Cardiology FAQ

Heart disease causes as much mortality and morbidity in women as it does in men. However, women do not often have the classic signs and symptoms as described in the literature. For example, heart attack symptoms in women are different from signs of a heart attack in men. Women must be very vigilant because certain symptoms are not as easy to detect. They don’t have the “classic” symptoms such as chest pain. Any inability to conduct previously normal activity or any discomfort in the chest area should be viewed with some suspicion.

Your risk for heart attack is a combination unique to your age, family history, current lifestyle and other risk factors for heart disease. A cardiologist can work with you to evaluate your specific risk and explain the signs of a heart attack.

Your risk for stroke is dependent upon several factors. A cardiologist doctor can evaluate you for certain cardiac conditions such as atrial fibrillation that would increase your risk for stroke. Other conditions that increase your risk for stroke are smoking and hypertension. Your doctor will educate you about stroke symptoms, including signs of a stroke in women.

Certain cardiovascular conditions place people who have them at increased risk for sudden cardiac death. Some of the conditions that place people at risk for sudden cardiac death are inherited conditions. Luckily, these are not very common. Sometimes a weak heart due to prior heart attack or other cardiac conditions may increase a patient’s risk for sudden cardiac death. An evaluation by a cardiologist can determine if you have a condition such as a weak heart that might predispose you sudden cardiac death. There is often an increased risk for sudden cardiac death. A cardiologist or electrophysiologist can administer certain treatment such as a defibrillator, if indicated, to decrease this risk.

Sleep apnea puts a lot of stress on the whole body, and in particular, the heart.  Sleep apnea is a condition where people are not breathing efficiently or effectively while they’re sleeping. If they’re not able to get enough oxygen to their tissues while they’re sleeping, it puts a lot of stress on the heart. And they have a lot of episodes where they wake up in the middle of the night without even knowing they wake up, because they’re just partially awake and then go back to sleep. That puts a lot of stress on the heart and that can lead to heart rhythm problems. It can also lead to things like hypertension and other problems with tiredness, which the hypertension itself leads to the increased risk of heart rhythm problems, but treating sleep apnea is particularly important in preventing atrial fibrillation.

The coronary arteries are the arteries that give the heart its blood supply and its oxygen. So diseases of the coronary arteries happened when there was a plaque buildup or narrowing of the coronary artery, so that the arteries don’t give the heart enough oxygen for it to function.

What are some causes of coronary artery disease?

Coronary artery disease tends to happen as people get older. Some of the most important factors that cause coronary artery disease are a genetic predisposition. If there’s a lot of coronary artery disease in the family, particularly early coronary artery disease, people will also have a risk of having coronary disease. Then there are some factors that increase the risk of early coronary artery disease. These factors are uncontrolled high blood pressure, diabetes and high cholesterol levels. There are also some avoidable factors such as smoking, excessive weight and obesity and poor eating habits. Sometimes using recreational drugs can increase the risk of coronary artery disease.

Most common symptoms for coronary artery disease are pain or discomfort in the chest. This tends to happen mostly when people are active, such as when they’re walking around or when they’re exercising. The chest pain and discomfort are called angina.

Energy drinks can cause an increase in your heart rate and can sometimes lead to abnormal heart rhythms. They haven’t really been found to specifically affect coronary artery disease in any fixed pattern.

Angina or chest pain is the most common presentation in both men and women, but more women than men tend to have unusual symptoms.  Symptoms that people could have include things like just tiredness, an unusual amount of fatigue or shortness of breath/trouble breathing.  Other symptoms could be like fainting or rapid heartbeat. When you try to do things and have pain in the jaw or pain in the back and sometimes pain is in the arm.  Sometimes it’s not really pain, it’s sort of pressure, tightness or discomfort.

That is a very important question and it’s usually best to see a physician to help determine that difference. When people are seen in the clinic, we take a very detailed history to try to pinpoint what are the triggering factors and other little or large factors that may help us determine if this is more likely to be coronary disease or if this is more likely to be other causes of chest pain. In some people, we may need to do further testing, such as stress testing to see if when we put them under some sort of exercise or chemically induced sort of stress, it shows up in the heart. This tends to point more towards coronary disease, being the cause of the chest pain. There’s other tests too, which may be more invasive which may include things like angiograms which we do in the hospital. Angiograms also help to determine if people have coronary artery disease, but the specific order of evaluation and testing is usually highly dependent on these specific patients. So it’s important to see a cardiologist to help make that determination.

Well, it could progress and some people have angina or discomfort that occurs when they exert themselves. Then it could get worse. The coronary blockage or heart disease could progress to where they start having symptoms, even when they’re not exerting themselves. The worst or the most dramatic form of this is a heart attack, which is what happens when people have a sudden blockage of a coronary artery which can be life threatening.

Well, one of the first things we want to do for people who have stable coronary artery disease is to prevent progression or if possible have some regression of the coronaries. We try to make sure that blood pressure is controlled. We try to put these patients on medications to prevent blood clotting, such as aspirin. We try to make sure that their cholesterol is controlled and we try to make sure that if they’re doing any sorts of habits like smoking, we try to stop those so we can stop the progression of the coronary disease. Acute coronary disease is having things like a heart attack, which is an emergency and needs to be treated in the hospital. And when that happens the coronary artery is blocked by a blood clot and that usually needs to be opened up in the hospital using some specific cardiac tools that we have.

When some people have coronary artery disease that is severe enough, it’s important to open the artery up to the blocked artery. Those we do by putting in catheters to inject some contrast, a radiographic dye into the artery. When we inject that contrast into the artery, we can see the shape of the artery and we see whether the artery is blocked or not. If the artery has some blockages were often able to put a small, very thin wire to pass through the blockage, and then we can use a specific balloon to open up the blockage. Once we’ve opened up the blockage, we insert a stent, which is a small scaffold to keep the artery open. That’s a procedure called angioplasty and stenting, which we can do to relieve the blockage that has happened in coronary artery.

It really depends on the patient. Most of the time it’s very long lasting, but with some people, the coronary disease progresses so that they may need to have other stents in other places. So it’s very important once people have any sort of treatment for coronary disease, they get on a very intense regimen to prevent the progression of coronary disease. Now some coronary disease is too extensive to be treated with stents. Those people benefit from having open-heart surgery to bypass the blocked arteries with other veins or arteries. That’s a lot of treatment for coronary artery disease.

Well, it really depends on what part of the artery is blocked, how much blockage there is, how many total arteries that are either blocked or if there is an underlying medical condition the person has like diabetes. Do they have a lot of disease elsewhere? There are a lot of factors going into trying to pick the best treatment for each particular person and each persons particular anatomy.

Yes, once again, a lot depends on how many stents a person is having at one time. Usually  for a standard stent procedure, some patients may go home the same day and some patients stay overnight. The recovery time really varies a lot, but some people will feel different and better immediately after.

Usually depending on the type of blockage that they have, how long they’ve had the blockage, whether it’s a heart attack or whether it’s just a chronic blockage that they’ve had for a long time. So that determines how much recovery time they will need, but if everything went well and people have a stent opening a chronic blockage, a lot of times they can be back to their normal activities by the next day.

You should only take it if your doctor tells you to. The research on that has changed over the last few years, and every few years we get more data. The current data suggests that you should only be taking a baby aspirin if you already have coronary disease, or if your doctor asked you to. The reason for this is there are different classes of people. There are some people who have no coronary disease, and you’d be trying to take a baby aspirin to prevent coronary disease. Those people should have a good discussion with their doctor before getting on the aspirin. But people who already have coronary disease should all be on aspirin, unless there’s a problem, or unless there’s a specific reason for them not to be on aspirin.

Congestive heart failure is a condition when the heart is not able to pump enough blood to fulfill the needs of the body in general.

There are different kinds of congestive heart failure.  There’s a congestive heart failure where the heart is just too weak to pump the blood. And then there’s another kind of congestive heart failure where the heart may be strong enough to pump the blood, but the heart does not relax very well. This type causes high pressure in the other parts of the body and the circulatory system.

Usually a congestive heart failure that includes an enlarged heart is because the muscles are thickened.  When the heart has to both squeeze the blood out as a pump and it has to relax, it can accept more blood to squeeze the blood out as a pump.  The heart does not relax very well.  It cannot accept the blood.  So it’s function is decreased, but it may be very strong.  It may be very good at squeezing and pumping the blood out, but it just doesn’t relax very well to accept the blood.  So that causes a backlog of pressure in some of the veins.  It’s called congestive heart failure with preserved systolic function and used to be called diastolic congestive heart failure.

The enlarged heart type of congestive heart failure is not associated with a weak heart.

Congestive heart failure may occur because people have had coronary artery disease, they’ve had blockages and because of these blockages have made it impossible for the heart muscle to get any oxygen. So the heart muscle doesn’t function as usual. Congestive heart failure is related to coronary artery disease. There’s also congestive heart failure related to excessive and prolonged hypertension because the heart has had to work too hard to deal with the high blood pressure. The heart starts to get weak and there are some other forms of congestive heart failure, usually related to some sort of underlying cardiac illness that has gone on for a while. Then there are some forms of congenital congestive heart failure that has no cause sometimes it’s genetic, but for the most part, it represents the heart being unable to meet the needs of the body.

Yes, that is a possibility.  Some people may have a viral infection of the heart.  Sometimes when a virus infects the heart, people can have a weakened heart and congestive heart failure.  A lot of times this is reversible and the heart gets better, but rarely stays weak.

Obviously some of the diseases that cause congestive heart failure are more common in older people such as; high blood pressure, coronary blockages and valve problems.  These diseases are more common in older people so therefore these types of congestive heart failure are more common in this age group.

Yes. With most people the congestive heart failure is kind of the end result of other cardiac problems. So if you have had hypertension, that’s uncontrolled for a long time, the heart can eventually get weak. So the best way to control that kind of heart failure would be to make sure your blood pressure is well treated to avoid hypertension.  It could also be the end result of coronary artery disease or blockages.  So if one treats or prevents coronary artery disease, one can prevent congestive heart failure.

The surgical interventions for congestive heart failure have most to do with congestive heart failure that are due to valve problems. The valve problems can be treated. Some heart valves are too tight and some heart valves are too leaky. So those valves can be treated and that would improve the congestive heart failure. Congestive heart failure could also be due to blockages such as coronary artery disease. If those blockages are opened up and blood flow is reestablished in the heart, then congestive heart failure can improve. So those are some procedural treatments or surgical treatments for congestive heart failure opening up or treating a bad valves, opening up or treating blocked arteries.The congestive heart failure is due to abnormal heart rhythms, ablations or treatment of the abnormal heart rhythms can improve the congestive heart failure. So congestive heart failure, it has many causes, for the most part. If the causes can be reversed, congestive heart failure can be treated. Now, there are some congestive heart failure patients who have congestive heart failure that are very, very far advanced. And some of these very; far advanced patients with congestive heart failure may need to have some sort of cardiac support such as a specialized heart pump, used to help the heart pump better.  Some people who have very bad congestive heart failure that have not responded to medications may need to have a heart transplant.

As far as we know, the corona virus tends to affect mainly respiratory health.  I don’t think that it has any long term affects on the heart.  When the corona virus first strikes, it may have some short term affects on the heart.

Ejection fraction is a measure of how well the heart is performing its pumping function.  The left ventricle is the heart’s main pumping chamber and pumps blood through the entire body.  Thus, the left ventricular ejection fraction is a description of the pumping effectiveness of the heart’s main pumping chamber. And normal ejection fraction is usually above 50%.

These patients are recommended to have a defibrillator, which is a kind of device that monitors for cardiac arrest and shocks the heart to prevent death from cardiac arrest.  For these people a defibrillator is implanted by an electrophysiologist to prevent a premature death from cardiac arrest.

Some types of congestive heart failure are definitely well-treated by an electrophysiologist.