Flu shots: Important if you have heart disease

Larry Baddour, M.D.

---

If you have heart disease, you should get an annual flu shot. That's the message put out by the American Heart Association and the American College of Cardiology.

Studies have shown that death from the flu (influenza) is more common among people with cardiovascular disease than among people with any other chronic condition. Doctors have long recommended that older adults and other high-risk groups get flu shots, but have recently placed more emphasis on the importance of flu shots for those with heart disease. The flu shot could prevent thousands of flu-related complications and deaths every year in people who have heart disease.

Larry M. Baddour, M.D., an infectious diseases specialist at Mayo Clinic, Rochester, Minn., and professor of medicine at Mayo Clinic College of Medicine, was on a joint American Heart Association and American College of Cardiology advisory panel that developed the flu shot recommendation for those with heart disease. He shares his insight about the group's recommendation.

Is it safe to get a flu shot if I have heart disease?

Flu shots are safe for most people who have heart disease. Get your flu vaccine injected by needle, usually in the arm. Some people develop mild arm soreness at the injection site. The flu vaccine that is given by nasal spray isn't recommended for people with heart disease because it's made with live virus that can trigger flu symptoms in people with heart disease.

Do I have to get a flu shot from my cardiologist?

You don't have to get your flu shot from your cardiologist. However, the American Heart Association recommends that cardiologists have the flu shot available at their clinics. The flu shot is also available through primary care doctors, some specialists and cardiology clinics, public health departments and some pharmacies. It's best to call ahead to determine if vaccine is available and when. Some places may require an appointment.

Signs and symptoms

A migraine aura usually occurs about 20 minutes before head pain begins and generally lasts from 10 to 25 minutes before disappearing. Rarely, aura may occur with no headache. This is referred to as a migraine equivalent.

Visual disturbances are the most common feature of migraine aura. Signs and symptoms may include:

• Shimmering spots or stars
• Zigzag lines that gradually float across your field of vision
• Loss of vision in one eye
• Blurred vision
• Blind spots (scotomas)
• Objects in your surroundings that appear as if they are shimmering in heat
• Flashes of light

Other types of sensations may accompany the visual disturbances, including:

• Feelings of numbness
• Tingling in parts of your body
• Dizziness (vertigo)
• Difficulty with speech

Risk factors

The following factors may increase your risk of migraine with or without aura:

• Family history. Many people with migraines have a parent with migraine.
• Sex. Women are three times as likely to have migraines as men are.
• Hormonal changes in women. Migraine may worsen or change during menstruation, pregnancy or menopause. Migraine may also worsen if you take birth control pills or hormone replacement therapy.

When to seek medical advice

If you experience the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision, see your doctor immediately to rule out more serious conditions, such as stroke or retinal tear. Once these conditions have been ruled out, future migraines with aura can be considered not to be a sign of a more serious condition and won't require a visit to your doctor.

Complications

People who have migraine with aura are at a slightly higher risk of stroke. Women with migraines have an even higher risk of stroke if they smoke, take birth control pills or have high blood pressure.

Although the link between stroke and migraine isn't clearly understood, it could be connected to changes in the blood vessels or blood flow in your brain.

Self-care

Exercising regularly, controlling stress and avoiding or managing migraine triggers can help limit or prevent migraine with aura. Common migraine triggers include:

• Stress or anxiety
• Certain foods, such as aged cheese, red wine, caffeine, chocolate and others
• Fatigue
• Certain medications, such as birth control pills or hormone replacement therapy
• A sensory stimulus, such as bright lights or strong odors

To help uncover your migraine with aura triggers, keep a log of your migraines — including when, where and to what extent they occurred — along with your activities and the foods your ate or medications you took that day.