure and heart catheterization shows no blockage in the heart arteries. The good news is that most people make a good recovery with a low incidence of recurrence. I have seen patients present with this condition after a heated argument or after the death of a loved one. So, yes, emotional heart break can lead to a real heart break!

My sister got a cold and it caused heart damage. How is this possible?

Most common colds are caused by viruses, and it turns out that in rare instances some viruses can affect the heart, as well. We call this viral myocarditis and it can lead to heart failure in some cases. Make sure to wash your hands frequently to minimize the spread of germs!

Why does your left arm hurt when you’re having a heart attack?

The symptoms of a heart attack can be vague and are variable from person to person, especially in patients with diabetes or older age. One of the most common symptoms is chest discomfort, usually described as a tightness. Other symptoms include neck pain, left arm pain, right arm pain and shoulder pain. This phenomenon of pain that can occur at a different location than its actual source is known as referred pain. There are many theories as to why this  occurs and it is related to the complex network of nerves that feed this area of the body resulting in overlap and crossing of signals that can confuse the brain as to where exactly the pain is originating.

I have high cholesterol. What does that mean for my heart?

Elevated cholesterol is a known risk factor for cardiovascular disease, but, interestingly, over half of all first heart attacks occur in patients that have normal cholesterol levels. With the exception of cases with very high cholesterol levels, we have been moving away from simply treating cholesterol levels. Instead we focus on overall risk, which is affected by many other factors including age, gender, high blood pressure, diabetes and race, in addition to cholesterol levels. If your doctor identifies you as being at an elevated risk for cardiovascular disease, he or she may decide to treat you with a “statin” class cholesterol medication, even if your cholesterol levels are not elevated. We have learned that treating overall risk is probably better than simply focusing on a single cholesterol number. And, of course, a healthy diet and physical activity also helps to reduce cardiovascular risk.

How are diet and heart disease linked, and what should I eat to maintain a healthy heart?

Well, this is the million-dollar question! While there is no quick answer, I do think we’ve come a long way in understanding nutrition and heart disease over the past few decades. Let’s keep it simple, since complicated dietary advice usually doesn’t work! The media has a drastic impact on our diets, and unfortunately it’s not always for the better. Sugar free may mean high fat or artificial sweeteners, and fat free can mean high sugar. And if you’re trying to read nutritional labels, pay close attention to serving sizes. Don’t focus too much on certain nutrients, instead focus on healthy foods. For example, don’t avoid avocados because they are “high in fat.” Instead recognize that an avocado is a healthy food.

Sometimes it feels like my heart skips a beat, or beats harder from one beat to the next. Is this normal?

The sensation of a skipped or forceful beat is known as a palpitation. Sometimes this occurs as a result of an abnormality in the heart rhythm, and sometimes it can occur in the absence of rhythm abnormalities, related to anxiety, excitement or stress. A rare occurring skipped beat can be common in many people and usually does not indicate a serious problem. Symptoms are most concerning when they are prolonged and/or accompanied by chest discomfort, lightheadedness or passing out. The best way to tell if there is an abnormality in the heart rhythm is to have an electrical recording of the heart, known as an ECG, during an episode. We also have various monitors that can be worn at home or work on a day to day basis to capture episodes as they occur.

When it comes to simple dietary advice, I think Michael Pollan said it best in his book “Food Rules: An Eater’s Manual.”

Here are some of my favorites from his book along with some of my own advice!

1. Eat mostly plants, especially leaves, and eat your colors.

2. Limit your snacks to unprocessed plant foods.

3. Avoid foods with sugar or sweeteners as one of the first three ingredients.

4. Eat all the junk food you want as long as you cook it yourself.

5. Eat sweet foods as you find them in nature.

6. The whiter the bread, the sooner you’ll be dead.

7. Shop in the periphery of the supermarket and stay out of the middle.

8. Eat more like the French…or the Japanese, Italians or Greeks.

9. Don’t buy food where you buy gas.

10. Real food goes bad. If it can hold in the pantry for weeks, it’s probably not good for you.

11. Drink more water.

12. Eat less! Stop eating before you feel full. Use smaller plates.

Don’t think in terms of a heart healthy diet, diabetic diet or weight loss diet. Focus on being healthy and the rest will come with it! And don’t forget to exercise! And sleep!


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