Condition & Treatment Questions

A Holter monitor is a portable electrocardiogram (EKG) that monitors the electrical activity of an ambulatory (freely moving) patient's heart for a 24hr. period. It is most often used when your physician suspects an abnormal heart rhythm often based on specific complaints of a sensation of a beating heart, a fast heartbeat, or palpitations. There is no special preparation for this painless test. Wires from the monitor are taped to the patient's skin via electrodes as the patients are asked to go about their usual daily activities. Patients will keep a diary of symptoms so it may be reviewed by the physician for symptom correlation.

Also known as transthoracic (across the chest) echo, it is a painless test that looks at the heart chambers and valves. This test does not use x-ray but rather high frequency sound waves (ultrasound) to get a picture of four heart chambers and four valves. The sound waves bounce back from the heart and valves producing images and sounds that can be used by the cardiologist to detect damage and disease. An echocardiogram is a very safe test and in fact is the same technology that is used to image a fetus before it is born. To perform the test, a special gel is placed on the chest wall and a transducer is then moved over the gelled areas to produce images for interpretation

Coronary artery disease is a chronic condition which leads to the narrowing and hardening of the arteries that supply blood to the heart muscle itself. This narrowing leaves less room for the blood to flow through and deprives the heart muscle its needed blood. There are many risk factors which can contribute to the development of coronary artery disease. These include smoking, diabetes, high cholesterol, high blood pressure, lifestyle, and family history. All of the risk factors aside from family history can be modified and risk of heart disease can be reduced.

These are the newest type of metal struts that look like small springs found in pens. These are expanded in the blockages in the heart arteries to relieve chest pains or stop heart attacks. The older bare metal stents reblocked with scar tissue 15% of the time. The new coated stents release a chemical similar to chemotherapy in very small doses to prevent the scar tissue. With these stents the risk of reblocking is now down to less than 2% in patient followed for over three years.

There are several ways to increase your HDL cholesterol. Fats that are monounsaturated can improve your HDL as well as reduce triglycerides and bad cholesterol (LDL). These include olive oils and other vegetable oils, nuts and avocados. Some foods such as peanuts, green peas, sunflower seeds and corn can also raise HDL. Other important strategies to raise HDL include a regular exercise program, alcohol in moderation and the cessation of smoking. Calcium supplements have also been shown to increase HDL levels.

There have been observational studies that have shown lower risk of cardiovascular events in patients who regularly drink red wine. Since these early observations, several studies have suggested that it may just be the alcohol that confers these benefits, although there may be some benefit in the grape as well. Males who have two drinks a day and women who have one drink had a risk reduction of heart disease of 30 to 50% (beer 12 ounces, wine 5 ounces, liquor 1 ounce). The American Heart Association does not recommend prescribing alcohol as a means of risk reduction. The benefits of alcohol are attributed to several factors. One is raising the "good cholesterol", HDL. Other beneficiary effects may be "blood thinning" and sometimes in certain patients, even blood pressure may be lowered although of course in other patients, blood pressure can be raised by alcohol consumption. Whether alcohol is good for an individual patient should be decided on a case by case basis with your physician. The benefits in people who do drink, seem to have their drink on a regular basis with a meal and not episodically. Moderation is the key; no more than two drinks for men and one drink for women and regular follow up with your physician.

Atrial fibrillation (A fib) is one of the most common heart rhythm disorders, affecting more than two million people in the United States. In A fib, the heart beats rapidly and irregularly. Although not directly life threatening, A fib can cause palpitations, other rhythm problems, chronic fatigue, shortness of breath, chest pain, dizziness and stroke. The chance of a stroke is increased five-fold in patients with A fib. The likelihood of developing A fib increases with age but it can occur in young patients as well. Treatment of A fib includes medications to convert A fib back to the normal rhythm, medications to slow the heart rate during A fib, and medications that thin the blood. Often A fib can be difficult to control. New procedures are now available which can cure A fib in selected patients.

One of the most common presenting complaints to a cardiologist is the complaint of a skipped heart beat. The normal heart rhythm is dictated by the sinus node (the pacemaker of the heart) that resides in the top right cardiac chamber (right atrium). The sinus node sends electrical impulses to the bottom chambers of the heart (the ventricles) through specialized conduction tissue. The resulting rhythm is regular; the top chambers (the atria) beat first followed by beating in the bottom chambers (the ventricles). The sensation of skipped beats usually comes from extra electrical beats originating in the atria or ventricles. These extra beats are very common and can increase in times of stress (due to high doses of adrenaline) as well as with increased caffeine intake. The frequency of these extra beats tend to increase as we get older. Generally these extra beats do not represent a serious problem but if they persist consultation with a physician is recommended.

A pacemaker is a small device that is implanted in the upper chest region for prevention of an abnormally slow heart beat. A slow heart beat develops when the hearts natural pacemaker slows down with age or when the hearts natural electrical conducting fibers wear out. Patients requiring pacemaker implantation often present with symptoms of dizziness, lightheadedness, fatigue and/or fainting associated with a slow pulse. Not uncommonly, patients who require pacemakers are on necessary medications that result in excessive heart rate slowing. A pacemaker system generally consists of a pulse generator (which houses the pacemaker battery and circuitry) and two pacemaker leads. The leads are inserted through the veins into the top and bottom chambers of the heart. A typical pacemaker implantation is done under local anesthesia with light sedation and can be completed in 60-90 minutes. Patients with pacemakers can enjoy active normal lifestyles with minimal restrictions. Most electronic devices in the environment (including microwave ovens) have no effect on the pacemaker.

It is not uncommon for persons to have strong emotional feelings after going through an ordeal such as a heart attack. Many times heart attacks occur suddenly in otherwise healthy people. They are not accustomed to the idea to having to deal with any illness. Sometimes there are feelings of depression, hopelessness, irritability and fear. Any patient struggling with these emotions after a heart attack should discuss them frankly with his or her physician. Counseling and medication can help remove this obstacle to good health. Enrolling in supervised cardiac rehabilitation after a heart attack can also be quite beneficial.