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Advancing Care - 2024 Issue 2



I'm so dizzy! Should I call my doctor?

You roll over in bed – and the room starts to spin. Or you stand up from the couch – and you suddenly feel woozy and disoriented. What’s going on? Why are you so dizzy?

“Dizziness” is one of the most frequently cited complaints when people seek medical help. According to estimates from the National Institutes of Health, dizziness, vertigo and balance problems affect between 15 - 20 percent of U.S. adults each year, with higher rates seen in people 65 and older. It affects females up to three times more than males.* 

Diagnosing dizziness can be frustrating because dizziness isn’t a disease or a condition– it’s a symptom. Many factors can disrupt your balance. Being hungry or dehydrated can make you feel lightheaded. Some medications can make you feel dizzy. Health problems such as infection, stroke or tumor can affect your inner ear or brain, throwing off your balance.

Read more about dizziness

Positional vertigo: What it is and what to do about it

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo – the sensation that the room is spinning or swaying around you. It’s triggered when tiny calcium carbonate crystals inside your inner ear become dislodged and fall into one of the balance canals – an area where they don’t belong. This leads to an intense sensation of vertigo when you move your head, especially when you look up at a high cabinet, roll over in bed or sit up. It may also cause nausea and a feeling of being unbalanced. BPPV can affect people of all ages but is most common in people over the age of 60.

Read more about BPPV

When it comes to coronary artery disease, think “prevention”

Coronary artery disease (CAD) is the most common type of heart disease, according to the Centers for Disease Control and Prevention. The good news is many CAD risk factors can be controlled through lifestyle changes and medications.

In coronary artery disease, also known as ischemic heart disease, at least one of the three coronary arteries that supply blood to the heart has plaque, a buildup of calcium and cholesterol. Plaque can create a blockage in blood flow and lead to angina, heart attack or cardiac arrest.

“Both men and women are at risk of coronary disease, but men often present earlier in life when compared with women,” said Jennifer Frampton, DO, an interventional cardiologist with Yale New Haven Health’s Heart and Vascular Center and assistant professor of Medicine at Yale School of Medicine (YSM).

CAD risk factors include smoking, diabetes, high cholesterol, high blood pressure and obesity. Women who’ve had pre-eclampsia, gestational hypertension or gestational diabetes may also be at risk, said Dr. Frampton. 

Diagnosing coronary artery disease

Test help diagnose CAD, but symptoms can also be telling.

Common symptoms include chest pain, pressure or discomfort or shortness of breath with exertion that subsides at rest. If these symptoms occur during a heart attack, they are often much more severe and can occur even when you are sitting down, said Dr. Frampton. Women and people with diabetes may experience atypical symptoms of nausea, vomiting, dizziness or fainting.

Tests to assess CAD risk include:

  • lipid profile blood panel to measure cholesterol levels - stress test ;
  • coronary calcium CT scan to check for calcium deposits in the heart’s arteries
  • angiography, a medical imaging technique, to capture photos and video of the heart’s anatomy

If necessary, an angioplasty is performed. This procedure uses a balloon that is temporarily inserted within the artery and inflated to break up blockage and expand the blood vessel. The balloon is then removed after which at least one stent (a metal, mesh-like tube) may be placed within the vessel wall to keep the artery open for normal blood flow.

Prevention and choices are key

Personal choices like what you eat and your activities can impact your risk for CAD.

“Aggressive risk factor modification and maintaining a healthy lifestyle are the best things to do to prevent development of coronary artery disease or to slow progression once diagnosed,” Dr. Frampton added.

This includes not smoking, keeping a healthy weight, exercising regularly, eating healthy foods and controlling your blood sugars if you have diabetes. Learning to manage emotional stress is another important component.

Dr. Frampton favors the Mediterranean diet. “This diet focuses on eating lots of fruits, vegetables, whole grains, beans, and olive oil. It recommends eating more seafood, particularly fish, as well as replacing saturated fats with unsaturated fats. Saturated fats consist of butter, fatty meat, and cheese, for example. I also recommend avoiding excess trans fats which are found in fried foods as well as desserts like cakes and cookies,” she said.

Treatment for CAD

Medications for CAD include statins to lower LDL cholesterol, reduce inflammation and stabilize plaque; aspirin to reduce clotting; and beta blockers to lower blood pressure and treat angina symptoms.

In addition to an angioplasty, other patients may benefit from open heart surgery with a coronary artery bypass grafting procedure offered at Bridgeport and Yale New Haven hospitals. Other surgeries include arterial bypass grafting and minimally invasive direct coronary artery bypass.

“The best thing that a patient can do is have a conversation with their primary care provider or cardiologist about their risk factors and how to modify them to prevent the development of coronary artery disease,” Dr. Frampton said.

Learn more about how Yale New Haven Health takes care of your heart.

Better Beats: Learn how to monitor your blood pressure at home

Keeping your blood pressure within a healthy range is important in managing certain health conditions such as diabetes and heart disease. According to the American Heart Association, you can take an active role by monitoring your blood pressure at home and sharing the information with your doctor.

To help you get started, consider Better Beats, a self-monitoring blood pressure (SMBP) program that shows you how to measure blood pressure at home and keep a diary of readings. The program, from YNHH Health Promotions, is offered as a short-term two-week program or a longer 90-day program. A registered nurse coaches participants on heart-healthy lifestyle changes, including diet and exercise, and helps them set individualized goals.

Benefits of Better Beats:

  • Participants in the two-week program meet twice weekly with the registered nurse for coaching and to gain a better understanding of how lifestyle choices impact blood pressure. This program is ideal for those:
    • who have just been discharged from a hospital or telemonitoring program and want to make sure their blood pressure remains in check, or 
    • who know they are at risk for high blood pressure, hypertension or heart disease and want to gain a better understanding of their heart health and their blood pressure numbers
  • Participants in the 90-day program have regular coaching sessions with the registered nurse and are expected to meet blood pressure reduction goals set based on individual needs by the end of the program. People are expected to work closely with their primary care physician to review blood pressure results as well as medications. The 90-day program is ideal for those with diagnosed high blood pressure or uncontrolled high blood pressure, high cholesterol, hypertension or other heart-related conditions, as well as those who have completed the two-week program and feel they can benefit from additional nurse coaching. The coach conducts a monthly check-in to review current blood pressure trends and provide continued coaching for the three months with a final check-in call six months later.

To learn more about the Better Beats program, call 203-688-9010.

Find a provider at YNHH

Are you looking for a physician? Call 888-700-6543 or visit our Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience.

Billing questions? 

Yale New Haven Health offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.