WHAT DOES AN ECHOCARDIOGRAM DO?
An echocardiogram is a tool that creates pictures of the heart, its chambers and its vessels. Those pictures are used to help diagnose cardiac diseases, such as cardiomyopathies, or to show damage to the heart following a heart attack.
IS AN ECHOCARDIOGRAM PAINFUL?
No, an echocardiogram is not typically painful. An echocardiogram is created using sound waves which produce the video image. The technician/doctor will perform an echocardiogram using the sonic probe. The sound waves travel through your chest, bounce off your heart and produce an image which shows the doctor the structures of your heart. The image can also determine whether an area has been damaged and can provide other detailed information. The sound waves aren't painful and patient should feel no discomfort.
DO I NEED TO BE SEDATED FOR AN ECHOCARDIOGRAM?
DO I NEED TO BE FASTING FOR AN ECHOCARDIOGRAM?
How long does it take to get the results from an echocardiogram?
The results are available as soon as the echocardiogram is completed, but the doctor will need to interpret the results. For most patients, the results are read by Dr. Rotatori and discussed with the patient within a few days.
ARE THERE DIFFERENT TYPES OF ECHOCARDIOGRAMS?
Yes, there is a variety of echocardiogram. Most people have a transthoracic echocardiogram, which is simply a collection of images created with the ultrasound wand on the chest wall. A more complex procedure is the trans-esophageal echocardiogram, which takes images from the inside of the esophagus. This is performed in the hospital under sedation.
Regular Stress test
Picture of a guy running on the treadmill
WHAT IS A STRESS TEST?
A stress test is a test that provides data about the physical reactions oh the heart as it undergoes physical exercise or stress. As you exercise, your heart must do more work to keep up with the demand of your muscles for blood and oxygen. That demand is considered stress, and the stress test measures how well your heart adjusts to varying degrees of stress.
WHAT KIND OF INFORMATION DOES THE STRESS TEST SHOW?
The stress test shows the electrical rhythm of the heart and any anomalies that might be present while the heart is being tasked by physical activity. The result may show irregular heart rhythm or changes that are suspicious for coronary artery disease, a condition where a blockage in an artery causes reduced blood supply of portion of the heart muscle.
WHAT HAPPENS IF I FAIL A STRESS TEST?
If the stress test is abnormal it is usually necessary proceeding with more invasive tests, like cardiac catheterization to confirm the diagnosis and to possibly fix the problem (see angioplasty below).
Other type of Stress Test
Sometimes we add imaging to a regular stress test to increase the accuracy of the result. This can be done by performing a stress echocardiogram or a nuclear stress test.
1. STRESS ECHOCARDIOGRAM.
Before and after performing a regular stress test, echocardiographic images are collected to check the motion of the heart muscle. An abnormality will support the suspect that a portion of the heart is not receiving enough blood supply.
2. NUCLEAR STRESS TEST.
During this test, a radioactive tracer is injected in the IV of the patients at the peak of exercise. This tracer will reach the heart based on blood supply. Soon after the test the patient will lay on a table where a machine will receive the signal from the tracer. The better is the blood supply, the higher will be the signal. Also, in this case, abnormalities in the tracer will support the suspect of a blockage in an artery. This test is very useful also for patient who cannot exercise on the treadmill, because he can be done by injecting a drug (Pharmacological stress test) that simulates he exercise.
DO I NEED TO BE FASTING FOR A STRESS TEST?
Yes, from the night before. And please avoid caffeine for 12 hours before the test.
WHAT IS AN ANGIOPLASTY?
Angioplasty is a type of procedure that specialized cardiologists use to unblock cardiac vessels, that are called coronary arteries.
Genetic factors, high blood pressure, diabetes, other chronic diseases and lifestyle can predispose you to build atherosclerotic plaque (deposit of cholesterol) in your vessel. Sometimes these plaques are large enough to obstruct the flow. In this case, very often, the patient develops chest pain. During the angioplasty procedure, a catheter is inserted in an artery in your wrist (85% of the times) or groin and advanced to your heart. A thin wire is used as guide to advance a small balloon that is inflated at the level of the obstruction, so to open up the artery. Usually, this procedure is completed by positioning a stent (in a similar fashion). A stent is a metallic scaffold that maintains the artery open virtually forever.
WHAT SHOULD I EXPECT AFTER ANGIOPLASTY?
You should expect a diminishing of symptoms of chest pain or shortness of breath. You may find that you have more energy and that you can do more without getting tired as quickly. From a preventive perspective, you should expect to take some medication regularly. In particular, for at least one year, you should take 2 anti-platelet medication (commonly known, somehow incorrectly, blood thinner) to maintain the stent open. This medication might increase the risk of bleeding and for this reason before an angioplasty procedure you should notify your doctor about previous bleeding problem or a planned surgery. Also, you should continue or begin a cardiac diet that is low in salt, fat and sugar. You should also expect that the doctors would instruct you to exercise more often. Exercise in fact will help to strengthen your heart muscle and increase your endurance. This is a slow process, so expect your exercise routine to increase slowly.
WILL I BE SEDATED FOR ANGIOPLASTY?
Yes, but not fully. Patients who undergo angioplasty are given conscious sedation, which helps them to relax and removes all of the pain. You will still be able to follow vocal commands, but you may seem as though you are lightly napping.
IS ANGIOPLASTY AN OUTPATIENT PROCEDURE?
Under most conditions, angioplasty is an outpatient (day-hospital) procedure. In cases where the patient is medically fragile, angioplasty may be an inpatient procedure.
You will be instructed not to eat after dinner the night before and not to drive the day of the procedure (due to the sedation medication).
WHEN CAN I GO BACK TO WORK?
Generally, we suggest 72 hours off work, avoiding heavy lifting.
How will I know if the angioplasty was successful?
The success of the procedure is seen once the final images are taken. After that, the resolution of symptoms and future no invasive testing will monitor the durability of the results.
WHAT IS HIGH CHOLESTEROL?
High Cholesterol occurs when your cholesterol level is higher than what the guidelines are suggesting. The target level for every person is based on the presence of other co-morbidities. For example, if you have diabetes, the level should be kept “aggressively” low. Generally speaking, a normal cholesterol level is considered less than 200 mg/dl. Often, when checking cholesterol level, we also differentiate between good cholesterol (HDL) and bad cholesterol (LDL), which helps guiding treatment.
WHY IS HIGH CHOLESTEROL DANGEROUS?
High levels of cholesterol are what cause certain forms of cardiac disease and can increase the risk of heart attack. Arterial plaque is the deposition of cholesterol that can lead to hardening of the blood vessels. When the diameter of the blood vessel narrows because they have hardened and no longer expand, it makes it easier for clots to form and stroke or heart attack to occur.
BESIDES MEDICATION, WHAT IS THE TREATMENT FOR HIGH CHOLESTEROL?
The treatment for high cholesterol is typically cholesterol medication in conjunction with lifestyle changes, including diet and exercise. Diet and exercise are two very powerful tools of preventive medicine.
Will I have to lose weight if I have high cholesterol?
Losing weight is a good way to lower your bad cholesterol level. You can lose weight by eating healthier, following stricter diet and by exercising more often. Obesity is linked to high cholesterol levels. So, dropping stored fat is part of the lifestyle treatments that the doctors will likely prescribe.
WHAT IS HYPERTENSION?
Hypertension is high blood pressure. To flow in the artery, our blood needs to be pushed by the heart. The “squeezing” of the heart muscle generates a pressure which allows the blood to flow. Certain condition, like hardening of the arteries, causes an increase of this pressure, and this is Hypertension.
In the long term, hypertension will damage the arteries and so it is a risk factor for cardiac and vascular diseases.
WHAT CAUSES HYPERTENSION?
The cause of hypertension is generally unknown (primary) and results from a combination of genetic predisposition (Hypertension usually “runs in the family”) and lifestyle factor, including poor diet (high sodium intake), obesity, smoke and lack of exercise. Rarely, it is a consequence of other medical problems (secondary) such as hormonal disease (adrenal problem, thyroid problem, neuro-endocrine tumor) or even physical defects in arteries (renal artery stenosis).
WHAT IS THE TREATMENT FOR HYPERTENSION?
Treatment for hypertension is almost always multidisciplinary. Most people need medication to help control the high blood pressure and at the same time are expected to make lifestyle changes, such as getting more exercise or eating a healthier diet. High intake of salt can cause high blood pressure, as can smoking cigarettes or indulging in recreational drugs. Treatment for hypertension is based on the type of hypertension you have – primary or secondary.
Congestive Heart Failure
WHAT IS CONGESTIVE HEART FIALURE?
Congestive heart failure is a cardiac disease that occurs when the heart is weakened (systolic) or “stiff” (diastolic). This leads to fluid retention in the lungs (which can lead to shortness of breath) as well as other tissues of the body, notably of the legs or abdomen causing swelling.
IS THERE A CURE FOR HEART FAILURE?
Heart failure is a chronic disease. However, we do have a number of different treatment options that have shown to improve quality of life as well as improve survival in patients with heart failure. The key to improving the quality of life is to manage the symptoms of congestive heart failure. This includes an intensive treatment plan with medications, life style modifications, rehabilitation, and close follow up. It is important for both the patient and the physician to work together to ensure the best outcome possible for the patient.
WHAT IS THE TREATMENT FOR HEART FAILURE?
The treatment of heart failure involves both intensive life style changes and medical therapy regimen. Life style changes include dietary changes to eliminate salt intake, as well as limiting fluid intake to prevent fluid overload and cardiovascular. Medical therapy includes a combination of multiple blood pressure medications, which include beta-blockers, ACE inhibitors, Angiotensin receptor blockers, diuretics, as well as new medications indicated in certain cases. You will be followed closely with the cardiologists for regular dosage and medication adjustments until the optimal therapy for you has been achieved. In certain cases, further treatments with device therapy or implantation of a defibrillator may be indicated.
WHAT ARE THE CAUSES OF CONGESTIVE HEART FAILURE?
Heart failure can be caused by a number of conditions. It can be the result of a heart attack or long-standing coronary artery disease. Other causes of heart failure include: genetic predisposition, chronic diseases such as hypertension, valvular heart disease, arrhythmias (abnormal heart rhythms), infections, and toxins, including excessive alcohol use.
WHAT IS ATRIAL FIBRILLATION?
Atrial fibrillation is an abnormal heartbeat that occurs in the atria of your heart. Doctors and patients sometimes describe atrial fibrillation as a quivering or fluttering type of movement. This is because when atrial fibrillation is occurring, the atria of the heart are not contracting appropriately. Instead, they contract partially and quickly rather than in rhythm with your normal heart rate.
IS ATRIAL FIBRILLATION DANGEROUS?
Atrial fibrillation can be dangerous. The loss of purposeful contraction of the atria creates a “sluggish” flow of blood in the atria which can cause the formation of blood clots. If one of these clots enters the blood stream, it can reach the brain and cause a stroke or other embolic event.
HOW IS ATRIAL FIBRILLATION TREATED?
There are multiple treatment strategies for atrial fibrillation, the most common treatment is medication, but ultimately it is tailored to the individual. In most cases, doctors prescribe blood thinners, which help in the prevention of clot formation and thus decrease the risk of stroke. Medications that slow your heart rate or that help maintain normal rhythm are often included in the treatment plan as well. Lifestyle changes are also in order, such as improving diet, stopping smoking, limiting drinking and increasing exercise.
There are also nonsurgical procedures which can help with atrial fibrillation. These include electrical cardioversion, which is shocking the heart back into a normal rhythm. In certain cases of atrial fibrillation, an ablation procedure may also be an option. Ablation is the insertion of a small catheter into the heart that entails “burning” or “freezing” portions of the atria to try and prevent atrial fibrillation from occurring. The process works because the scarring left behind causes overactive cells to stop sending signals to contract.
CAN I LIVE A NORMAL LIFE WITH ATRIAL FIBRILLATION?
The answer to this question is given on a patient- by-patient case. Each patient with atrial fibrillation is different, and the causes and stresses that your body is under are different and unique. For that reason, it’s impossible to give a definitive answer to this question. However, people who can control atrial fibrillation through medication, diet, or lifestyle change can live a normal life. The best person to answer this question are our doctors, whose plan of care is unique to you. They can evaluate your lifestyle and your symptoms and can develop a plan that helps correct these issues.
WHAT IS A HEART ATTACK?
A heart attack is when you have a sudden occlusion of one of the vessels providing blood supply to the heart. If prolonged, this event causes death of part of the cardiac muscle with partial loss of function. The more cardiac muscle damage, the more severe the clinical implications.
When this emergent condition develops, the patient needs to be transferred immediately to the hospital where our cardiac team will reopen the vessel (see angioplasty). Unfortunately, if not detected in time, a heart attack can cause heart failure (see heart failure).
What is my quality of life after a heart attack?
The answer is largely dependent on the severity of the damage the heart muscle withstood. For the most part, people can live a happy life if they comply with the treatment. This entails taking the prescribed medication, making certain lifestyle adjustments, and being committed to improving their health.