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Ablations:
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A Catheter ablation is a non-surgical technique
that destroys parts of the abnormal electrical pathway that is
causing your arrhythmia(abnormal heart rhythm).
During catheter ablation, doctors insert a special electrode
catheter (long, flexible wire) into the heart. They position
the catheter so that it lies close to the abnormal electrical
pathway, then pass heat energy through it. The tip of the
catheter heats up and destroys the small area of heart tissue that
contains the abnormal pathway.
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Arrhythmia Evaluation:
What are arrhythmias?
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Arrhythmias are problems that affect the electrical
system of the heart muscle, producing abnormal heart rhythms.
They can cause the heart to pump less effectively.
The heart has four chambers. The top two are the atria, and
the lower two are the ventricles. Normally the heartbeat starts
in the right atrium when a special group of cells sends an electrical
signal. (These cells are called the sinoatrial or SA node, the
sinus node or the heart's "pacemaker.") This signal spreads throughout
the atria and to the atrioventricular (A-V) node. The A-V node
connects to a group of fibers in the ventricles that conduct the electrical
signal. The impulse travels down these specialized fibers (the His-Purkinje
system) to all parts of the ventricles. The electrical signal must follow
this exact route for the heart to pump properly.
Under some conditions almost all heart tissue can start a
heartbeat. In other words, another part of the heart can become
the pacemaker. An arrhythmia occurs...
• when the heart's natural pacemaker develops
an abnormal rate or rhythm.
• when the normal conduction pathway is
interrupted.
• when another part of the heart takes over
as pacemaker
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Cardiac Catherization:
What is cardiac catheterization?
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This is a procedure done on the heart. In it,
a doctor inserts a thin plastic tube into an artery or vein in
the arm or leg. >From there it can be advanced into the chambers
of the heart or into the coronary arteries.
This test can measure blood pressure within the heart and
how much oxygen is in the blood. It's also used to get information
about the pumping ability of the heart muscle. Catheters are also
used to inject dye into the coronary arteries. This is called
coronary angiography or coronary arteriography.
Catheterization is also done on infants and children to examine
or treat congenital heart defects.
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What causes congenital cardiovascular defects?
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Congenital cardiovascular defects are present in about 1
percent of live births. They're the most common congenital malformations
in newborns. In most cases scientists don't know why they occur.
Sometimes a viral infection causes serious problems. German measles
(rubella) is an example. If a woman contracts German measles while
pregnant, it can interfere with how her baby's heart develops or produce
other malformations. Other viral diseases also may cause congenital
defects.
Heredity
sometimes plays a role in congenital cardiovascular defects.
More than one child in a family may have a congenital cardiovascular
defect, but this rarely occurs. Certain conditions affecting
multiple organs, such as Down's syndrome, can involve the heart,
too. Some prescription drugs and over-the-counter medicines, as well as
alcohol and "street" drugs, may increase the risk of having a baby
with a heart defect. Researchers are studying other factors.
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What are the types of congenital defects?
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Most heart defects either obstruct blood flow in the heart
or vessels near it, or cause blood to flow through the heart
in an abnormal pattern. Rarely defects occur in which only one
ventricle (single ventricle) is present, or both the pulmonary artery
and aorta arise from the same ventricle (double outlet ventricle). A third
rare defect occurs when the right or left side of the heart is incompletely
formed - hypoplastic heart.
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Congenital Heart Defects:
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Congenital means inborn or existing at birth. Among the
terms you may hear are congenital heart defect, congenital heart
disease and congenital cardiovascular disease. The word "defect"
is more accurate than "disease." A congenital cardiovascular defect
occurs when the heart or blood vessels near the heart don't develop normally
before birth.
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Coronary Disease:
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Coronary artery disease generally refers to the buildup
of cholesterol in the inside layers of the arteries. This will
slowly narrow the flow of blood through the vessel, and the muscle
it supplies will not get enough blood. The plaque weakens the
wall. A crack may develop in the plaque and a blood clot may form - this
is the mechanism of most heart attacks.
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Coumadin Clinic:
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Staffed by nursing professionals who specialize in anticoagulation
therapy, the clinics utilize the latest technology to obtain "instant"
protime results without venipuncture. Your PT/INR can be determined
in minutes from only a few drops of blood obtained form a finger-stick
puncture. The professional then uses the results to determine
if a dosage adjustment is required, and if so, can discuss the change "face
to face"--- no more waiting for a phone call. Most importantly, the
nurse can educate you about Coumadin and answer any questions
you may have about your Coumadin therapy. You will receive
education that is tailored to your needs, preferences, and lifestyle.
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Defibrillators a/k/a Implantable Cardioverter Defibrillator:
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An ICD is a small electronic devise
that’s implanted inside the body. The ICD continuously
monitors your heartbeat. If it senses a dangerous rapid
heart rhythm, it delivers one or more pulses or shocks to the heart
and restores a more normal rhythm.
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Echocardiography:
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An echocardiography is a diagnostic test which
uses sound waves to provide information about the size and condition
of your heart’s chambers, walls, valves, and blood flow.
What happens: You will be asked to lie quietly on an
exam table and a gel will be applied to the skin on your chest.
The sonographer will move a “probe” or “transducer” across the
gel covered area to obtain images of your heart. There is
no pain or discomfort with this test. The transducer sends
out harmless sound waves that then bounce back to the computer
to create pictures of your heart. The sonographer will be doing
various measurements and calculations while obtaining the images of your
heart. He/She will record the test on video tape for the cardiologist
to review.
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Electrophysiology Procedures:
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An EP study is an accurate method for assessing
the heart’s electrical function. It allows doctors to locate
abnormal sites inside the heart that may be causing serious arrhythmias
(abnormal heart rhythms).
During an EP study, doctors insert special electrode catheters
(long, flexible wires) into veins and guide them into the heart.
Once inside, the catheters can sense electrical impulses in various
areas of the heart; they can be used to stimulate different parts
of the heart.
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Heart, How It Works:
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The normal heart is a strong, muscular pump
a little larger than a fist. It pumps blood continuously through
the circulatory system. Each day the average heart "beats" (expands
and contracts) 100,000 times and pumps about 2,000 gallons of
blood. In a 70-year lifetime, an average human heart beats more
than 2.5 billion times.
The circulatory system is the network of elastic tubes that
carries blood throughout the body. It includes the heart, lungs,
arteries, arterioles (small arteries), and capillaries (very
tiny blood vessels). These blood vessels carry oxygen- and nutrient-rich
blood to all parts of the body. The circulatory system also includes
venules (small veins) and veins. These are the blood vessels that
carry oxygen- and nutrient-depleted blood back to the heart and lungs.
If all these vessels were laid end-to-end, they'd extend about 60,000 miles.
That's enough to encircle the earth more than twice.
The circulating blood brings oxygen and nutrients to all the
body's organs and tissues, including the heart itself. It also
picks up waste products from the body's cells. These waste products
are removed as they're filtered through the kidneys, liver and
lungs.
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What is the heart's
structure?
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The heart has four chambers through which blood
is pumped. The upper two are the right and left atria. The lower
two are the right and left ventricles. Four valves open and close
to let blood flow in only one direction when the heart beats:
• The tricuspid valve is between the right
atrium and right ventricle.
• The pulmonary or pulmonic valve is between
the right ventricle and the pulmonary artery.
• The mitral valve is between the left atrium
and left ventricle.
• The aortic valve is between the left ventricle
and the aorta.
Each valve has a set of flaps (also called leaflets or cusps).
The mitral valve has two flaps. The others have three. Under normal
conditions, the valves let blood flow in just one direction. Blood
flow occurs only when there's a difference in pressure across
the valves that causes them to open.
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How does the heart
pump blood?
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A heart's four chambers must beat in an organized
manner. This is governed by an electrical impulse. A chamber of
the heart contracts when an electrical impulse moves across it.
Such a signal starts in a small bundle of highly specialized cells
in the right atrium -- the sinoatrial (SA node), also called the
sinus node. A discharge from this natural "pacemaker" causes the heart
to beat. This pacemaker generates electrical impulses at a given rate,
but emotional reactions and hormonal factors can affect its rate
of discharge. This lets the heart rate respond to varying demands.
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Heart Murmurs:
What causes heart murmurs?
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Heart murmurs are normal findings (“innocent”
or functional”). Abnormal heart murmurs are most often are most often caused
by defective heart valves. A stenotic heart valve has a smaller-than-normal
opening and can't open completely. A valve may also be unable
to close completely. This leads to regurgitation, which is blood
leaking backward through the valve when it should be closed.
Murmurs also can be caused by conditions such as pregnancy,
fever, thyrotoxicosis (a diseased condition resulting from an
overactive thyroid gland) or anemia.
A diastolic murmur occurs when the heart muscle relaxes between
beats. A systolic murmur occurs when the heart muscle contracts.
Systolic murmurs are graded by intensity (loudness) from one to
six. A grade 1/6 is very faint, heard only with a special effort.
A grade 6/6 is extremely loud. It's heard with a stethoscope slightly
removed from the chest.
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Holter Monitors:
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A holter monitor is used to help diagnose and
evaluate types of heart problems. The monitor records your
heart rhythm continuously while you go about your daily activities.
It is about the size of a portable tape recorder, and is connected
to your chest by four electrodes. It is typically worn for
24 hours.
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Event Monitors:
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Cardiac event monitors are small portable devices
worn by a patient during normal activity for up to 30 days. The
device has a recording system capable of storing several minutes
of the individual's electrocardiogram (EKG) record. The patient
can initiate EKG recording during a symptomatic period of arrhythmia.
Cardiac event monitors have primarily been used to diagnose and
evaluate cardiac arrhythmias. These monitors are particularly useful
in obtaining a record of arrhythmia that would not be discovered on a routine
EKG or an arrhythmia that is so infrequent that it is not detected during
a 24-hour period by a Holter monitor.
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Lipid Clinic:
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Our Clinic for Lipids and Cardiovascular Health
was established to offer a community service that focused on cardiovascular
prevention. Our patients are referred to the Clinic by
physicians requesting assistance in the care of patients with
lipid disorders, cardiac risk factors and metabolic disorders.
Our mission is to identify and treat individuals who have
or are at risk for heart disease and/or metabolic syndrome, including
family members; to prevent, reverse, or stabilize heart disease;
to provide access to new and specialized testing; and to provide
customized approach to treatment.
The evaluations include: medical history and appropriate
physical exam; nutrition/lifestyle assessment; establish individualized
nutrition/exercise plan; evaluation of cardiac risk factors, including
risk assessment techniques for heart, arterial or circulatory
disease, and stroke; education about the nature of heart disease
and atherosclerosis; and ongoing care in collaboration with primary
care physicians.
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Nuclear Cardiology:
Radionuclide Imaging or Radionuclide Angiography:
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These tests involve injecting radioactive substances
called radionuclides into the bloodstream. Computer-generated
pictures can then find them in the heart. These tests show how
well the heart muscle is supplied with blood, how well the heart's
chambers are working, or identify a part of the heart damaged by
heart attack.
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Pacemakers:
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A pacemakers is a small, lightweight, electronic
device that is implanted (inserted into the body), ready to pace
the heart (make a beat). It is prescribed for people whose
hearts are beating too slowly.
The pacemaker keeps track of your heart’s electrical activity.
If it senses that the heart is beating too slowly or is pausing
too long between beats, the pacemaker delivers electrical impulses
that stimulate the heart and keep it beating at the proper rate
(speed).
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Risk Factor Evaulation:
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Extensive clinical and statistical studies
have identified several factors that increase the risk of coronary
heart disease and heart attack. Major risk factors are those that
research has shown significantly increase the risk of heart and
blood vessel (cardiovascular) disease. Other factors are associated
with increased risk of cardiovascular disease, but their significance
and prevalence haven't yet been precisely determined. They're called
contributing risk factors.
The American Heart Association has identified several risk
factors. Some of them can be modified, treated or controlled,
and some can't. The more risk factors you have, the greater your
chance of developing coronary heart disease. Also, the greater
the level of each risk factor, the greater the risk. For example,
a person with a total cholesterol of 300 mg/dL has a greater risk than someone
with a total cholesterol of 245 mg/dL, even though everyone with a total
cholesterol greater than 240 is considered high-risk.
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What are the major
risk factors that can't be changed?
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• Increasing age — 84 percent
of people who die of coronary heart disease are 65 or older. At
older ages, women who have heart attacks are more likely than
men are to die from them within a few weeks.
• Male sex (gender) — Men have a greater
risk of heart attack than women do, and they have attacks earlier
in life. Even after menopause, when women's death rate from heart
disease increases, it's not as great as men's.
• Heredity (including Race) — Children of
parents with heart disease are more likely to develop it themselves.
African Americans have more severe high blood pressure than Caucasians
and a higher risk of heart disease. Heart disease risk is also
higher among Mexican Americans, American Indians, native Hawaiians
and some Asian Americans. This is partly due to higher rates of
obesity and diabetes. Most people with a strong family history of
heart disease have one or more other risk factors. Just as you can't control
your age, sex and race, you can't control your family history. Therefore,
it's even more important to treat and control any other risk factors
you have.
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What are the major
risk factors you can modify, treat or control by changing your lifestyle or taking medicine?
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• Tobacco Use — Smokers'
risk of developing coronary heart disease is 2–4 times that of
nonsmokers. Cigarette smoking is the biggest risk factor for
sudden cardiac death; smokers have about twice the risk of nonsmokers.
Cigarette smoking also acts with other risk factors to greatly
increase the risk for coronary heart disease. People who smoke
cigars or pipes seem to have a higher risk of death from coronary heart
disease (and possibly stroke) but their risk isn't as great as cigarette
smokers'. Exposure to other people's smoke increases the risk of
heart disease even for nonsmokers.
• High blood cholesterol — As blood cholesterol
rises, so does risk of coronary heart disease. When other risk
factors (such as high blood pressure and tobacco use) are present,
this risk increases even more. A person's cholesterol level is
also affected by age, sex, heredity and diet.
• High blood pressure — High blood pressure
increases the heart's workload, causing the heart to thicken
and become stiffer. It also increases your risk of stroke, heart
attack, kidney failure and congestive heart failure. When high
blood pressure exists with obesity, smoking, high blood cholesterol
levels or diabetes, the risk of heart attack or stroke increases
several times.
• Physical inactivity — An inactive lifestyle
is a risk factor for coronary heart disease. Regular, moderate-to-vigorous
physical activity helps prevent heart and blood vessel disease.
The more vigorous the activity, the greater your benefits. However,
even moderate-intensity activities help if done regularly and
long term. Exercise can help control blood cholesterol, diabetes
and obesity, as well as help lower blood pressure in some people.
• Obesity and overweight — People who have
excess body fat — especially if a lot of it is at the waist —
are more likely to develop heart disease and stroke even if they
have no other risk factors. Excess weight increases the heart's
work. It also raises blood pressure and blood cholesterol and triglyceride
levels, and lowers HDL ("good") cholesterol levels. It can also
make diabetes more likely to develop. Many obese and overweight
people may have difficulty losing weight. But by losing even as
few as 10 pounds, you can lower your heart disease risk.
• Diabetes mellitus — Diabetes seriously
increases your risk of developing cardiovascular disease. Even
when glucose levels are under control, diabetes increases the
risk of heart disease and stroke, but the risks are even greater
if blood sugar is not well controlled. About three-quarters of
people with diabetes die of some form of heart or blood vessel
disease. If you have diabetes, it's extremely important to work with your
healthcare provider to manage it and control any other risk factors you
can.
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What other factors
contribute to heart disease risk?
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• Individual response to
stress may be a contributing factor. Some scientists have noted
a relationship between coronary heart disease risk and stress
in a person's life, their health behaviors and socioeconomic
status. These factors may affect established risk factors. For example,
people under stress may overeat, start smoking or smoke more than they otherwise
would.
• Drinking too much alcohol can raise blood
pressure, cause heart failure and lead to stroke. It can contribute
to high triglycerides, cancer and other diseases, and produce
irregular heartbeats. It contributes to obesity, alcoholism, suicide
and accidents.
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Stent and Balloon Angioplasty:
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During a balloon angioplasty, the interventional
cardiologist inserts a special type of catheter into an artery
in your groin or arm. This catheter has a small deflated balloon
attached to the leading end. The catheter is slowly guided by X-ray
into the coronary artery that is clogged or blocked. The deflated
balloon is then carefully inflated and deflated several times. This
process of inflation presses the plaque buildup back against the artery
wall, and opens the vessel so blood can flow more freely through
the vessel. As the balloon is inflated, you may briefly experience
chest discomfort. This passes quickly.
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Stent Placement:
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Once the blockage is pressed back against the
artery wall, your doctor may decide to place a device called
a stent into the area to help keep the artery open. A stent is
a small tube-shaped mesh screen that is implanted in the artery
permanently at the site of the blockage. It allows blood to pass freely
through the artery, helps to keep the artery open, and reduces the future
buildup of plaque.
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Stress Echo:
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Stress echocardiography is a comprehensive test that allows
your medical team to evaluate the function of your heart and
to determine the need for heart catheterization. The test can
be completed in a short amount of time using ultrasound waves
and EKG tracings of your heartbeat. The sonographer will use a transducer,
which is something like a microphone, to send sound waves through the
chest wall and to the heart. The sound waves bounce off the heart structures
and return to the transducer. The computer images are seen on a TV like
screen and recorded.
Echocardiograms (echo) can show the size of heart chambers,
how well the heart pumps and how well the heart valves function.
Echo only uses sound waves (not x-rays) and is safe and almost
always painless.
A Stress Echo compares how your heart works at rest to how
it works during or immediately after exercise or stress.
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Stress Testing:
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Stress test, sometimes called a treadmill test or exercise
test, helps a doctor find out how well your heart handles work.
As your body works harder during the test, it requires more oxygen,
so the heart must pump more blood. The test can show if the blood
supply is reduced in the arteries that supply the heart. It also helps
doctors know the kind and level of exercise appropriate for a patient.
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A person taking the test:
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is hooked up to equipment to monitor the heart.
walks slowly in place on a treadmill. Then
the speed is increased for a faster pace and the treadmill
is tilted to produce the effect of going up a small hill.
can stop the test at any time if needed.
afterwards will sit or lie down to have their
heart and blood pressure checked
Heart rate, breathing, blood pressure, electrocardiogram,
symptoms (chest pain, shortness of breath, dizziness, and lightheadedness).
Healthy
people who take the test are at very little risk. It's about
the same as if they walk fast or jog up a big hill. Medical professionals
will be present in case something unusual happens during the
test.
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A physician may recommend an exercise stress test for various
reasons:
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To diagnose coronary artery disease
To check the effectiveness of medication for heart
arrhythmias
To diagnose a possible heart-related cause
of symptoms such as chest pain, shortness of breath or lightheadedness
To determine a safe level of exercise
To check the effectiveness of procedures
done to improve coronary artery circulation in patients with
coronary artery disease
To predict risk of dangerous heart-related
conditions such as a heart attack
Depending
on the results of the exercise stress test, the physician may
recommend more tests such as a nuclear stress test or cardiac
catheterization.
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