FREQUESTLY ASKED QUESTIONS

I have important concerns about my heart - what information should I be sure to share with my doctor? 
Upon an initial examination, a physician is concerned with your current and past medical history, particularly any personal or family history of cardiovascular disease. To help your physician, you should prepare a list of your blood relatives and their diseases (if they have any). List the causes of and ages at death of those relatives who have died. Also list your major illnesses and cardiovascular risk factors (e.g. smoking, high blood pressure, and high blood cholesterol levels). You should describe in detail any breathing problems, chest pain, palpitations, extreme fatigue, or fainting spells. Explain what you were doing when these symptoms occurred. If you are experiencing any of these symptoms, please consult your doctor as soon as possible.

What are the risk factors for heart disease? 
There are two types of risk factors for heart disease - those that you have no control over and those that you can modify. Uncontrollable risk factors include personal or family history of heart disease that places an individual at higher risk for heart disease regardless of lifestyle choices. Age is another uncontrollable risk factor - men 45 and over and women 55 and over are at an increased risk. There are controllable risk factors that you can control, reducing your likelihood of heart disease. They include: cigarette smoking, obesity, high blood pressure, diabetes, physical inactivity, alcohol consumption, caffeine consumption and chronic stress. If you are trying to minimize your risk for cardiovascular disease, maintain a diet that is low in cholesterol, saturated fats and sodium, exercise regularly and above all, don't smoke! These simple lifestyle changes can help to reduce your blood pressure, blood cholesterol levels, and weight.

HEALTH TARGETS

Systolic Blood Pressure < 120 mm Hg

Diastolic Blood Pressure < 80 mm Hg

Total Cholesterol < 200 mg/dL

LDL (Bad) Cholesterol < 130 mg/dL

HDL (Good) Cholesterol > 59 mg/dL

Cholesterol Ratio (Total / HDL) < 4.1

Body Mass Index < 25

Fasting Glucose < 110 mg/dL

Nonfasting Glucose < 200 mg/dL

Fasting Triglycerides < 150 mg/dL

What is a normal heart rate? 
The average heart rate for an adult is between 65 and 75 beats per minute. Trained athletes can have a pulse rate as low as 50 beats per minute.

Why is high blood pressure called "the silent killer"? 
A person can suffer hypertension (high blood pressure) for years without even knowing it. There are no discernable symptoms, but the long term effects are serious. Left untreated, hypertension can lead to damage of the heart (enlarged heart, heart attacks, heart failure), kidneys (renal failure), brain (strokes) and the blood vessels (arterial aneurysms and blockage of the arteries).

What is congestive heart failure? 
Congestive heart failure (CHF) is a condition in which fluid accumulates in the liver and lungs, as well as the feet, ankles and legs because the heart has lost the ability to pump blood effectively throughout the body. It is marked by extreme fatigue and shortness of breath because the heart is unable to supply the necessary oxygen to the rest of the body. CHF is usually caused by atherosclerotic coronary artery disease (hardening of the arteries around the heart), hypertension, and disease of the heart valves. It can also be caused by pulmonary embolism (blot clot in the lungs), infection or a congenital (from birth) abnormality. Treatment may include dietary changes, drug therapies, and sometimes surgery.

What is an arrhythmia? 
It is an abnormality in the heart rhythm that can be detected by an electrocardiogram . Arrhythmias can cause minor symptoms and problems, or they can be life threatening. The causes and treatments for arrhythmias can be equally varied. Treatment can include medications, pacemaker or defibrillator implantation, or ablation (the destruction of the tissue of the heart causing the disorder).

What is homocysteine? 
Homocysteine is a metabolic product of one of the amino acids. Amino acids are the building blocks of proteins. Excessively high levels of homocysteine in the blood can damage the arterial walls and predispose blood factors to form clots. Between 20% to 40% of the people with clogged arteries, strokes and heart attacks have elevated levels of this substance. B-complex vitamins (B6, B12 and folic) can help the body dispose of excessive homocysteine.

What is an ECG (or EKG)? 
An electrocardiogram is a non-invasive test which records the electrical impulses of the heart. An abnormal ECG can indicate arrhythmias, enlarged heart, or damage to the heart muscle. However, by itself, this test is not conclusive. Half of all patients with heart disease can have a normal ECG, and further testing must be done if cardiac problems are suspected.

What is a stress test? 
A stress test is a non-invasive test that records the electrical impulses of the heart during exercise. In some cases, a follow-up test is performed where a radioactive dye called thallium is injected into the blood stream. The heart is then scanned and pictures are taken, allowing the physicians to visualize the blood flow through the arteries of the heart.

What is an echocardiography? 
A non-invasive test that produces a live-action image of the heart through sound waves (ultrasound); echocardiography allows doctors to observe the heart muscle pumping and to visualize the heart chambers and portions of the heart that are enlarged .

What is ultrafast Computed Tomography (or ultrafast CT/CAT Scan)? 
An ultrafast CAT scan is a non-invasive test that provides detailed three-dimensional moving pictures. It can show the heart pumping and the flow of blood through the arteries and chambers of the heart. Using electron beams that scan at a rate of 17 scans per second, this diagnostic tool can delineate the coronary arteries and the calcium deposits in them. Such deposits commonly indicate the amount of blockage in the arteries.

What is Positron Emission Tomography (PET)? 
PET is a non-invasive diagnostic procedure that detects high energy gamma rays from multiple x-ray sources that surround the patient to produce high resolution, three-dimensional images of the heart muscle and blood flow. It can be especially useful for determining whether the heart muscle cells are temporarily or permanently damaged and thus which course of treatment is best.

What is a Magnetic Resonance Imaging (MRI)?
MRI is another non-invasive diagnostic procedure that uses radio waves with a magnet and computers to create three dimensional images of internal organs, such as the heart. It is useful for diagnosing congenital heart defects and diseases of the heart muscle (cardiomyopathies).

What is a cardiac catheterization? Cardiac catheterization is an invasive diagnostic procedure that uses X-rays and a dye to view and biopsy the chambers of the heart, its vessels and arteries. During the procedure, a cardiologist inserts a long, slender and flexible tube (catheter )into the groin or arm and guides it to the heart, where the contrast dye is released and pictures are taken. The procedure is used to rule out or diagnose a coronary artery disease and disease of the valves of the heart. Patients are mildly sedated but remain awake during the procedure.

What is angiography? 
Angiography is a type of X-ray of the arteries made after a contrast solution (dye) is injected into the blood stream.

What is Percutaneous Transluminal Coronary Angioplasty (PTCA)? 
In the PTCA procedure, a tiny balloon is placed into an artery by means of a catheter and later inflated to flatten cholesterol plaques against the arterial wall and restore adequate blood flow.

What is a stent? 
A stent is a one-inch wire mesh tube made of stainless steel that is used during angioplasty to keep collapsed arteries open. Stents are implanted during catheterization and once the balloon inflates the vessel and stent, the stent remains open and the catheter is extracted.

What is a pacemaker? 
A pacemaker is an implanted device that sends electrical impulses to the heart so that it pumps at a rate sufficient for the needs of the body. Modern technology has advanced this device to the point where it can be programmed to change the heart rate depending if the body is at rest or under stress. A pacemaker can be temporary or permanent and is powered by a battery that can last up to 15 years.

What is coronary artery bypass graft? 
In this procedure, a small portion of a vein in the leg or a vessel from the chest is removed and grafted to the healthy parts above and below the blocked portion of a coronary artery. The graft re-routes the blood flow around the obstructed portion of the vessel restoring blood flow to the heart.

What are the symptoms of a heart attack? 
The symptoms of a heart attack are varied and may include sweating, shortness of breath, nausea, light-headedness, or chest pain that radiates to the shoulders, neck or jaw. If you are experiencing these symptoms, call 911 immediately. Do not drive yourself to the hospital. Call a friend or neighbor for assistance after calling 911 if you are able.

What is an endarterectomy? 
An endarterectomy is an invasive surgical procedure to remove plaque from within an artery. Carotid arteries may be candidates for endarterectomies to prevent strokes.

What is a stroke?
A stroke is the disruption of the normal flow of blood to the brain, damaging or destroying brain tissue. Strokes are the third leading cause of death in the U.S., behind cardiovascular disease and cancer. There are two different causes for strokes: 20% of all strokes are caused by cerebral hemorrhage, where a cerebral artery breaks causing blood to bleed out into the brain. More commonly, however, is an ischemic (thrombotic, embolic or lacunar) stroke caused by a blockage of arterial blood flow to the brain. Symptoms of a stroke may include muscular weakness or paralysis of one side of the body, slurring or loss of speech or inability in understanding the spoken word, double vision, dizziness or loss of balance. Strokes can be avoided through lifestyle changes (stop smoking, control cholesterol or hypertension, etc.) or through surgical procedures such as endarterectomy to remove the blockage within a vessel. Should stroke occur, immediate treatment may potentially reduce or eliminate its permanent consequences.

What is cardiomyopathy?
Cardiomyopathy is a general term for diseases of the heart muscle. Cardiomyopathies impair the heart 's pumping efficiency. They may be genetic or caused by a virus, bacteria, or coronary heart disease.

What is an aneurysm?
An aneurysm is caused by a weakening of an arterial wall leading to a bubble or balloon-like appearance to the vessel. An aneurysm in vital sites is life threatening because the weakened vessel wall can burst. Aneurysms can be found nearly anywhere in the body; the abdomen, heart, neck, brain, or legs and can only be corrected through surgical procedures.

What are the cardiovascular issues of hormone therapy replacement in post-menopausal women?
Estrogen increases HDL (the "good cholesterol") and decreases LDL (" the bad cholesterol"), Reducing the risk of atherosclerosis (hardening of the arteries). In atherosclerosis, a plaque forms on the artery walls, narrowing the flow of blood. Estrogen also has direct effects on the walls of arteries, keeping the blood vessels from constricting, which reduces the blood flow in the coronary arteries. If the coronary blood vessels constrict, chest pain and heart attacks may occur. At menopause, women lose estrogen's protective cardiovascular effects, becoming more vulnerable to heart disease. By age 60, their death rate from heart attacks equals that of men. Because a women's risk of coronary heart disease increases at this time, physicians often recommend HRT (hormone replacement therapy). Women should discuss with their physicians the pros and cons of this therapy.