December 04, 2023

To Your Good Health: Heart attacks occur after treatment of infections

My mom had a throat and palate infection that was treated in 2017, and about two weeks later, she had a heart attack. In 2023, she had pneumonia, and was briefly hospitalized and treated, but again about two weeks later, she had another heart attack. We asked her cardiologist if there is a relationship between either the infections themselves or the treatment of infections and heart attacks, but he was not aware of any. This seems too unlikely to be a coincidence. What is your experience on this?

A heart attack happens when the demand for blood from the heart is greater than the ability of the blood vessels can provide. In practice, this almost always means that there are blockages in the blood vessels.

However, an increase in the workload of the heart, such as strenuous exercise or an infection — fever tends to increase heart rate, and the blood flow from the heart usually increases with serious infection — can be what leads a person to have a heart attack.

It’s possible that this is what happened with your mom. The timing of two weeks after the event is longer than expected, but it’s possible.

Whether from chronic infection or inflammatory conditions like rheumatoid arthritis, inflammation in the blood increases the risk of heart disease in the long term, so if there is a connection, and it’s not just coincidental, that would be the most likely cause.

You wrote about the dangers of testosterone replacement in men over 70 in your column a few months ago. Could you please describe the dangers of this again? My husband is 73 and injects testosterone every 10 days or so. He’s not feeling too well overall, but he doesn’t know why. He’s been to the cardiologist, but the studies came back fine. He says he feels nerves in his stomach and a bit of shortness of breath. He’s also tired and without much energy.

There are clear dangers with excess testosterone use, especially in older men. Some men use very high doses of testosterone or other androgens for muscle building, and this can cause heart damage, blood clots and stroke. I strongly do not recommend doing this, but it is generally used illicitly.

By contrast, for men in whom testosterone therapy is given appropriately, the dangers are quite small, and in most men, the benefits outweigh the risks.

Men should have a clear reason to receive testosterone therapy, such as having low bone density, low libido, loss of body hair, or development of breast tissue, in addition to repeatedly low testosterone levels — including a level taken between 8 a.m. and 10 a.m. when testosterone levels are highest.

In these men, the goal is to stabilize the testosterone level, and the risks of the catastrophic outcomes listed above appear to be very small, or even zero. Testosterone levels should also be measured during therapy.

I can’t speculate on the cause behind your husband’s symptoms. Nonspecific symptoms, such as low energy, can be caused by low testosterone, but unless there are more specific symptoms of low testosterone, I generally do not recommend testosterone replacement.

Keith Roach

Dr. Keith Roach

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to © 2023 North America Synd., Inc.