Frequently
Asked Questions
What
is high blood pressure and how is it treated?
High
blood pressure, or hypertension, results from constriction or tightening
of arteries that regulate blood flow through the body. As the arteries
constrict, the heart has to work harder to pump the blood through
the vessels, and the pressure inside the vessels grows. High
blood pressure is considered the silent killer because there are
often no symptoms.
High blood pressure tends to run in families. Men are at
higher risk than women, and blacks are at greater risk than whites.
High blood pressure has no symptoms. Most physicians don't make
a final diagnosis until they measure a patient's blood pressure
on several occasions.
In many cases high blood pressure can be controlled by maintaining
a low-salt diet, losing weight, stopping smoking, and regularly
exercising. In other cases, physicians may use various medications
called antihypertensives.
What
is cholesterol and why is it so important?
Cholesterol
is a soft fat like substance that occurs naturally in the body,
in animal fats, and in dairy products. It is manufactured by the
liver and transported in the blood. Limited quantities are essential
for the normal development of cell membranes.
A safe or acceptable cholesterol level involves a delicate balance
of various lipids, which can vary substantially from one person
to another. Total cholesterol provides a starting point for assessing
a person's heart disease risk. Two types of lipids and their relationship
to each other are important to physicians.
Low-Density Lipoprotein (LDL) has earned the reputation as the
"bad" cholesterol because it appears to promote lipid storage
in blood tissue causing fatty deposits to form. These fatty deposits,
called plaque, clog the blood vessels, dramatically increasing
the chance of a heart attack or stroke.
High-Density Lipoprotein (HDL) is the so-called "good" cholesterol.
It carries lipids away from blood tissue and helps the body excrete
the oily substances. High levels of HDL correlate with low levels
of coronary heart disease.
What
are triglycerides?
Triglycerides,
a type of lipid, are produced in the liver and taken in through
the consumption of fats. Alcohol stimulates the liver's production
of triglycerides, and most of the grams of fats eaten every day---including
saturated, polyunsaturated and monounsaturated fats---are triglycerides.
Triglycerides serve as a source of energy for the body, but very
high levels can lead to serious disorders including diabetes and
chronic kidney disease. As triglyceride levels rise, HDL levels
fall, which may help explain the increased risk of heart disease
seen in people with elevated triglyceride levels. Studies of persons
who have survived heart attacks reveal that they have high triglycerides
levels.
What
is atherosclerosis?
The
most common form of heart disease, atherosclerosis occurs when fatty
deposits, called plaque, form inside the arteries that supply the
heart. If enough plaque accumulates, blood flow through an artery
becomes restricted, and the risk of a heart attack grows. This arterial
narrowing is know as coronary artery disease or coronary heart disease.
Atherosclerosis may continue for years without causing symptoms.
What
is atrial fibrillation?
Atrial
fibrillation or is a form of tachycardia (rapid heartbeat) that
may result from disease processes such as rheumatic heart disease
or hyperthyroidism. But atrial arrhythmias occur in response
to a variety of certain stimulants, such as caffeine, tobacco, alcohol,
and several kinds of medication, especially decongestants.
Frequent or sustained atrial arrhythmias can be uncomfortable
and difficult to tolerate, especially among the elderly. This
condition usually responds well to drug treatment or to the use
of an implanted pacing device. As many as 9% of Americans
over the age of 65 have atrial fibrillation.
What
is mitral valve prolapse?
The
mitral valve, located between the heart's left upper and lower chambers,
consists of two flaps or leaflets which normally open and shut to
allow blood to flow in only one direction---from the heart's upper
chamber to the lower chamber. In patients with mitral valve prolapse
(MVP), one or both of the flaps are enlarged. Instead of closing
evenly, the flaps collapse or bulge into the upper chamber, sometimes
allowing small amounts of blood to flow backwards into the upper
chamber.
Mitral valve prolapse (MVP) often occurs in people who have no
other heart problems, and the condition may be inherited. Most
of the time, MVP is not a serious condition, even though some
patients report palpitations or sharp chest pains. Patients usually
require no treatment, except for antibiotics to prevent infections
that can occur after surgery or dental procedures. Although affecting
5% to 7% of the population, the cause for MVP is unknown. MVP
occurs more often in women than in men.
What
is congestive heart failure?
Heart
failure simply means the heart is not pumping blood as effectively
as it should.
Congestive heart failure occurs when weak heart function is accompanied
by a build-up of fluids in the body. This happens because blood
flow slows, thus decreasing the amount of blood pumped from the
heart. Blood returning to the heart backs up in the veins and
forces fluid into surrounding tissues, most often the feet and
legs. The feet, legs, and ankles begin to swell under the increased
fluid volume. Sometimes the fluid spreads to other parts of the
body including vital organs. If the fluid accumulation affects
the lungs, it can be a life-threatening situation.
Therapy for congestive heart failure usually begins with rest
and a salt-restricted diet. Diuretics are often prescribed as
are other agents that help strengthen the heart's pumping action
and widen or dilate blood vessels. Some physicians prescribe high
blood pressure medications called angiotensin-converting enzyme
inhibitors and recommend modest exercise regimens.
What
does the term "enlarged heart" mean?
An
enlarged heart means the heart is larger than normal due to heredity,
long-term heavy exercise, or diseases and disorders such as obesity,
high blood pressure, and excessive long term use of alcohol.
What
is cardiac catheterization?
Cardiac
catheterization is a procedure that involves the insertion of a
catheter (a long, flexible, thin tube) into the body. The
catheter is inserted in a vein or artery directed towards the heart.
This procedure allows doctors to check the heart valves and
the coronary arteries (the vessels supplying oxygen rich blood to
the heart muscle).
Purpose
With this
test the cardiologist can:
- Locate
coronary artery disease-determine if there is a blockage in
your coronary arteries that supply your heart with blood and
oxygen.
- Decide
how severe the blockage is.
- Decide
if the heart has been damaged.
- Select
the best form of treatment.
No other
test provides such a detailed and clear view of the function of
your heart and the possible trouble areas that may need repair.
Preparation
You will
be asked not to eat or drink anything after midnight on the day
of your catheterization.
An intravenous
solution will be started in your arm which will be used to administer
medicine. Before the test, you will be given a sedative
which will make you feel relaxed and drowsy. Throughout
the test you will remain awake.
The
procedure
The cardiac
catheterization is done in a "cath lab". You will be on
an x-ray table and an electrocardiogram will continuously monitor
your heart throughout the procedure.
A technician
will cleanse and shave the groin area where the catheter will
be inserted, and a sterile sheet will then cover you. A
local anesthetic will be injected to numb the area so you will
not feel any sharp pain.
Next, a special
needle in a sheath is used to puncture the femoral artery that
flows into the aorta. The aorta is the main artery of your
body. A guidewire is then inserted through the sheath and
the needle is removed. The catheter is then inserted and
gently guided toward the level of the heart.
The catheter
will reach the beginning of the coronary arteries where a dye
is then injected into the vessel. The dye will help detect
areas of narrowing or blockages and assess the severity of the
problem. An x-ray camera takes pictures of the arteries
where there is a blockage.
What
you can expect?
You will
be awake during the procedure and will be able to watch some of
the pictures on the television screen. You may be asked
to hold your breath during each picture to make it easier to read
or they may ask you to cough to aid in moving the dye throughout
the heart.
This is usually
not painful, although you may feel slight pain when the catheter
is inserted into the groin. There may also be some discomfort
from lying in the same position for an extended period of time.
You may also
feel discomfort during the injection of dye into the coronary
arteries. This will usually go away within a few minutes
and is not a cause for concern.
Aftercare
When the
procedure is complete, the catheter will be removed and hand pressure
will be applied for about 10-20 minutes. This is done to
prevent bleeding.
You will
be transported to the recovery room or back to your room where
you will need to:
- stay in
bed for 4-8 hours
- keep your
leg straight to prevent bleeding from the artery
- tell your
nurse if you feel sudden pain, numbness or a warm sensation
at the site of insertion
You will
be asked to drink a lot of fluids to flush your system of the
dye.
Some patients
will go home the same day as the procedure, while many stay overnight
in the hospital.
The doctor
will discuss the results of your catheterizaiton after the film
has been reviewed.
What
is a Myoview stress test?
A
non-invasive test performed by a physician in order to determine
if their patient may have the early signs of heart disease. Throught
the use of a radio tracer (Myoview) a patient can be imaged after
exercise and again at rest in order to determine if the heart is
receiving an adequate supply of blood flow through the coronary
arteries. The redio tracer (Myoview) has no side effects since it
mimics the potassium used by the heart. Myoview stress testing is
also used as a follow-up to post therapy and to re-evaluate a patient
should symptoms reoccur years later..
What
is an EPS?
The
electrophysiological study, called EPS, makes use of cardiac catheterization
techniques to study patients who have arrhythmias. Electrical current
stimulates the heart in an effort to cause an arrhythmia, which
will be immediately treated with medication. EPS is used primarily
to identify the origin of arrhythmias and to test the effectiveness
of drugs used to treat abnormal heartbeats.
What
is a "clot buster drug?"
Clot busters are thrombolytic agents used to dissolve a thrombus
(clot). These drugs can dissolve a clot within minutes after an
injection or after starting an infusion in a vein. The most commonly
known clot busters are streptokinase and TPA (tissue plasminogen
activator).
Clot busters work best when given soon after chest pain begins.
Some studies have indicated the drugs may offer little benefit
when given more than a few hours after the first symptoms of a
heart attack. For this reason, people experiencing signs
of a heart attack should to immediately to their emergency room.
What
is carotid artery disease?
Carotid
artery disease is a relatively common condition involving the major
arteries of the neck that supply blood to the brain. When these
arteries---the carotid arteries---become clogged or blocked, a stroke
may occur.
Carotid artery disease is usually caused by atherosclerosis, hardening
and narrowing of the arteries. As we age, fat deposits, cholesterol,
calcium, and other materials build up gradually on the insides
of the arteries walls and form a wax-like substance called plaque.
As the plaque builds up, the arteries become narrower, and the
flow of blood through the arteries becomes slower.
If diagnostic tests show that plaque has partly blocked the carotid
arteries, surgery can usually correct the problem. The most common
surgical procedure is called carotid endarterectomy. During this
operation, the carotid artery is opened and the plaque is carefully
removed from the artery's wall. The artery is then sewn closed.
The surgery usually takes about two hours and requires a five-day
hospital visit.
What
is an aneurysm and how is it treated?
An
aneurysm is a sac-like protrusion formed by a damaged or weakened
section of a blood vessel or the heart. Aneurysms can occur in blood
vessels anywhere in the body. They usually form in the brain and
in the aorta, the main artery carrying blood from the heart. In
many instances aneurysms are associated with other types of cardiovascular
disease especially hypertension and atherosclerosis. Traumatic injuries,
infections, and congenital (inherited) disorders also can cause
aneurysms.
Treatment for aneurysms depends upon the location and size of
the aneurysm. Although surgery is often indicated, some aneurysms
can be managed medically. The surgical procedure varies depending
on the aneurysm's location, but generally involves cutting away
the weakened section of the vessel and lining the vessel with
a piece of Dacron tubing. The typical patient will spend about
10 days in the hospital recovering from surgery. A new, less invasive
procedure for repair of aneurysms, called endovascular grafting,
may eventually allow certain patients to avoid surgery entirely.
What
is a stroke and what are the warning signs of stroke?
A
stroke is a disorder closely related to heart disease. The most
common form type of stroke occurs when a clot becomes wedged in
a diseased artery and shuts off blood flow to the brain---the same
process that causes the most common type of heart attack, except
blood to the heart is interrupted. Less common are strokes resulting
from ruptures or leaks in blood vessels in the brain.
Risk factors for stroke include high blood pressure, smoking,
heart disease, diabetes, and a high red blood cell count. The
risk of stroke also increases with age. Heavy alcohol consumption
increases the risk of hemorrhagic and bleeding strokes.
The warning signs for stroke include a sudden, temporary weakness
or numbness in the face or in an arm or leg; temporary impairment
of speech or the ability to understand speech; a sudden, temporary
vision impairment, especially in one eye; an episode of double
vision; unexplained headaches or a change in headache pattern;
and temporary dizziness or unsteadiness when walking.
What
is echocardiograph?
Echocardiography
is a test that uses sound waves to take moving pictures of your
heart. You will not have to stay in the hospital for this
procedure and it does not hurt. This test is done to help
the doctor find out how your heart is working, or to find out if
you have any heart problems.
This test
may be needed if you:
- have had
a heart attack
- have unexplained
chest pain
- have a
heart murmur or a congenital heart defect
How
is the procedure done?
- You'll
lie on your side or back on a bed.
- A technician
will put a special jelly on a probe and the probe will be moved
across your chest.
- The probe
moving across your chest will show images of your heart and
valves. These are picked up by ultrahigh frequency sound
waves.
- A video
screen will show your heart movement and videos or photos can
be taken on the pictures on the screen.
- It usually
takes less than 15-20 minutes and you can watch during the test.
- It is
painless and has no side effects
- Your doctor
will discuss the results with you
What
will the test show?
- The size
and shape of your heart.
- The overall
working condition of your heart.
- If a section
or wall of your heart is not working correctly.
- If any
of your hearts valves have problems.
- If you
have a blood clot.
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