Our “Frequently Asked Questions” on cardiac and vascular health issues provide you with information specific to your problem and our services. Please browse through the questions and answers in the area of your concern.

If you still have questions, or would like to schedule a consultation, contact us at (918) 744-2598.

• What is cardiac catheterization?  answer
• What does cardiac catheterization show?  answer
• How do you prepare for this procedure?  answer
• What should I expect?  answer
• What can I do when I return home?  answer
• When should I call my doctor?  answer
• What are the risks?  answer
• How does the circulatory system work?  answer
• What is claudication?  answer
• What are the symptoms of claudication?  answer
• What causes arteries to become blocked?  answer
• How can I tell if I have arterial blockages?  answer
• How is claudication diagnosed?  answer
• How is claudication treated?  answer
• What are the risks?  answer
• What is congestive heart failure?  answer
• What are the symptoms of congestive heart failure?  answer
• How is congestive heart failure diagnosed?  answer
• How is congestive heart failure treated?  answer
• What are the risks?  answer
• What is coronary angioplasty?  answer
• What do angioplasty and stenting do?  answer
• What should I expect?  answer
• What happens the day of the angioplasty?  answer
• What happens after the angioplasty?  answer
• What can I do when I return home?  answer
• When should I call my doctor?  answer
• How will I feel after the angioplasty?  answer
• What are the risks?  answer
• How does your heart work?  answer
• What is bypass surgery?  answer
• What causes a blocked artery?  answer
• Where does atherosclerosis come from?  answer
• How is your problem diagnosed?  answer
• How do we determine if you need bypass surgery?  answer
• How do I prepare for bypass surgery?  answer
• What happens before bypass surgery?  answer
• What happens during bypass surgery?  answer
• What happens to the blockage?  answer
• How will I feel after my bypass surgery?  answer
• What can I do when I return home?  answer
• What are the risks?  answer
• What is electrophysiology?  answer
• How does electricity work in my heart?  answer
• How do I prepare for my electrophysiology study?  answer
• How is the electrophysiology study done?  answer
• How do the pacing wires work?  answer
• What is ablation therapy?  answer
• What happens next?  answer
• What are the risks?  answer
• How do I know if I have heart or circulatory disease?  answer
• What are the risk factors for heart or circulatory disease?  answer
• Why see a cardiologist?  answer
• What will a cardiologist do?  answer
• What is an echocardiogram?  answer
• What is an electrophysiological (EP) Study?  answer
• What is a stress test?  answer
• What is a nuclear imaging test?  answer
• What will the results of these tests tell the doctor?  answer
• Should I know the signs of a heart attack?  answer
• What are the risks?  answer
• Is heart disease a concern for women?  answer
• What are the risk factors and prevention?  answer
• What are the symptoms or warning signs?  answer
• How is heart disease diagnosed?  answer
• What should you do if you suspect you have a heart problem?  answer
• What are heart valves?  answer
• What causes a heart valve problem?  answer
• What is heart valve surgery?  answer
• How do I prepare for heart valve surgery?  answer
• What happens after surgery?  answer
• What are the risks?  answer
• What is the heart?  answer
• What are the heart’s chambers?  answer
• What are the heart’s valves?  answer
• How do the chambers and valves work together?  answer
• What are coronary arteries?  answer
• How are heart problems diagnosed?  answer
• What can I do?  answer
• What is a pacemaker?  answer
• Why do I need a pacemaker?  answer
• What is done during pacemaker surgery?  answer
• How will I feel with my new pacemaker?  answer
• What may I do when I get home?  answer
• When should I call my doctor?  answer
• What about diet and activities?  answer
• What about electrical interference?  answer
• How does my pacemaker work?  answer
• Can the battery/timer or wires of my pacemaker be changed?  answer
• What are the risks?  answer
• What is atherosclerosis?  answer
• What is balloon angioplasty?  answer
• How do I prepare for an angioplasty?  answer
• What happens the day of my angioplasty?  answer
• What happens after my angioplasty?  answer
• How will I feel after my angioplasty?  answer
• What can I do when I get home?  answer
• When should I call my doctor?  answer
• What are the risks?  answer
• What is peripheral arterial disease?  answer
• How is arterial blockage diagnosed?  answer
• How is arterial blockage treated?  answer
• What is bypass surgery?  answer
• How do I prepare for bypass surgery?  answer
• What happens before bypass surgery?  answer
• How will I feel after bypass surgery?  answer
• What can I do when I return home?  answer
• When should I call my doctor?  answer
• What are the risks?  answer
• What does Cardiac Rehabilitation offer?  answer
• Who benefits from cardiac rehabilitation?  answer
• What is the Phase IV Maintenance program?  answer
• What fees are covered by insurance?  answer
• How do I enroll?  answer
• How do I know if I have circulatory problems in my legs?  answer
• What are the risk factors for peripheral vascular disease?  answer
• Should I see a vascular specialist?  answer
• What will a vascular specialist do?  answer
• How can vascular disease be treated?  answer
• What is an angioplasty?  answer
• What is bypass surgery?  answer
• What can I do?  answer
• What are the risks?  answer
• What are the causes and risk factors of Congestive Heart Failure?  answer

• What is the relation between sleep apnea and conjestive heart failure?

    answer
• What testing/procedures are used in patients with congestive heart failure?  answer

Cardiac catheterization is a diagnostic procedure that provides your doctor with information that cannot be obtained by any other means.

The procedure is sometimes referred to as a coronary angiogram or coronary arteriography and is simply a special X-ray test used to look at the arteries and chambers of the heart.

A cardiac catheterization is NOT surgery. It is a diagnostic study that generally takes about one to two hours to complete.

Back to top

This procedure helps doctors to diagnose heart conditions such as coronary artery disease, defective heart valves, or congenital heart defects (defects you are born with). Cardiac catheterization also provides important information about the heart’s pumping function.

Back to top

There are several routine tests done before a cardiac catheterization:

• EKG (electrocardiagram)
• Blood tests (less than one week prior)
• Medical history and exam
• Chest X-ray

You will receive specific instructions about the food you may have. Generally, may have nothing to eat or drink six to eight hours before the procedure.

Some suggestions to help you prepare:

• Pack a small bag of overnight clothing in case your doctor decides you need to stay overnight
• Do not bring any valuables
• Bring a list of your medications (with exact names and dosages) that you currently take
• Your physician will tell you which medications you may take on the day of the procedure
• Arrange for someone to drive you home
• Be sure to mention if you are allergic to X-ray dyes
• Empty your bladder for your own comfort
• You may wear your dentures, hearing aids, or glasses

Back to top

The procedure is done in a catheterization laboratory (also called a cath lab).

Generally, you will arrive on the morning of the day of the procedure. You will possibly go home later that same day, unless you are already a patient in the hospital.

You will be awake during the procedure, which usually takes less than an hour for catheterization only. If you have a balloon angioplasty or other procedure, more time will be required.

A local anesthesia is injected and a small tube, or sheath, is inserted into the artery in your arm or leg. You may feel a little pressure.

The procedure begins when the doctor inserts a thin, flexible tube (called a catheter) through the sheath into the artery. The catheter is passed toward your heart. As this is done, the doctors and technicians check the TV monitors to follow the catheter’s movement to the heart.

Then a dye is injected through the catheter. This helps the doctor to pinpoint where the problem with your coronary arteries might be. When the procedure is finished, the doctor will remove the catheter. A nurse or technician will apply pressure for 15-20 minutes.

A pressure bandage is placed on the site before you are returned to your room.

If the catheter was inserted in the groin, you’ll remain lying down for several hours and be asked not to move your leg. The nurses will watch you carefully, take your blood pressure, and check the site frequently to make sure there is no bleeding. You will be asked to drink a lot of fluids to flush the dye out of your system. Most people have no pain, and, in most cases, you will go home that same day.

Your doctor will return to explain the results to you. Sometimes cardiac catheterization will show that your heart is just fine. If there is a problem, your doctor will discuss all possible treatments.

Back to top

Be sure to make arrangements to have a friend or family member drive you home.

Avoid heavy lifting, and do only light activities for a few days.

You may have a small bruise or lump the size of an olive under the skin at the insertion site. This should go away in a few weeks.

Back to top

You should call your doctor if:

• The insertion site bleeds
• You feel chest pain or discomfort
• Your arm or leg feels cold or numb
• The bruising or swelling gets worse or increases
• You have a fever, or signs of infection appear at the insertion site
• You have any other unusual symptoms

Back to top

This is called an invasive procedure because a catheter is inserted into the body. As with any procedure of this type, there can be some risk involved. Please ask your doctor to discuss the risks and benefits so that you are fully informed.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Heart — Your heart is the pump for your circulatory system. It is made of muscle and is able to contract in order to pump blood through your body.

Arteries and Veins — The arteries and veins are the roadways through which blood is transported to all parts of your body. Arteries carry oxygen-rich blood from your heart to the rest of your body. Veins return the blood to the heart after the oxygen has been used.

Oxygen — Your body needs oxygen in order to function. When you walk, your leg muscles need increased amounts of oxygen in order to do their work. If the arteries in your lower body are able to carry blood unimpeded to your muscles, then you are able to walk comfortably.

If you have blockages in your leg arteries, or in the arteries leading to the legs, you may not be able to get enough oxygen-rich blood down to your legs. The decrease in oxygen to your legs will often result in claudication.

Back to top

Claudication is a term used to describe the discomfort felt in leg muscles that occurs when you walk because of a decrease of blood pressure in the leg.

Back to top

Symptoms may occur in one or both legs and they are most often described as cramps. They may also be described as a burning sensation, an ache, or a feeling of heaviness in the leg.

The most common place to feel the cramping is in the calf muscle, although cramping may also appear in the thigh or buttock.

Typically, persons with claudication will be able to walk a certain distance, say three blocks, before the cramping becomes so severe they must stop and rest. When they have rested until the pain is gone, they may walk exactly the same distance again before having to stop and rest. The distance a person is able to walk varies with the severity of the blockages in the arteries. Most people with claudication experience no leg discomfort when they are at rest.

Back to top

Arterial blockage, or atherosclerosis, is caused by a buildup of fatty deposits on the inside of the arteries. This fatty buildup makes the artery narrow which reduces the amount of blood flow through the vessel.

Back to top

Tell your physician about your symptoms. After your physician has spoken to you and has done a physical exam, you may need to have some testing done.

Back to top

There are relatively simple tests that can be performed to determine whether your arterial blood flow is normal:

Arteries and Veins — During this test, the technologist will place blood pressure cuffs at several points along your legs and take the blood pressure using a Doppler. You may be asked to walk on a treadmill, after which your ankle pressures will be taken again to determine if the pressures decreased when you walked.

Ultrasound scan — During an ultrasound scan, blood flow is evaluated and the diameter of the arteries is measured.

Arteriogram — During an arteriogram, dye is injected into the arteries while X-rays are taken. The dye “lights up” the arterial system allowing the areas of blockage to be accurately pinpointed.

Back to top

With the information obtained from your diagnostic tests, your physician will be able to determine the best treatment plan and course of action to take for your particular situation. Whatever you and your doctor decide will be explained to you in full detail. This can include:

• Angioplasty
• Bypass Surgery
• Diet
• Exercise
• Medication
• Stent

Back to top

There can be some risk involved with certain diagnostic procedures, and in most cases they are relatively minor. Please ask your doctor to discuss the risks and benefits so that you are fully informed about any tests you may have.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

You have congestive heart failure when excess fluid starts to leak into the lungs and/or the peripheral parts of the body. Normally the pumping actions of the left and right sides of the heart compliment each other, producing a continuous flow of blood. Heart failure may occur with both ventricles failing, although one ventricle may precede the other in dysfunction.

The most common form of initial heart failure is left-sided failure which occurs when the left ventricle is not working properly. This causes blood to back up through the left atrium and into the pulmonary veins, resulting in pulmonary congestion and edema because the fluid is backed up into the lungs. The most common causes of left-sided failure are disease of the coronary arteries, hypertension (high blood pressure), cardiomyopathy (enlarged heart), and rheumatic heart disease.

Right-sided failure can occur as a result of damage to the right ventricle, such as a heart attack or enlargement of the right ventricle. Right-sided heart failure from a weakened right ventricle causes fluid to back into the body, resulting in swollen ankles and weight gain.

Back to top

Symptoms of congestive heart failure may include:

• Persistent coughing or wheezing
• Fatigue and weakness
• Feeling of suffocation while sleeping (unless propped up on two or more pillows)
• Unusual swelling in the lower legs and ankles
• Sudden weight gain from fluid retention (two or more pounds overnight)
• Shortness of breath during normal activities
• Increased heart rate
• Digestive problems

Back to top

If you are having the symptoms of CHF, it is important to see your physician. Your doctor will ask about your medical history and your symptoms. After a full physical examination, your doctor will want to assess the condition of your heart and may conduct some of the following tests:

• Chest X-ray to check for heart enlargement
• Electrocardiogram (EKG) to assess the electrical activity of the heart and to diagnose abnormalities, such as a previous heart attack
• Echocardiogram (Echo) to check valve function and heart size by ultrasound
• Nuclear ventriculogram to evaluate the pumping function of the heart
• Cardiac catherization to diagnose coronary artery disease and evaluate previous heart attacks

Back to top

With the information obtained from your tests, your doctor will be able to determine the best treatment plan for you. Whatever plan you and your doctor choose will be explained to you in full detail.

In most cases, heart failure is a chronic condition that will not go away, although it may be successfully managed by taking medications and making healthy changes in habits such as diet and exercise.

Remember, successful treatment of heart failure requires teamwork on the part of you, your family, and your doctor. The earlier you start treatment for heart failure, the better your chances of maintaining energy, controlling symptoms, and preventing further damage to your heart.

Back to top

There can be some risks involved with certain diagnostic procedures, and in most cases they are relatively minor. Please ask your doctor to discuss the risks and benefits so that you are fully informed about any tests you may have.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Coronary artery disease, or hardening of the arteries, is the most common form of heart disease in the United States. It can coexist with other forms of heart disease such as a weakened heart muscle or diseases of the heart valves.

Cardiac catheterization is a diagnostic procedure that provides your doctor with precise information about your particular heart condition, allowing much more individualized treatment.

The results of your cardiac catheterization may indicate that you have a narrowed artery that can be opened by angioplasty and/or stenting.

Angioplasty is sometimes referred to as a PTCA — percutaneous transluminal coronary angioplasty, or balloon angioplasty. It is a non-surgical way to treat artery buildup (atherosclerosis). Angioplasty is commonly performed with stenting, in which a balloon is used to expand a metal sleeve inside the artery.

Back to top

Angioplasty is a non-surgical treatment designed to open clogged arteries. This procedure is done after the doctor has seen the angiogram (picture) that shows where the arteries are blocked. Angioplasty, with or without stenting, opens the arteries to restore blood flow.

Back to top

Several routine tests are done before the angioplasty:

• EKG (electrocardiagram)
• Blood tests
• Medical history and exam
• Chest X-ray

You will receive specific instructions about the food you may have. Generally, you will be allowed nothing to eat or drink six to eight hours before the procedure.

Some suggestions to help you prepare:

• Pack a small bag of overnight clothing and clothing for the next day
• Do not bring any valuables
• Bring a list of your medications (with exact names and dosages)
• Arrange for someone to drive you home
• Be sure to mention if you are allergic to X-ray dyes or shellfish, or if you have problems taking aspirin or blood thinners
• Empty your bladder for comfort
• You may wear your dentures, hearing aids, or glasses

Back to top

The procedure is done in a catheterization laboratory (cath lab). It begins with a thin, flexible tube (the catheter) which the physician inserts through a sheath (previously inserted) in your arm or leg and maneuvers toward your heart.

A radio-opaque dye is injected, which allows the physician to view the coronary arteries. Blood pressure recordings may be made in the various chambers of your heart, and valve function can be examined. Pictures will be taken with specialized cameras.

When the blockage is located, a balloon catheter is placed in the narrowed artery and slowly inflated to press the fatty deposits against the artery walls.This allows the blood to flow more freely to the heart muscle.

In many cases, superior results can be obtained if the cardiologist inserts a stent into the area of the blockage and expands it with the balloon. A stent is an expandable wire mesh tube, sized to fit your artery. Once in place, a stent can provide a better channel for blood flow through the artery, with a better long-term result.

Back to top

You will be asked to drink plenty of fluids to help flush the dye contrast out of your system. Later, when the sheath is removed, a sandbag or pressure bandage will be placed on the insertion site to prevent bleeding. You will remain lying down for several hours.

Back to top

Avoid heavy lifting and do only light activities for a few days.

Back to top

You should call your doctor if:

• The insertion site bleeds
• You feel chest pain or discomfort
• Your arm or leg (at the insertion site) feels cold or numb
• The bruising or swelling gets worse or increases
• You have a fever, or signs of infection (redness or oozing) appear at the insertion site
• You have any other unusual symptoms

Back to top

Your doctor will talk to you about the amount of improvement in the artery opening and the possibility of your symptoms returning, medications, restrictions, and changes in daily habits to reduce the risk of more arteries narrowing. You’ll also be told when to return for follow-up visits.

Back to top

There can be some risk involved with certain diagnostic procedures. In most cases they are relatively minor. Please ask your doctor to discuss the risks and benefits so that you are fully informed about any tests you may have.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

It is important for you to know as much as possible about how your heart functions in order to have a complete understanding of bypass surgery.

Your heart is a muscle that pumps blood throughout your body. To do its work, your heart needs a constant supply of oxygen-rich blood which it gets from the lungs.

Coronary arteries are blood vessels that wrap around the heart muscle and keep it supplied with oxygen-rich blood. When blood is pumped by the left ventricle, it is forced into the body’s largest artery, the aorta, located at the top of the heart. Two coronary arteries, the left main artery and the right coronary artery, branch off the aorta.

The left main artery is about as wide as a drinking straw and less than an inch long. It branches into two narrower arteries: the left anterior descending, which travels down the front side of the heart, and the left circumflex, which circles around the left side and then to the back of the heart. The right coronary artery branches from the aorta, circles around the right side and then to the back of the heart. These arteries are on the outside surface of the heart. They divide into smaller branches, similar to a tree, and go deep into the heart muscle carrying oxygen-rich blood to the cells.

Back to top

Coronary bypass surgery is an operation in which other blood vessels are used to go around, or bypass, clogged coronary arteries. Blood can then flow freely to the heart through the new arteries.

Back to top

Atherosclerosis is the buildup of fatty deposits on the inside of the arteries. They become narrow and reduce the blood flow to the heart (like a clogged drain).

Back to top

Cholesterol is a necessary component of the human cell; but, over time, cholesterol in the blood can become deposited on the inside walls of the arteries. This seems to happen faster in people who:

• Smoke
• Have high blood pressure
• Eat high fat, high cholesterol foods, or, for other reasons, have high cholesterol
• Are overweight
• Have a lot of tension and stress
• Do not exercise regularly
• Have diabetes and/or family members with a history of atherosclerosis

Back to top

If you have a blockage in one or more of your arteries, the blood supply to your heart is severely compromised. The chest pain, chest discomfort, arm pain, or other symptoms you may have experienced are the warning signs that your heart muscle is not getting enough blood. If this persists, you could suffer a heart attack and the muscle will be damaged.

Back to top

A cardiac catheterization may be done. Pictures, called angiograms, are taken to show the blockages.

Back to top

Rest, eat well, quit smoking, and walk or do the exercise allowed by your doctor. Several routine tests are done before surgery:

• EKG (electrocardiagram)
• Echocardiogram
• Blood tests
• Medical history and exam
• Chest X-ray

Make a list of any questions you have and ask the doctor before surgery. You will receive specific instructions before surgery to completely prepare you for the procedure.

Back to top

The morning of surgery you will be given medication to make you feel relaxed and drowsy. You will be taken to surgery and will be in the operating area for several hours. The waiting time will seem long to your family, but the heart surgery will not take that long.

Back to top

The operation will take 2 1/2 to 5 hours. The surgeon will connect you to a coronary bypass machine (heart/lung machine) which assumes the function of your heart and lungs until the surgery is completed. The surgeon takes a blood vessel from your leg and attaches one end to the aorta (the large artery that comes out of the heart) and the other end to the coronary artery below the point where it is blocked — this is the bypass. A blood vessel from within the chest may also be used. Blood now flows freely through the new bypass graft to the heart.

Back to top

The blockage remains as is. The blood supply has been rerouted around it to the heart muscle.

Back to top

You will wake up in the ICU (Intensive Care Unit), and you may feel confused at first. Your family will be able to visit briefly. Be assured you are in capable, caring hands. You may be uncomfortable and unable to talk, but the nurses will help you communicate.

The equipment surrounding you helps you breathe, measures heart function, checks your blood pressure, heart rate, and kidney function. After all your vital signs are stable and you are doing well, you’ll be sitting up in a chair.

Most of the tubes and catheters will be removed within a day or two, and you’ll be moved to a regular room. You will be asked to breathe deeply and cough hard to clear any fluids from your lungs. You will feel sore, and you may experience night sweats, moodiness, or even feel down. This is all quite normal. If necessary, the surgeon will prescribe medication to keep you comfortable. If you are in pain, don’t hesitate to tell your nurse or doctor so that pain medication can be prescribed for you.

The nurses will have you moving and walking around right away. Within a few days you will eat a normal meal and begin to feel better each day.

Back to top

Your surgeon and the hospital staff will discuss any restrictions you may have.

You will be seen by your doctor a few weeks after surgery. After six to eight weeks, you should be 80% recovered, and completely recovered from the operation within three months. Most people with sedentary office jobs can return to work in four to six weeks; those with physically demanding jobs will have to wait longer.

You may be instructed to make some changes in your life style such as reducing your consumption of fat and cholesterol, and exercising daily.

Back to top

Almost half a million bypass surgeries are performed each year. As in all major surgery, there are risks. Coronary bypass surgery has an excellent success rate. There is a small risk of stroke, bleeding, infection, heart attack, or death. After careful review of your medical history and a physical exam, your surgeon will identify your risks.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

An electrophysiology study, or EPS, is a diagnostic procedure to look more closely at the electrical function of your heart. It is the most accurate and reliable method of evaluating your heart rhythms and will help your physician determine the treatment option that is most appropriate for you.

Back to top

The body naturally produces electricity that travels over the heart muscle and stimulates the heart to contract or beat.

The electrical signal that tells your heart to beat comes from a small area of the right atrium of the heart. This area is located in the upper right chamber of your heart and is called the sinoatrial node, or SA node.

When a signal is given by the SA node, a small electrical impulse runs through your heart and stimulates the heart muscle to contract. The contraction of the heart muscle produces a heartbeat and forces blood out of your heart to the rest of your body.

Certain conditions can cause the electrical system to make the heart beat too slowly, too fast, or in an uncoordinated manner. These irregular patterns are called arrhythmias and they can occur in any of the four chambers of the heart.

An electrophysiology study will help your physician determine the best treatment for you by showing where the arrhythmias are occurring.

Back to top

If you are currently taking medications to control your heart rhythms, you will be asked to stop taking them prior to the study. Your physician will give you specific instructions regarding other medications you may be taking. You will be asked not to eat or drink anything for eight hours prior to your EPS. On the day of your study, you will be admitted to the hospital where you will have blood tests, an ECG, and a chest X-ray done.

Back to top

An EPS is performed in an electrophysiology lab that will be darkened to make it easier to see the cardiac monitors. You will lie flat on a padded X-ray table and an IV will be started for administration of medications and the dye that will be used. Your groin will be shaved and cleaned with an antiseptic solution and an area on the neck may also be cleaned, depending on the type of arrhythmia you have. A local anesthetic will be used to numb the skin and a small tube (called a sheath) will be placed into a blood vessel in the groin. Once the sheath has been placed, small plastic catheters (pacing wires) are guided up to the heart.

A fluoroscopic X-ray allows your doctor to watch as the catheter is carefully guided to various locations in the heart. You will not feel the catheter being inserted into your heart because there are no sensory nerves inside veins and arteries. Recordings are made from the catheters, from which your physician can diagnose the type of arrhythmia you have and determine the best treatment.

Back to top

The pacing catheters are inserted into your heart to serve two purposes:

• Record ECG signals from the inside of your heart
• Deliver electrical impulses to your heart muscle (called “pacing”)

The pacing will trigger the arrhythmia that is causing your problem. During the test, you may feel your heart race or skip beats. This is caused by the electrical impulses from the pacing. When the arrhythmia is triggered, you may feel the same symptoms you have had in the past: chest pain, dizziness, warmth, palpitations, or in some cases, loss of consciousness.

The arrhythmia can be stopped by pacing your heart, administering medications, or by shocking your heart.

When an arrhythmia can be started and stopped, your physician may test an antiarrhythmic medication (through the IV) for a period of 20 to 30 minutes. When a satisfactory amount of medication has been given, your physician will repeat the pacing to determine if the drug will prevent your heart arrhythmia.

When the entire study has been completed, the catheters and sheath will be removed. Firm pressure will be applied to the groin area for approximately 15 minutes to prevent bleeding from the insertion site. Once the bleeding has stopped, you will be moved to a patient room to recover. The entire EPS takes about 2-3 hours from start to finish.

Back to top

Ablation therapy is a technique designed to treat tachycardias (fast heart rhythms) and eliminate the need for medications. After the area of the heart causing the arrhythmia is pinpointed, your physician treats the problem by applying radio frequency energy through the catheter which destroys (ablates) the arrhythmic tissue.

Back to top

You will be required to lie flat for 4 to 6 hours following your study. Your blood pressure, heart rate, and areas where the catheters were inserted will be checked frequently. Notify your nurse immediately if you should develop any numbness or tingling in your arm or leg, bleeding from the insertion site, or if you have chills or fever.

Back to top

This is called an invasive procedure because a catheter is inserted into the body. As with any procedure of this type, there can be some risk involved. Your physician will discuss the risks of your particular case in detail with you.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Some people have symptoms such as chest pain, shortness of breath, irregular heart beats, and others have no symptoms. However, just having a simple blood test to check your cholesterol, or having your blood pressure checked and discussing your health history with a qualified physician will give you the information you need to decide whether or not you need further treatment.

More than 2,500 Americans die each day from heart disease, the nation’s number one killer! Many are struggling to recover from a heart attack, while others at high risk are getting the care they need and making the necessary changes to lower their risks.

Back to top

The number of risk factors you have determines your risk of heart disease. Some risk factors can be controlled, and it has been proven that doing so will reduce the chances of heart or circulatory disease developing or worsening. Risk factors include:

• Family history of heart disease
• High cholesterol
• Gender and age: females 55 years or older or past menopause; males 45 years or older
• Diabetes
• Smoking
• High blood pressure
• Low HDL (good) cholesterol

Back to top

A cardiologist is a medical doctor who specializes in diseases of the heart. This is a highly specialized field requiring four years of medical school, three years of internal medicine residency, and two-to-four years of cardiology fellowship or training.

Back to top

A thorough medical history and physical exam will give the doctor information needed to determine if further tests are required. At your first visit, the nurse will take your blood pressure. You may have a blood test to check your cholesterol, and you may have an EKG (electrocardiogram). This simple test graphically records the electrical activity of the heart and can reveal evidence of heart attacks or insufficient blood supply to the heart. Other tests, such as an echocardiogram, electrophysiology (EP), exercise stress test, vascular studies, or nuclear imaging test may also be ordered.

Back to top

An echocardiogram, also called an echo test, uses sound waves to take moving pictures of the heart. This test is used to assess the pumping function of the heart and can show the doctor if there is heart disease or problems with the heart valves. It is painless and has no side effects.

Back to top

An EP study evaluates the electrical function of your heart and helps your physician to evaluate rhythm disturbances accurately and reliably. It will help your physician to determine the most appropriate treatment option for you.

Back to top

An exercise stress test, or treadmill test, is done to examine the heart’s ability to function under physical stress and exercise. The results help diagnose heart disease, causes of chest pain, and coronary artery disease.

Back to top

Nuclear medicine is a specialty that has been practiced since the 1940s. A nuclear medicine test carries no greater risk than conventional X-ray procedures. The purpose of this test is to evaluate the cause of certain symptoms you may be having such as chest pain and/or shortness of breath. This test will help establish a diagnosis of heart disease.

Back to top

After your exam and any tests that were done have been reviewed, you and your doctor can determine the best treatment for your diagnosis. Your doctor may tell you that further diagnostic testing, such as cardiac catheterization, is necessary. This is usually done as an outpatient procedure at the hospital.

Your doctor may tell you that lifestyle changes, modifications to diet, and exercise are needed. You may need to be put on special medications.

You can do plenty to get your heart in shape. Healthy changes will help you feel and look better:

• Improve your eating habits
• Stop smoking
• Be more active, and EXERCISE!
• Take your medications

Back to top

Absolutely! The signs of a heart attack are:

• Pain and/or pressure in the chest
• Pain spreading to shoulders, arms or neck
• Feeling faint or out of breath
• Nausea
• Sweating

If you experience any of these symptoms, seek emergency medical attention.

Back to top

There can be some risk involved with certain diagnostic procedures, and in most cases they are relatively minor. Please ask your doctor to discuss the risks and benefits so that you are fully informed about any tests you may have.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Diseases of the heart and circulatory system kill over half a million women every year. Approximately 35 percent of heart attacks in women go unnoticed or unreported. This is because some women and their doctors do not always take heart disease symptoms seriously, and also because women’s symptoms are sometimes more subtle than men’s. Women do not often view heart disease as a women’s problem. They will frequently continue activities when they feel ill, either seeing their symptoms as not serious, or just not realizing that they represent a heart condition. Women and their doctors need to understand the significance of heart disease and the gender differences in risk factors and symptoms.

Heart disease and stroke can strike women at any age. The processes that lead to heart disease start in young women and develop over time. There are some risk factors you cannot control such as getting older, but by making some lifestyle changes you can lower your risk for cardiovascular disease.

Back to top

Smoking is the single most preventable risk factor. Women who smoke increase their heart disease risk two to four times more than that of a nonsmoking woman. You can do something about this risk factor. If you don’t smoke, don’t start! If you do smoke … find help and quit now!

High cholesterol in the blood can build up and lead to deposits that narrow arteries and block blood flow. There are two main types of cholesterol:

• LDL (low-density lipoprotein) is often called “bad cholesterol” because it raises the risk of heart disease and stroke.
• HDL (high-density lipoprotein), or “good cholesterol,” helps to remove cholesterol from the blood, and lowers the risk of heart disease. Research shows that low levels of HDL appear to be a stronger risk factor for women than for men. Losing extra weight, quitting smoking, and regular physical activity may help to boost HDL cholesterol levels.

High blood pressure, also known as hypertension, is the most important risk factor for heart failure and stroke. Women have a greater risk of developing high blood pressure if they are 20 pounds or more over a healthy weight for their height and build, have a family history of high blood pressure, take certain oral contraceptives, or have reached menopause. More than half of all women over the age of 55 suffer from this condition. The only way to find out if you have high blood pressure is to have it checked at least every two years. High blood pressure can be reduced by:

• Reducing the sodium (salt) in your diet
• Maintaining normal body weight
• Limiting alcohol consumption
• Increasing physical activity
• Taking prescribed medications

Physical inactivity is also a risk factor, especially when combined with excess weight and high cholesterol. About three-fourths of American women are not active enough to keep their hearts healthy. Thirty minutes of moderate-intensity physical exercise a day on most days will help gain heart health benefits.

Being overweight (obesity) increases your risk of cardiovascular disease. Excess body weight in women is linked with coronary heart disease, congestive heart failure, stroke, and death from heart related causes.

Diabetes mellitus is a condition where the body is unable to either produce or respond to the hormone insulin. Women with diabetes have from three to seven times greater risk of heart disease and heart attack, and are at much greater risk of having a stroke. Diabetes doubles the risk of a second heart attack in women, but not in men.

Other risk factors for women:

• Menopause and estrogen loss
• Birth control pills
• High triglyceride levels
• Excessive alchohol intake

Back to top

The classic warning signs of a heart attack are pressure in the chest and pain shooting down the left arm. These symptoms are more common for middle-aged men. Only 50 percent of women will experience these symptoms.

Common warning signs:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back
• Pain that spreads to the shoulder, neck, or arms
• Chest discomfort with light-headedness, fainting, sweating, nausea, or shortness of breath

Less common warning signs:

• Unusual chest, stomach, or abdominal pain
• Shortness of breath, difficulty breathing, and dizziness
• Unexplained anxiety, weakness, or fatigue
• Heart palpitations, cold sweat, or paleness

If you are having these symptoms, it is important that you speak to your physician about your symptoms.

Back to top

When you visit your physician, you will be asked about your medical history and symptoms. To diagnose a possible cardiovascular problem, a physical examination will be done that may include checking blood pressure, weight, heart, lungs, and blood vessels. Your physician will want to assess the condition of your heart and may suggest additional blood tests, X-ray, ECG, ambulatory ECG, exercise test, heart catheterization and/or nuclear imaging. These tests will help determine if you have heart disease.

Your doctor will explain the results of your tests. With the information obtained from your tests, your doctor will be able to determine the best possible treatment plan for you. Whatever you and your doctor decide will be explained to you in full detail.

Back to top

A primary care physician may recommend a cardiologist, or you may have the option to choose one yourself. The cardiologist will guide your care and plan treatments and tests.

Now that you have a better understanding of heart disease in women, you should be able to more fully understand your symptoms and the treatments you may need.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

There are four valves that control the flow of blood through the four chambers of the heart. The valves are made of thin but extremely strong flaps of tissue that open and close as your heart beats.

The job of the four valves is to ensure that the blood flows forward as your heart contracts and relaxes. They are like one-way doors that keep the blood moving in one direction and prevent it from backing up into the chamber from which it came. When the heart beats, the valves close to keep the blood from flowing backward.

Back to top

There are several things that can cause problems with your heart valves. A heart valve may have a mild defect at birth that will slightly weaken the valve and affect blood flow. Over time, this leads to failure of the valve. Diseases like rheumatic fever or bacterial infections may scar or destroy the valve.

Aging and normal wear and tear of tissues will weaken or harden heart valves. A human heart beats more than 100,000 times a day. Your heart valves have been opening and closing with each heart beat for your entire life. The valves must flex, stretch and hold back pressure hundreds of millions of times in an average lifetime.

The mitral and aortic valves on the left side of the heart are most commonly affected by aging because pressures are higher on the left side. The right heart valves can be damaged by infection or by back-pressure from the lungs because of lung disease. When disease causes the valves to harden and weaken, they will not open properly and the blood flow is blocked.

Back to top

Heart valves may either be repaired or replaced, depending on the damage. These operations have become very common and are done to improve the health, quality and longevity of life for those who have heart valve disease.

Sometimes the surgeon can restore the valve to function normally by remodeling the tissue — removing stretched tissue or sewing the edges. Prosthetic or artificial rings are used to narrow a dilated valve and to reinforce valve repairs. One advantage of a heart valve repair operation is that a person’s own valve tissues are used.

Heart valves that are seriously deformed or degenerated cannot be repaired. The old valve is removed and replaced with a new valve mechanism. The new valve is attached by sewing it to a rim of tissue kept from the original valve. There are different types of valve mechanisms in two categories — tissue valves and mechanical valves.

Back to top

Feeling anxious is very natural when considering any type of operation. You can reduce your anxiety by resting, eating well, limiting exercise, and talking to the health care professionals who are handling your case. Having the procedure explained to you, voicing your concerns, and getting your questions answered will help put you at ease. Being well informed will help you feel more relaxed as the procedure draws near. It is best to get specific information about your own case from your doctor.

Back to top

After you are discharged from the hospital, you will have regular visits with your surgeon and cardiologist.

Eating nutritious meals is very important to your healing. Limiting how much salt you eat is often advised after heart valve surgery.

If you smoke, you are strongly urged to give up tobacco products.

Follow a gradual exercise program to help you have a quicker recovery.

You will discuss with your surgeon when you can resume driving, return to work, and with what limitations. Your doctor will also discuss your medications. Even over-the-counter medications will need your physician’s approval.

Your successful recovery depends on how well you follow medical advice, exercise, and follow healthy living suggestions.

Back to top

As in all major surgery, there are risks. Heart valve surgery has an excellent success rate. There is a small risk of:

• Stroke
• Bleeding
• Infection
• Heart attack
• Kidney failure
• Death

After careful review of your medical history and a physical exam, your surgeon will identify your risks.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Your heart is a muscle that pumps blood throughout your body. Every time your heart beats it is pumping blood. To do its work, your heart needs a constant supply of oxygen-rich blood which it obtains from the lungs.

The heart pumps the oxygen-rich blood to provide nutrients, minerals, and oxygen needed for your body to work.

Back to top

The heart muscle is divided into four compartments or chambers, with two on the left side and two on the right side.

The upper chamber on each side is called an atrium. The atrium receives and collects blood. The lower chamber on each side is called a ventricle. The ventricles pump blood. The right ventricle pumps blood only to the lungs. The left ventricle is the main pumping chamber of the heart. It pumps blood to all parts of the body except the lungs.

Back to top

There are four valves that control the flow of blood inside the heart. They are like one-way doors to keep the blood moving in one direction. When the heart beats, the valves close to keep the blood from flowing backward.

Back to top

Oxygen-poor blood that returns from the body collects in the right side of the heart (right atrium). It passes through the tricuspid valve into the right ventricle which pumps it through the pulmonic valve into the lungs where it picks up fresh oxygen.

Oxygen-rich blood coming from the lungs flows into the left side of the heart (left atrium) where it passes through the mitral valve into the left ventricle. It is then pumped through the aortic valve into the aorta (main artery) and all the other arteries. The aorta is the largest artery in the body.

Back to top

Coronary arteries are the blood vessels that wrap around the heart muscle and keep it supplied with oxygen-rich blood. When blood is pumped by the left ventricle, it is forced into the body’s main artery, the aorta, located at the top of the heart.

Two coronary arteries, the left main artery and the right coronary artery, branch off the aorta.

The left main artery is about as wide as a drinking straw and less than an inch long. It branches into two narrower (smaller) arteries: the left anterior descending, which travels down the front side of the heart; and the left circumflex, which circles around the left side and then to the back of the heart.

The right coronary artery branches from the aorta, circles around the right side and then to the back of the heart.

Remember, these arteries are on the outside surface of the heart. They divide into smaller branches, similar to a tree, and lead deep into the heart muscle carrying the oxygen-rich blood to the cells.

Back to top

A procedure called cardiac catheterization can help your doctor identify the heart problem you have: coronary artery disease, heart valve disease, or heart muscle disease.

With the information obtained, your doctor can determine the best treatment plan and course of action to take for your particular situation. These can include:

• Diet and exercise
• Medication
• Coronary angioplasty
• Coronary atherectomy
• Coronary stent
• Pacemaker
• Bypass surgery
• Heart valve surgery

Back to top

You should change any unhealthy habits (also called risk factors) that helped to create your heart problems in the first place.

Some risk factors are smoking, eating too much fat or salt, and not getting enough exercise.

Making changes to reduce risk factors can help keep your heart condition from getting worse and may even improve the health of your heart.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

A pacemaker is a small device (about the size of two silver dollars stuck together) placed under the skin of your chest just below the collar bone. A pacemaker helps to regulate your heart rhythm. The pacemaker runs on batteries and sends out electrical impulses that keep the heart beating at its proper speed.

A pacemaker has two parts:

• A pulse generator, which is the battery/timer unit
• One or more electrodes and wires that carry the electrical impulses to the heart

Back to top

A pacemaker will keep your heart contracting and pumping blood. It is needed when there is a problem with the heart’s electrical system.

You may have very slow heartbeats or both slow and fast heartbeats if there is an electrical problem in any of the heart’s cells. Dizziness, fainting spells, shortness of breath, and blurred vision may be symptoms of a heart rhythm disturbance.

Back to top

Having a pacemaker implant is not considered major surgery. The procedure takes only one to two hours and is performed under local anesthesia with the patient sedated, but awake.

The surgeon makes a three to four inch incision in the upper chest area and a small pocket is made under the skin over a vein. The pacemaker will rest in this pocket. As the physician watches progress on a monitor, the wires are guided through a vein into the heart’s chambers. The electrode rests directly against the inner wall of the heart. The battery/timer is attached to the wires and placed in the pocket under the skin.

Back to top

Most patients realize dramatic improvement in their well being after the pacemaker is inserted. Your pacemaker may require some fine tuning, and medications may be adjusted, but chances are excellent that you will feel a lot better.

We know the decision to undergo pacemaker surgery may be stressful, but it is an important decision that you and your doctor will make together.

Back to top

Do not get water on the incision for at least seven to ten days following surgery. Take sponge baths until it is okay to tub bathe or shower. Some doctors will instruct their patients to wipe the incision with alcohol or other antiseptic.

You will also be told when you should have your stitches removed. Often, tiny strips of tape are placed over the incision instead of stitches. These can be removed if they don’t wear off in a few weeks’ time.

Back to top

Call your doctor if:

• The incision is red or draining
• The incision is hot to the touch or very tender
• You have a fever

Antibiotics are often used to prevent infection after pacemaker surgery. It takes a few weeks for the pacemaker wire to become secure. Do not lift weights or do hard arm exercises. DO NOT lift more than five pounds, or do things like playing tennis, for a few weeks. Slow arm circle exercises will help the soreness go away.

Back to top

Eating a balanced diet helps speed recovery after surgery. Follow your doctor’s advice regarding the activities you can return to within a few weeks without fear of causing problems with the pacemaker. You should avoid contact sports that could result in the pacemaker being hit or crushed. Ask your doctor about specific activities.

Back to top

Your pacemaker has built-in features that will protect it from outside electrical interference. Since 1977, pacemakers have been well protected against signals from microwave ovens, and all other electrical appliances are safe to use.

Back to top

The pacemaker is always sensing your own heartbeats. It paces your heart only when it has waited a certain amount of time and no heartbeats have occurred.

Back to top

Most pacemakers can be programmed. This means the doctor can adjust the pacemaker from outside the body, without surgery.

The life-span of a pacemaker will depend on how much it is being used and how much energy is required to pace the heart. Pacemakers usually last from four to eight years.

Back to top

Complications are rare with pacemaker insertion. However, as with any operation, possible complications include bleeding problems or infection. Problems specific to pacemaker implants include the possibility of a lead becoming dislodged after surgery, which would require a return to the operating room to have the lead repositioned. Another possible complication is collapse of a lung when the lead is passed under the collar bone into the subclavian vein and then into the heart.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Atherosclerosis, or “hardening of the arteries,” affects millions of people. Atherosclerosis is the term used to describe a buildup of plaque — hard, fatty deposits — on the inside of your arteries. This buildup reduces the amount of blood that can flow through the vessels to your legs and, therefore, also reduces the amount of oxygen to the lower extremities. Your physician may have talked to you about the possibility of balloon angioplasty and stenting to open the narrowed areas in your arteries.

Back to top

Balloon angioplasty is a minimally invasive technique that can be used to open clogged arteries. To perform angioplasty, your vascular specialist will make a small puncture in the artery in your groin and slip a small plastic tube called a sheath into your artery. Your physician will then place a balloon catheter through the sheath and, while watching with live X-ray images, will maneuver the balloon to the area of your blockage. The balloon is inflated to fracture the plaque buildup that is blocking the artery, which creates a wider channel for blood flow through the artery.

Sometimes a stent will also be placed in the artery. A stent is an expandable wire mesh tube that is maneuvered into place on a balloon catheter. The stent expands as the balloon is inflated. After the stent is deployed, the balloon catheter is withdrawn leaving the stent in place. The purpose of the stent is to provide a smooth surface on the inside of the vessel, creating a better channel for blood flow.

Back to top

You will receive specific instructions from your physician, but generally you will be asked not to have anything to eat or drink for eight hours before your procedure. You may have some routine tests done before your angioplasty:

• EKG
• Blood tests
• Chest X-ray

Your physician will be able to tell you how long you can expect to be in the hospital; some patients may stay for a day or two, while others may leave within a few hours.

Some suggestions to help you prepare:

• If you will be staying in the hospital overnight, pack a small bag with a robe, slippers, and toiletries
• Do not bring valuables or currency to the hospital
• Bring your list of medications with the exact names and dosages
• Arrange for someone to drive you home
• Be sure to mention if you are allergic to X-ray dyes or shellfish
• You may wear your dentures, hearing aids, or glasses

Back to top

Most patients will be asked to arrive at the hospital a couple of hours before the scheduled time of their procedure. Before your procedure, you will have an IV started. You will be transported to a procedure room on a rolling bed and your nurse will tell your loved ones where they may wait. You may be given some sedatives through your IV. Some patients will have local anesthetic administered to numb the area in the groin where the sheath will be inserted. Other patients may have epidural anesthesia. Your vascular specialist will be able to tell you what kind of anesthesia will be right for you.

Back to top

You will be asked to remain lying down for several hours. Your nurse will monitor you carefully, taking your blood pressure and checking the puncture site frequently to make sure there is no bleeding. You will be asked to drink lots of fluids to flush the dye out of your system.

Back to top

After the procedure, most people enjoy complete relief from the discomfort felt in their legs. Some people may still experience some discomfort when they walk, but the distance they are able to walk usually increases after a balloon angioplasty.

Back to top

Avoid heavy lifting and do only light activities for a few days.

Back to top

Call your doctor if:

• The insertion site bleeds
• Your leg feels cold or numb
• You notice worsening of the bruising around the insertion site
• You have a fever, or signs of infection such as redness, swelling, or drainage at the inserion site

Back to top

As in any invasive procedure, there can be some risk involved. Your physician will discuss with you the risks particular to your individual case.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your vascular specialist. Early detection of circulatory problems is the key to effective treatment.

Back to top

Peripheral arterial disease, or PAD, refers to diseases of any of the blood vessels outside of the heart. PAD is a range of disorders that can affect the blood vessels in the legs, feet, arms, or hands.

The most common form of PAD is atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up to form a substance called plaque that clogs the inside of the artery. This build up causes a gradual narrowing of the artery, which will decrease the amount of blood flow. When the flow of blood decreases it results in a decrease of oxygen supply to the body’s tissues, which in turn causes pain. When the arteries to the legs are affected, the most common symptom is pain in the calf when walking. This is known as intermittent claudication.

Claudication is a term used to describe the discomfort in the leg muscles that occurs when walking. The discomfort most often is described as a cramp, but it may also be described as a burning sensation, an ache, or a feeling of heaviness in the leg. The most common place to feel discomfort is in the calf muscle, though it may also occur in the thigh or buttock. Typically, a person with claudication will only be able to walk a short distance before the discomfort becomes so severe they must stop and rest. Having rested until the pain is gone, they may then walk exactly the same distance again before having to stop and rest. The distance a person is able to walk varies with the severity of the blockages. Most people with claudication do not experience leg discomfort when they are at rest.

Back to top

There are some relatively simple tests that can be done to determine if your arterial blood flow in you legs is normal.

Segmental Pressure Test — in this test the blood pressure at several points in your leg is checked using a blood pressure cuff and a Doppler. Then, you are asked to walk on a treadmill, following which your ankle pressure will be taken again to determine if the pressure decreased when you walked.

Ultrasound Scan — the scan produces images of arteries on a screen and is used to evaluate the blood flow, locate blockages, and measure the size of the artery.

Arteriogram — in this test dye is injected into the arteries while X-rays are taken. The dye “lights up” the arteries allowing the area of blockage to be accurately pinpointed.

Back to top

The best treatment for PAD depends on a number of factors, including overall health, and the location, size and cause of the blockage. In some cases, lifestyle changes can be enough to slow the progress and manage PAD. However, some patients will need surgical intervention to restore the blood flow to their legs. For that reason, your physician may recommend bypass surgery.

Back to top

Bypass surgery is used as a method of circumventing the obstructed artery. In this procedure, either a vein or a graft made from synthehetic material is joined to the obstructed artery above and below the blockage to create a detour and increase flow to the legs.

Back to top

Rest, eat well, quit smoking, and walk or do the exercise allowed by your doctor. During your pre-operative visit, you will be instructed on special breathing exercises to help in your recovery. You will also be asked if you routinely take a blood thinner, such as an aspirin product or coumadin.

Several routine tests are done before surgery: EKG, echocardiogram, chest X-ray, and blood tests. Make a list of any questions you have and be sure to ask your doctor before surgery. Prior to your surgery, you will receive specific instructions about the food you can have. Generally, nothing to eat or drink after midnight the night before surgery. You may be instructed to shower with special soap.

Some suggestions to help you prepare:

• Pack a suitcase for the next five days
• Do not bring any valuables
• Bring a list of your medications (with exact names and dosages) that you currently take
• Bring your insurance cards to the hospital

Back to top

The morning of surgery you may be given medication that will make you feel relaxed and drowsy. You will be taken to surgery on a rolling bed and your nurse will tell your loved ones where to wait. The length of time you will be in surgery depends on what type of bypass you are having. Your surgeon will be able to give you an estimated time based on your particular case.

Back to top

You will wake up in the recovery room and you may feel confused at first. It is normal to lose track of time. When you are awake you will either go to a hospital room or the Intensive Care Unit. Your family will be able to visit briefly. Be assured you are in caring, capable hands. You will be asked to breathe deeply and cough hard to clear any fluids from your lungs. The nurses will have you moving and walking around soon. Your surgeon will have ordered pain medication, so don’t hesitate to let your care provider know if you are uncomfortable.

Back to top

Most people who have bypass surgery are in the hospital for five days, some stay as few as three days if they recover quickly and some may need longer recovery in the hospital. Your physician will be able to let you know your expected length of stay. A home health nurse may come to your home after you are discharged.

You may be instructed to make some changes in your lifestyle such as modifying your diet to reduce consumption of fat and cholesterol, and exercising daily. Your surgeon will see you after surgery, usually within 2 weeks.

Back to top

You should call your doctor if:

• The incision site bleeds
• Your leg or incision site feels numb or cold
• You have leg swelling that increases
• You have sudden shortness of breath not related to exercise
• You have fatigue, especially with a fever
• You have signs of infection such as increasing redness, pain or oozing at the incision site

Back to top

We know the decision to undergo bypass surgery is stressful and an important one that you and your doctor have to make together. We hope this information has helped you gain a better understanding on which to base your decision.

As in all surgeries there are risks. Though peripheral bypass surgery has an excellent success rate, there is a small risk of stroke, bleeding, infection, heart attack, and death. After careful review of your medical history and a physical exam your surgeon will identify your risks.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

Cardiovascular rehabilitation offers specialized rehabilitation programs for patients who have cardiac and vascular problems.

We provide a professional team of registered nurses, registered dietitians, psychologists and exercise physiologists. Working together with you and your physician, they will design an individualized program to meet your specific wellness goals. We will help you address your heart disease risk factors to keep you healthy in the future.

Back to top

Our program is recommended for patients who:

• Are at risk for developing coronary artery disease
• Have chest pain (angina pectoris)
• Have had a balloon angioplasty or stent of the heart or leg arteries
• Have had coronary artery bypass graft surgery
• Are post-heart attack patients
• Have had other cardiac or vascular interventions

Back to top

The Phase IV Maintenance program is open to the public and offers an ongoing, supervised cardiovascular exercise program for persons who need to exercise.

Workout sessions are conducted in the St. John Siegfried Health Club. Your physician may have recommended supervised exercise for health reasons.

Or, if you just want to get in shape and are looking for a safe and effective exercise program with personalized instruction and medical supervision, this program can work for you. Dietary consultation is also available at a nominal charge to our participants.

Back to top

Based on your diagnosis, Medicare and most insurance plans may cover cardiovascular rehabilitation. Our professional staff can help obtain a doctor’s consent and obtain insurance authorization.

Back to top

A doctor’s consent is required for both the Cardiac Rehabilitation and Maintenace Programs. Our staff will work with you and your physician to determine the program most appropriate for your need.

If you are interested in any of our programs, please call us at (918) 744-2826. We look forward to hearing from you and helping you to improve your quality of life.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is the key to effective treatment.

Back to top

When you walk, do you have pain or cramping in your leg muscles that goes away when you rest? After you rest, can you walk exactly the same distance again before the pain stops you and you must rest? If you answered “yes” to these questions, then you may be exhibiting the hallmark symptoms of intermittent claudication. Intermittent claudication is the term used to describe pain in the legs that occurs when you walk. The pain is the result of a decrease in blood flow to the legs. This diminished blood flow is most often the result of atherosclerosis, the term used to describe the buildup of fatty deposits (plaque) on the insides of the arteries.

Back to top

There are several conditions and habits that increase your chance for vascular disease. Fortunately, many of the risk factors are within your control. Risk factors include:

• Smoking
• High blood pressure
• High LDL cholesterol
• Low HDL (good) cholesterol
• Being overweight
• Sedentary life-style
• Diabetes
• Over 50
• Being postmenopausal
• Family history of atherosclerosis

Back to top

Do not ignore your leg pain! The severity of the disease and length of time it goes untreated can make a big difference in your treatment and recovery. If you think you may have a problem, make an appointment to see a vascular specialist. Remember, atherosclerosis can occur in any of your arteries. If you are having symptoms in your legs, it is possible that arteries in your heart or neck could also be narrowing, setting you up for a possible heart attack or stroke.

Back to top

A thorough medical history and physical exam will give the doctor information needed to determine if further tests are required.

Your doctor may order a test, called a Segmental Pressure Check, to check the blood flow in your leg arteries. A vascular technologist will wrap blood pressure cuffs around both arms, and at four places along your leg — the upper thigh, the lower thigh, the upper calf, and the ankle. The technologist measures the blood pressure at each location, and the blood pressures in the arms are compared to those in the legs. A decrease in blood pressure in the legs is an indication of arterial blockage. You may also have an ultrasound scan of your legs.

If angioplasty or surgery is being considered as a possible treatment for you, your doctor may recommend an angiogram. During an angiogram, dye is placed in the artery while X-ray pictures are taken. The dye “lights up” your arterial system, making it possible to pinpoint the exact location and severity of your blockages.

Back to top

The best treatment will depend on a number of factors. In some cases, life-style changes are enough to slow the progress and manage the disease. Sometimes, procedures are necessary to open up clogged blood vessels.

The goal of any treatment program will focus on reducing your number of risk factors and will usually include:

• Exercise program
• Reduction of fat and cholesterol in diet
• Controlling diabetes and hypertension
• Smoking cessation; if you are a smoker, it is absolutely essential that you stop

After your diagnostic testing is completed, your doctor may determine that you will benefit from angioplasty or a bypass procedure to treat your poor circulation.

Back to top

While watching a “live” X-ray, your physician guides a catheter (a hollow tube) to the area of blockage through the femoral artery in your leg. A tiny balloon located at the end of the catheter is inflated to widen the passageway for blood flow. Sometimes a stent (a small mesh tube) is placed inside the artery to hold it open and create a smooth surface within the artery.

Back to top

Bypass surgery is a way to create a new pathway through which the blood can flow. Either a vein or a synthetic graft is attached to your artery above and below the area of blockage, creating a route around the blockage and improving blood circulation to the legs and feet.

Back to top

You can change your life-style to reduce any unhealthy habits that contribute to peripheral vascular disease. If you smoke, it is very important to stop! Also, you will want to remove fat and salt from your diet, and start a daily exercise program.

Back to top

As with all invasive procedures, there is some risk associated with angioplasty and bypass surgery. Your physician will be able to inform you of any risk specific to your particular case.

Remember …
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your vascular specialist. Early detection of circulatory problems is the key to effective treatment.

Back to top

Congestive Heart Failure (CHF) is caused by other diseases or conditions that damage or overwork the heart muscle; over time, the heart muscle is weakened.
The leading causes of congestive heart failure are:

• Coronary artery disease (CAD)
• High blood pressure (hypertension)
• Diabetes
Coronary artery disease, including angina (chest pain or discomfort) and heart attack, are the most common underlying cause of congestive heart failure.
Most people with heart failure also have high blood pressure, and about one out of every three people with heart failure also has diabetes.

Other Causes of Congestive Heart Failure
Other conditions and factors that can cause congestive heart failure include:

• Cardiomyopathy (inflammation of the heart muscle)
• Diseases of the heart valves
• Abnormal heartbeats or arrhythmias
• Congenital heart disease (a heart defect or problem you are born with)
• Treatments for cancer, such as radiation and certain chemotherapy drugs
• Thyroid disorders -- having either too much or too little thyroid hormone in the body (hyper/hypo thyroidism)
• Alcohol abuse
• Cocaine and other illegal drug use

Back to top

Studies are being done on the relationship between sleep apnea and congestive heart failure. Patients with obstructive sleep apnea may suffer damage to the right side of their heart since it has to pump harder in order to support the added effort of their lungs attempting to overcome the airway obstruction. A test was done on forty-two patients with heart conditions. Nearly half of these patients had severe sleep apnea that had not been diagnosed prior to the study.

In conclusion, people with sleep apnea and congestive heart failure should consider treating their sleep apnea. This could greatly help their chances of surviving heart disease. Sleep apnea is long overdue for more attention; it is the second leading cause of daytime fatigue after insomnia. Getting a poor sleep is a major health problem that needs to be addressed sooner rather than later.

Back to top

There are a few tests commonly used throughout cardiology practices to assist in evaluating and treating Congestive Heart Failure (CHF).

• Echocardiogram: An echocardiogram or echo uses sound waves (ultrasound) to take moving pictures of your heart. This test is used to assess the pumping function, also known as your ejection fraction (EF). The test is painless and only takes 45 minutes to an hour to perform.

• Right Heart Cath: This is and invasive testing procedure that is preformed in the Cardiac Cath Lab. Special monitoring catheters are placed to determine abnormalities and record blood pressure in the heart chambers.

• Left Heart Cath: This is an invasive testing procedure that is preformed in the Cardiac Cath Lab. Contrast dye is injected into the coronary arteries to look for any possible blockages.

• Sleep Study: A Sleep Study or Polysomnogram (PSG) is a multiple-component test, which electronically transmits and records specific physical activities while you sleep. The recordings become data, which will be "read" or analyzed by a qualified physician to determine whether or not you have a sleep disorder. You will be hooked up to multiple surface electrodes (leads) on different areas of the body. The electrodes will transmit many, many different pieces of information to a technologist that is monitoring you as you sleep. This test is used for CHF patients because combining sleep apnea with CHF can greatly increase mortality if the sleep disorder goes untreated.

Back to top