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HEART Insight:
doi: 10.1097/01.HEARTI.0000363805.13294.25
Departments: Asked + Answered

A Panel Of Leading Cardiologists Tackles Your Questions

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Send your questions to: (please include “Ask The Experts” in the subject line) or write to HEART INSIGHT at: 333 Seventh Avenue, 19th Floor, New York, NY 10001.

This information is provided as an educational resource, and is not meant to substitute for medical consultation or care. All questions are subject to be edited for clarity. Neither the American Heart Association nor the publisher guarantees that every question will be published and answered.

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Puzzled? Confused? Or just plain curious?

A panel of leading medical experts tackles your questions.

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Heart Rhythm

Q After my first and only electrocardiogram (ECG), I was told I have bundle branch block. How serious is this condition? Will it lead to a dangerous heart problem? Can it be treated or cured?

A Bundle branch block is a delay or obstruction of electrical signals from the upper chambers of the heart (atria) to the lower chambers (ventricles) on either the left or right side of the heart. These signals prompt the heart chambers to contract and relax, producing a heartbeat. Most people with bundle branch block don't have symptoms, and the condition does not progress. However, when there is an underlying heart condition, doctors will want to perform additional testing, such as an echocardiogram, and may put you on drug therapy. For instance, if the condition is associated with heart failure, medication to reduce high blood pressure will be prescribed. If bundle branch block develops in someone with a history of fainting, a pacemaker may be implanted to normalize heart rate.

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N. A. Mark Estes III, M.D., F.A.C.C.

Director, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston

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Q My last blood test showed that my total cholesterol is 178 mg/dL; HDL, 36 mg/dL; LDL, 102 mg/dL; and triglycerides, 198 mg/dL. Is there a link between triglycerides and diabetes, and how can both be managed?

A People with diabetes often have elevated blood levels of triglycerides due to genetic factors, obesity, being inactive and/or poor blood glucose control (meaning, hemoglobin A1c level higher than seven percent). Triglycerides can be lowered by losing weight and keeping extra pounds off, being more physically active, better blood glucose control, and medications such as statins (including, atorvastin and lovastatin), fibric acid derivatives (gemfibrozil or fenofibrate) or nicotinic acid (niacin). The National Cholesterol Education Program Adult Treatment Panel III guideline recommends people with diabetes to keep total cholesterol below 130 mg/dL (below 100 mg/dL, for those who also have coronary heart disease), and LDL level below 100 mg/dL (below 70 mg/dL, if CHD is also present). Your doctor can help you set appropriate targets to help manage blood trigyceride and cholesterol levels.

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Robert H. Eckel, M.D.

Professor of Medicine University of Colorado, Denver

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High Blood Pressure

Q Is it possible to be treated for high blood pressure (160/90 mm/Hg), and have it drop to 110/70 mm/Hg after only three months? Do I need to stay on medication?

A Yes ... and yes. High blood pressure has a family history (genetic) component and is not curable. However, with proper treatment — which includes eating a healthy diet and reducing salt intake, increasing physical activity and medication — high blood pressure is very treatable in most people. Clearly, you are responding beautifully to the medication your doctor prescribed, and should keep taking it.

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George Bakris, M.D., M.A., F.A.H.A., F.A.S.N.

Professor and Director, Hypertensive Diseases Unit University of Chicago Pritzker School of Medicine

© 2009 American Heart Association, Inc.