What is Cardiology?


Cardiology is the study of cardiovascular illness and the care of all things related to the heart. Cardiology is classified as an internal medicine sub-specialty. It includes veins and arteries, and it used to diagnose and treat conditions like blockages. Cardiologists should not be confused with cardiac surgeons. Cardiac surgeons go into the chest and perform heart surgeries, while cardiologists perform tests and procedures like angioplasty.

Cardiology is the discipline that researches, diagnoses and treats heart injuries and diseases as well as their causes. Cardiologists will treat your heart problem while staying aware of other conditions, including high blood pressure, high cholesterol, diabetes and other factors that risk damaging the heart. Risk factors may include a family history of heart disease, obesity, cigarette smoking, poor diet and a sedentary lifestyle.


What Does a Cardiologist Do?


A cardiologist is a physician who is board certified to diagnose and treat problems of the cardiovascular system- the heart, arteries, and veins. Cardiology is classified as an internal medicine subspecialty. Knowledge of internal medicine and other specialties is required to obtain certification.


Finding A Top Cardiologist


Choosing a Cardiologist is an important decision. Thus, our goal is to assist you in making that decision.

First of all, when selecting a Cardiologist, you may want to begin your search several different ways:

 

Ask family, friends, neighbors and/or co-workers.
Contact your local Chamber of Commerce or Better Business Bureau for reputable Cardiologists that specialize in the area of medicine that you have a need for.
Contact your city, county or state medical agencies for names of qualified Cardiologists. Contact and ask for referrals from medical associations. Many are listed in this publication.
Ask your family doctor. They are in constant contact with all kinds of health care professionals and will be able to provide you with recommendations.

We recommend that you interview the Cardiologist and ask the following:

How long have you been in practice?

Is your staff friendly and accommodating?

What are the procedures if we need a doctor in the middle of the night or on a weekend?

Do you have an associate that covers for you when you are not available?

Do you have more than one office and if so, how is your time divided between offices?

What kind of continuing education do you utilize?

Do you accept phone calls during office hours?

How do you stay current on the latest drug prescriptions available and medical testaments?

What types of insurance coverage do you accept?

How do you handle billing? Do you require payment at the time of visit?

Discuss your family medical history and particular problems you are concerned about.

After you have consulted a few Cardiologists you should have a good idea which one you felt most comfortable with and best answered your questions.


How Cardiologists Were Selected


Consumers' Research Council of America has compiled a list of Cardiologists throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining top health care professionals.

The criteria that was used and assessed a point value is as follows:

Experience:

Each year the Cardiologist has been in practice

Training:

Education and Continuing Education

Professional Associations:

Membership in Professional Medical Associations

Board Certification:

Completing an approved residency program and
passing a rigid examination on that specialty

Simply put, Cardiologists that have accumulated a certain amount of points qualified for the list. This does not mean that doctors that did not accumulate enough points are not good Cardiologists; they merely did not qualify for this list because of the points needed for qualification.

Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals who they would recommend. We found this method to be more of a popularity contest. For instance, professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition, many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.

Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients of a particular Cardiologist on their level of satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.

We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, being board certified is better than not being certified, etc.

The Top Cardiologist list that we have compiled is current as of a certain date and other doctors may have qualified since that date. Nonetheless, we feel that the list of top Cardiologists is a good starting point for you to find a qualified specialist.

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, ensuring an unbiased selection.

 


Coronary Angioplasty


Coronary Angioplasty (AN-jee-oh-plas-tee) is a medical procedure used to restore blood flow through a narrowed or blocked artery in the heart. The arteries of the heart (the coronary arteries) can become narrowed and blocked due to buildup of a material called plaque on their inner walls. This narrowing reduces the flow of blood through the artery and can lead, over time, to coronary artery disease and heart attack. In angioplasty, a thin tube with a balloon or other device on the end is first threaded through a blood vessel in the arm or groin (upper thigh) up to the site of a narrowing or blockage in a coronary artery. Once in place, the balloon is then inflated to push the plaque outward against the wall of the artery, widening the artery and restoring the flow of blood through it. Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patient's legs, stomach or chest and grafting them to the front and back of the blocked arteries.

The illustration shows the placement of a stent in a coronary artery with plaque buildup. The coronary artery is located on the surface of the heart. Figure A shows the deflated balloon catheter and closed stent inserted into the narrowed coronary artery. In Figure B, the balloon is inflated, expanding the stent and compressing the plaque to restore the size of the artery. Figure C shows normal blood flow restored in the stent-widened artery.

 

Angioplasty is used to:

         Relieve chest pain caused by reduced blood flow to the heart.
Minimize damage to the heart muscle during a heart attack. This damage occurs when blood flow is totally cut off to an area of the heart

Angioplasty was first used in 1977. A tiny balloon was used to open or widen narrowed arteries. Since then, new devices and medicines have improved the procedure and made it appropriate for more people. The improvements include:

         Stents. A stent is a tiny mesh tube that looks like a small spring. The stent is inserted in the area where the artery is narrowed to keep it open. Some stents are "coated" with medication to help prevent the artery from closing again. Stents are used in most angioplasties except when an artery is too small for a stent to fit.
When a stent is used, in 2 out of 10 people the artery will close again within the first 6 months.
When a stent is not used, in 4 out of 10 people the artery will close again within the first 6 months.
Plaque removers. Many kinds of plaque removers exist. They are used to cut away plaque that narrows the inside of the arteries.
Laser. A laser is used to dissolve or vaporize plaque. First approved in 1992, laser devices are used in many major U.S. medical centers.

Today, angioplasty is performed on more than 1 million people a year in the United States. The procedure is best done:

         By doctors who do at least 75 angioplasties a year
In hospitals that do at least 400 angioplasties a year

Research on angioplasty continues to:

         Increase its safety
Prevent the artery from closing again
Make it an option for more people

What Happens After Coronary Angioplasty?

Angioplasty is not a cure for coronary artery disease (CAD). You should discuss with your doctor what led to CAD and the need for angioplasty. Select the links below for more information on how to slow the development of CAD and how to lower your chance of having a heart attack:

         Preventing coronary artery disease
Living with angina
Life after a heart attack

Going Home

When you are ready to leave the hospital, you will receive instructions to follow at home, including:

         How much activity or exercise you can do.
When you should follow up with your doctor.
What medicines you should take.
What you should look for daily when checking for signs of infection around the area where the tube was inserted, such as:
     Redness
Swelling
Drainage
When you should call your doctor, for example:
     If you have a fever or signs of infection
If you have pain or bleeding where the tube was inserted
When you should call 911. For example, if you have any chest pain.

Your doctor will prescribe medicine to prevent blood clots from forming. It is very important that you take the medicine as directed. The medicine can prevent the stent from becoming blocked. Types of medicine may include:

         Anticoagulants
Antiplatelet drugs, such as aspirin and clopidogrel (Plavix)

Most people can return to work and other normal activities about 1 week after angioplasty.

Cardiac Rehabilitation

Your doctor may recommend that you participate in a cardiac rehabilitation (rehab) program. Cardiac rehab provides medical guidance and support to help you return to work or daily activities. "Recovering From Heart Problems Through Cardiac Rehabilitation: Patient Guide" from the U.S. Agency for Healthcare Research and Quality gives more information on cardiac rehabilitation.


Coronary Artery Bypass Graft Surgery


Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patients legs, stomach or chest and grafting them to the front and back of the blocked arteries.

During a bypass procedure the heart-lung machine takes over the functions of the heart and  lungs. This is done so the heart can be carefully stopped and the surgeon can work in a blood-free environment. The heart-lung machine keeps oxygen-rich blood flowing through the body. It receives the blood and removes the carbon dioxide and other waste products, warms and/or cools the blood and adds oxygen as it pumps the blood through the patient's body. At the conclusion of the bypass surgery, the heart is restarted and the heart-lung machine is disconnected.

New advances in bypass surgery are continuing. A minimally invasive bypass surgery technique is being tested with promising results. This new procedure requires the surgeon to work on the front of the heart through a four inch incision while it is beating slowly. Another type is that the heart is stopped and a surgeon uses a fiberoptic scope that is passed through a 4 ½ inch incision and the surgeon works on all sides of the heart by viewing a video image. This less invasive procedure would be less expensive and requires a much shorter hospital stay.


Cardiac Catheterization


Cardiac catheterization (KATH-e-ter-i-ZA-shun) is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart. Cardiac catheterization is usually performed in a hospital by heart doctors (called cardiologists) that specialize in the treatment of heart diseases.

To diagnose some heart conditions, doctors may put a special dye into the catheter to make the inside of the heart and blood vessels show up on x rays. Doctors may take samples of blood and heart muscle through the tube. They can also treat certain heart problems during this procedure.

Why Is Cardiac Catheterization Done?

Often a doctor does a cardiac catheterization to find out why a patient is having chest pain. The procedure can reveal blocked or narrowed places in the heart’s arteries that can cause this pain. During the cardiac catheterization, a doctor might be able to open up the blocked arteries by doing another procedure called angioplasty (AN-jee-oh-plas-tee).

Most people who have heart attacks have arteries that are partly or completely blocked. That is why doctors often do cardiac catheterizations after patients have heart attacks. The procedure can tell them if there are blocked arteries that can be treated with angioplasty or surgery.

Another reason doctors may do cardiac catheterizations is to see the overall shape of the heart and the four large spaces (heart chambers) inside it. That way they can:

         Find any likely problems in people about to have open heart surgery
See heart abnormalities in children or adults

Sometimes doctors do cardiac catheterizations to see how well the tissue flaps (valves) at the openings and exits of the heart chambers are working. To do this, the doctor will measure blood flow and oxygen levels in different parts of the heart. Cardiac catheterizations are also done to check the functioning of artificial heart valves.

Doctors may also perform cardiac catheterizations so they can do minor surgery on the heart. For example, doctors may do the procedure to remove (biopsy) a small piece of heart tissue to see if there is an infection or tumor, or they might repair holes in the heart or other heart defects.

What are the risks with Cardiac Catheterization?

Cardiac catheterization is a common medical procedure that rarely causes serious problems. But complications can include:

         Bleeding, infection, and pain where the tube (catheter) was inserted
Damage to blood vessels
An allergic reaction to the dye used

Other less common complications of the procedure include:

         An irregular heartbeat.
Damage to the kidneys caused by the dye used.
Blood clots that can trigger strokes, heart attacks, or other serious problems.
Low blood pressure.
A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes, although rarely, be fatal.

The risk of complications with cardiac catheterization is higher in:

         People with diabetes
People with kidney disease
Older people (ages 75 and older)
Women
People having emergency catheterization for serious heart symptoms

What Happens During a Cardiac Catheterization?

During a cardiac catheterization, you are kept on your back and awake. That way you can follow your doctor’s instructions during the procedure. You are given a drug to help you relax. This drug may make you sleepy.

Your doctor or nurse will numb the area where the small plastic tube (catheter) will enter the blood vessel through a small cut or needle in the arm, upper thigh (groin), or neck. The doctor then threads the tube through the vessel and into the large spaces (chambers) of the heart. Special x-ray movies are taken of the tube as it is threaded up into the heart. This helps the doctor see where to put the tube.

Once the catheter is at the right spot, your doctor can use it to conduct several tests or treatments. Often, special dye is put in the tube to make the inside of the heart’s arteries and other structures show up on an x ray. Your doctor may use a procedure called angioplasty to open up the blocked arteries. He or she may also take blood samples from different parts of the heart or do minor heart surgery.

Once your doctor does all of the needed tests or treatments, the catheter will be taken out. The opening in the blood vessel that the tube went through will then be closed up and bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply more pressure. This will help prevent major bleeding from the site.

What Happens After a Cardiac Catheterization?

After a cardiac catheterization, you will be moved to a special care area where you will stay for several hours or overnight. While you recover in this area, your movement will be limited to avoid bleeding from where the tube (catheter) was inserted. Nurses will check your heart rate and blood pressure regularly. They will also check to see if there is any bleeding from the tube insertion site.

Eventually, a small bruise will appear where the tube was put in. That area may feel sore or tender for about a week. Be sure to let your doctor know if:

         You have a constant or large amount of blood at the site that cannot be stopped with a small bandage.
You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site.

Your doctor may tell you to avoid certain activities, such as heavy lifting, for a short time after the procedure.

Key Points

         Cardiac catheterization is a procedure in which a thin tube (catheter) is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart to do tests or treatments on the heart.
Cardiac catheterizations often are done after a heart attack or to find out why a patient is having chest pain.
Cardiac catheterization is a common medical procedure that rarely causes serious complications. The risk of complications is higher in people with diabetes and kidney disease, and in older people and women.
Before having a cardiac catheterization, it is a good idea to meet with your doctor to learn about the procedure and how to prepare for it.
You may have to stop taking certain medicines before the procedure.
Patients are not usually allowed to drive the same day as the procedure. If you don’t have to stay overnight after the procedure, you should arrange for a ride to and from the hospital.
You are kept awake during a cardiac catheterization. Afterwards, you will be moved to a special care area where you will stay for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the tube was inserted.
The area where the tube was put in may feel sore for about a week. You need to let your doctor know if you have an excessive bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the procedure.

 


All About Angina


What Is Angina?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of Coronary Artery Disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called Atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle. Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. The buildup of plaque on the inner walls of the arteries can cause angina in two ways:

         By narrowing the artery to the point where the flow of blood is greatly reduced
By forming blood clots that partially or totally block the artery

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.

Stable angina is the most common type. It occurs when the heart is working harder than usual. There is a regular pattern to stable angina. After several episodes, you learn to recognize the pattern and can predict when it will occur. The pain usually goes away in a few minutes after you rest or take your angina medicine. Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.

Physical exertion is the most common cause of pain and discomfort from stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you are sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. Other causes include:

         Emotional stress
Exposure to very hot or cold temperature
Heavy meals
Smoking

Unstable angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.

Unstable angina is caused by blood clots that partially or totally block an artery. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. The clot may grow large enough to completely block the artery and cause a heart attack. Blood clots may form, partly dissolve, and later form again. Chest pain can occur each time a clot blocks an artery.

Variant angina is rare, and usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medicine. Variant angina is caused by a spasm in a coronary artery. The spasm causes the walls of the artery to tighten. This narrows the artery, causing the blood flow to the heart to slow or stop. Variant angina may occur in people with and without CAD. Other causes of spasms in the arteries that supply the heart with blood are:

        

Exposure to cold

Emotional stress

Medications (vasoconstrictors) that constrict or narrow blood vessels

Cigarette smoking

Cocaine use

Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

The illustration shows a normal artery with normal blood flow (Figure A) and an artery containing plaque buildup (Figure B).

Other Names for Angina

        

 

Angina pectoris
Stable or common angina
Unstable angina
Variant angina
Prinzmetal's angina
Coronary artery spasms
Acute coronary syndrome

Who Is At Risk for Angina?

More than 6 million people in the United States have angina.

People with coronary artery disease or who have had a heart attack are more likely to have angina.

Unstable angina occurs more often in older adults.

Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. People with variant angina are often younger than those with other forms of angina.

What Are the Signs and Symptoms of Angina?

Pain and discomfort are the main symptoms of angina. These symptoms:

         Are often described as pressure, squeezing, burning, or tightness in the chest
Usually start in the chest behind the breastbone
May also occur in the arms, shoulders, neck, jaw, throat, or back
May feel like indigestion

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

Symptoms vary based on the type of angina.

Stable Angina

The pain or discomfort:

         Occurs when the heart must work harder, usually during physical exertion
Is expected, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or angina medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas

Unstable Angina

The pain or discomfort:

         Often occurs at rest, while sleeping at night, or with little physical exertion
Is unexpected
Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
Is usually not relieved with rest or angina medicine
May get continuously worse
May signal that a heart attack is impending

Variant Angina

The pain or discomfort:

         Usually occurs at rest and during the night or early morning hours
Tends to be severe
Is relieved by angina medicine

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having—or are about to have—a heart attack. Call 9–1–1 right away.

How Is Angina Diagnosed?

To find out if you have angina, your doctor will:

         Do a physical exam
Ask about your symptoms
Ask about your risk factors and your family history of coronary artery disease (CAD) or other heart disease

Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina. The tests your doctor may order include:

EKG (electrocardiogram). This test measures the rate and regularity of your heartbeat. Some people with angina have a normal EKG.

Stress Test. Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed. During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.

If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done. During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle.

Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.

Chest x ray. A chest x ray takes a picture of the organs and structures inside your chest. These include your heart, lungs, and blood vessels.

Nuclear heart scan. This test provides your doctor with moving pictures of the blood passing through your heart's chambers and arteries and shows the level of blood flood to the heart muscle. A small amount of a radioactive tracer is injected into your bloodstream through a vein, usually in your arm. A special camera is placed in front of your chest to show where the tracer lights up in healthy heart muscle and where it doesn't light up (in heart muscle that has been damaged or has a blocked artery). There are different types of nuclear heart scans. Most scans have two phases—taking pictures of the heart at rest and while it is beating faster (called a stress test), although sometimes only a rest scan is done. Many heart problems show up more clearly when your heart is stressed than when it is at rest. By comparing the nuclear heart scan of your heart at rest to your heart at "stress," your doctor can determine if your heart is functioning normally or not.

Echocardiogram. This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).

Cardiac catheterization. A thin flexible tube (catheter) is passed through an artery in the groin (upper leg) or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x ray.

Coronary Angiography. This test is done during cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through your heart and the location of blockages.

Your doctor may also order blood tests, such as:

         A fasting lipoprotein profile to check your cholesterol levels.
Fasting glucose test to check your blood sugar level.
C-reactive protein (CRP) test. This blood test measures CRP, a protein in the blood that shows the presence of inflammation. Inflammation is the body's response to injury. High levels of CRP may be a risk factor for CAD.
A test to check for low hemoglobin in your blood. Hemoglobin is the part of red blood cells that carries oxygen to all parts of your body.

How Is Angina Treated?

Treatment for angina includes lifestyle changes, medicine, special procedures, and cardiac rehabilitation. The main goals of treatment are to:

         Reduce the frequency and severity of symptoms
Prevent or lower the risk of heart attack and death

Lifestyle changes and medicine may be the only treatments needed if your symptoms are mild and are not getting worse. Unstable angina is an emergency condition that requires treatment in the hospital.


Lifestyle Changes

The first thing that you need to do is change your living habits to avoid bringing on an episode of angina.

         Slow down or take rest breaks, if angina comes on with exertion.
Avoid large meals and rich foods that leave you feeling stuffed, if angina comes on after a heavy meal.
Try to avoid situations that make you upset or stressed, if angina comes on with stress. Learn techniques to handle stress that can't be avoided.

You can also make other lifestyle changes, for example:

         Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity
Quit smoking, If you smoke
Be physically active, as directed by your doctor
Lose weight, if you are overweight or obese.
Follow your doctor's orders and take all medicines as directed, especially if you have diabetes

Medications

Nitrates are the most commonly used medicines to treat angina. Fast-acting preparations are taken when angina occurs or is expected to occur. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload.

You can use nitrates in different forms to:

         Relieve an episode that is occurring by using the medicine when the pain begins
Prevent an episode from occurring by using the medicine just before pain or discomfort is expected to occur
Reduce the number of episodes that occur by using the medicine regularly on a long-term basis

Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.

Other medicines can be used to treat angina:

         Beta blockers slow the heart rate and lower blood pressure. They can delay or prevent the onset of angina.
Calcium channel blockers relax blood vessels so that more blood flows to the heart, reducing pain from angina. Calcium channel blockers also lower blood pressure.
ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and reduce the strain on the heart. They also reduce the risk of a future heart attack and heart failure.

People who have angina may also use:

         Medicines to lower cholesterol levels.
Medicines to lower high blood pressure.
Oral antiplatelet (an-ty-PLAYT-lit) medicines (such as aspirin and clopidigrel), taken daily, to stop platelets from clumping together to form blood clots. Platelets are small blood cells that circulate through your blood vessels and help stop bleeding by sticking together to seal small cuts or breaks in tiny blood vessels. Antiplatelet medicines may not be appropriate for some people because they increase the risk of bleeding. Discuss the benefits and risks with your doctor before starting therapy with aspirin or the other antiplatelet medicines.
Glycoprotein IIb-IIIa inhibitors are potent antiplatelet medicines that prevent clots from forming in your arteries. They are given intravenously in hospitals for the treatment of angina or during and after angioplasty.
Anticoagulants (an-ty-ko-AG-u-lants) to prevent clots from forming in your arteries and blocking blood flow.

Special Procedures

When medicines and other treatments do not control angina, special (invasive) procedures may be needed. Two commonly used procedures are:

         Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.
Coronary artery bypass surgery. This procedure uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Bypass surgery improves blood flow to your heart, relieves chest pain, and can prevent a heart attack.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after bypass surgery, angioplasty, or a heart attack.

The cardiac rehab team may include:

         Doctors
Your family doctor
A heart specialist
A surgeon
Nurses
Exercise specialists
Physical therapists and occupational therapists
Dietitians
Psychologists or other behavioral therapists

Rehab has two parts:

         Exercise training. This helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
Education, counseling, and training. This helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

How Can Angina Be Prevented?

You can prevent or lower your risk for heart disease and angina by making lifestyle changes and getting treatment for related conditions.

Make Lifestyle Changes

         Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity.
Quit smoking, if you smoke
Be physically active, as directed by your doctor
Lose weight, if you are overweight or obese

Treat Related Conditions

In addition to making lifestyle changes, you can help prevent angina and heart disease by treating related conditions, such as:

         High blood cholesterol. If you have high cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed.
High blood pressure. If you have high blood pressure, follow your doctor's advice about keeping your blood pressure under control. Take blood pressure medications as directed.
Diabetes (high blood sugar). If you have diabetes, follow your doctor's advice about keeping your blood sugar levels under control. Take medicines as directed.
Overweight or obesity. If you are overweight or obese, talk to your doctor about how to lose weight safely.

Living With Angina

Angina is not a heart attack, but it does mean that you are at greater risk of having a heart attack than someone who does not have angina. The risk is even higher if you have unstable angina. For these reasons, it is important that you know:

         The usual pattern of your angina, if you have it on a regular basis
About your medicine
How to control your angina
The limits of your physical activity
How and when to seek medical attention

Know the Pattern of Your Angina

Stable angina usually occurs in a pattern. You should know:

         What causes the pain to occur
What it feels like
How long it usually lasts
Whether it is relieved by rest or medicine

After several episodes, you will learn to recognize when you are having angina. It is important for you to notice if the pattern starts to change. Changes in the pattern to look for may include:

         Occurring more often
Lasting longer
Being more severe
Occurring without exertion
Not going away with rest or medicine

These changes in the pattern may be a sign that your symptoms are getting worse or becoming unstable. You should seek medical attention. Unstable angina suggests that you are at high risk for a heart attack very soon.

Know Your Medicines

You should know what medicines you are taking, the purpose of each, how and when to take them, and possible side effects. It is very important that you know exactly when and how to take fast-acting nitroglycerin or other nitrates to relieve chest pain. They should be taken:

         Immediately when pain begins or before stressful activity
Three times spaced 5 minutes apart if pain does not go away
Always sit down before taking nitroglycerin.
Long-acting nitrate preparations should be used regularly as prescribed by your doctor.

Men with impotence (erectile dysfunction) who take sildenafil (Viagra®) should talk with their doctor. Taking sildenafil and nitroglycerin or other nitrates within 24 hours of each other can cause serious problems. Ask your doctor about your other medicines. Also, see the Treatment section to read descriptions of the medicines that you are taking.

Know How To Control Your Angina

After several episodes, you will know the level of activity, stress, and other things that can bring on your angina. By knowing this, you can take steps to prevent or lessen the severity of episodes.

Physical exertion. Know what level of activity brings on your angina and try to stop and rest before chest pain starts. For example, if walking up a flight of stairs leads to chest pain, then stop halfway and rest before continuing. When chest pain occurs during exertion, stop and rest or take your angina medicine. The pain should go away in a few minutes. If the pain does not go away or lasts longer than usual, call 9–1–1 and get emergency care.
Emotional stress. Anger, arguing, and worrying are examples of emotional stress that can bring on an angina episode. Try to avoid or limit exposure to situations that cause these emotions. Exercise and relaxation can help relieve stress. Alcohol and drug use play a part in causing stress and do not relieve it. If stress is a problem for you, talk with your doctor about getting counseling to help you deal with stress.
Eating large meals. If this leads to chest pain, eat smaller meals. Also, avoid eating rich foods.

Know the Limits of Your Physical Activity

Most people with stable angina can continue their normal activities. This includes work, hobbies, and sexual relations. However, if you engage in very strenuous activity or have a stressful job, you may need to discuss this with your doctor.

Know How and When To Seek Medical Attention

If you have angina, you are at high risk of having a heart attack. Therefore, it is very important that you and your family know how and when to seek medical attention. Talk to your doctor about making an emergency action plan. The plan should include:

         The signs and symptoms of a heart attack
Instructions for the prompt use of aspirin and nitroglycerin
How to access emergency medical services in your community
The location of the nearest hospital that offers 24-hour emergency heart care

Be sure to discuss your emergency plan with your family members. Take action quickly if your chest pain becomes severe, lasts longer, or is not relieved by rest or medicine.

Sometimes, it may be difficult to tell the difference between unstable angina and a heart attack. Most heart attack victims wait 2 hours or more after their symptoms begin before they seek medical help. This delay can result in death or lasting heart damage.

Key Points

         Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back.
Most people with angina have coronary artery disease, with narrowed arteries due to atherosclerosis. When arteries are narrowed, blood flow to the heart is reduced.
More than 6 million people in the United States have angina.
The most common types of angina are stable angina and unstable angina. A less common type of angina is called variant angina.
Stable angina is chest pain or discomfort that occurs when the heart is working harder than usual. Pain from stable angina goes away when you rest or take your angina medicine. Angina medicine, such as nitroglycerin, helps widen and relax the arteries so that more blood can flow to the heart.
Unstable angina is a very dangerous condition that requires emergency treatment. Unstable angina is a sign that a heart attack could occur soon. Unstable angina can occur without physical exertion. It is not relieved by rest or medicine.
Variant angina is caused by a spasm in a coronary artery. The spasm causes the walls of the artery to tighten. This narrowing of the artery slows or stops blood flow to the heart.
Doctors diagnose angina based on your health history, your family’s health history, a physical exam, and the results of various tests.
Angina is usually treated with medicines such as nitrates (nitroglycerin). People with angina may need to take other medicines to lower their blood pressure or cholesterol. They also may take medicine to prevent blood clots.
To prevent and treat angina, it is important to make changes to improve your health. Get regular physical activity, maintain a healthy weight, don't smoke, and eat a healthy diet that is low in saturated fat and cholesterol. A cardiac rehab program can be helpful for many people with angina.
When medicines and lifestyle changes do not control angina, special procedures may be needed. Angioplasty and coronary artery bypass surgery are two common procedures used to treat angina.
If you have angina, it is important to know the pattern of your angina, about your medicine, how to control your angina, and the limits on your physical activity. You should know how and when to seek medical help.

 


Minimally Invasive Heart Surgery


Recent advances in surgical techniques and equipment allow surgeons to perform Coronary Artery Bypass Surgery in a less traumatic way. Minimally Invasive Coronary Artery Surgery is also called Limited Access Coronary Artery Surgery. It is as an alternative to the standard methods of Coronary Artery Bypass Graft Surgery. Unlike conventional surgery, which utilizes a 10-12" incision and requires the patient to be placed on the heart-lung machine, new minimally invasive surgery may avoid placing the patient on the machine, and can be performed through a 3-5" incision placed between the ribs, or may be done with several small incisions. Like conventional surgery, the surgery is done to reroute, or bypass, blood around coronary arteries clogged by fatty buildups of plaque and improve the supply of blood and oxygen to the heart.

Minimally Invasive Coronary Artery Bypass—also called MIDCAB—is used to avoid the heart-lung machine. It's done while your heart is still beating and is intended for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes, or ports, in your chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision.

Minimally Invasive Bypass Surgery has the same beneficial results as conventional bypass surgery. It restores adequate blood flow and normal delivery of oxygen and nutrients to the heart. This type of surgery has additional advantages, including the ability of the surgeon to work on a beating heart or through smaller incisions.

         The procedure is performed in only two to three hours, compared to three to six hours for a traditional bypass.
The recovery time is dramatically reduced from months to days or a week. Complications associated with the heart-lung machine are avoided.
Due to less time under anesthesia, patients are moved out of intensive care more quickly.
Patients tend to experience less pain and discomfort.
There is a 25-40% savings of the cost of conventional surgery.
Lower infection rate: A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.
 

This surgery is available to more patients. Many patients are poor candidates for traditional bypass surgery because their illness is too widespread or their heart is too weak. Some patients are able to receive this life-saving surgery through minimally invasive techniques. 

Risks  

Performing surgery on a beating heart is more difficult than working on a heart that has been stopped with the help of the heart-lung machine. In addition, the stress on the heart during the procedure may lead to more heart muscle damage, lower blood pressure, irregular heartbeat and potential brain injury if blood flow to the brain is reduced for too long during surgery. In some cases—usually less than 10 percent—it is necessary to convert to conventional methods on an emergency basis.


Weight Control


Weight control is an important part of our culture. We are reminded daily in our society that being overweight is not "in" or fashionable. Just look at TV or any type of media advertising and you will soon see that being thin and in good shape is what is popular.

Your primary goal should be to have a healthy body. Healthy bodies come in different shapes and sizes. Weight control is just a part of having a healthy body. Other factors include your diet, nutrition and the amount and kind of exercising you are getting. Displayed later on in this chapter is a height/weight chart that will serve as a guideline.

When you see your family doctor, they will check your height, weight, and blood pressure, blood lipids, (cholesterol, triglycerides), and blood sugar (for people with diabetes). All of these involve medical conditions related to weight. Proper weight control and weight management can help provide for a healthy body.

Obesity

Obesity is basically a medical condition that signifies the excess storage of body fat. It is normal for the body to store fat tissue under the skin and around joints and organs. Fat is essential for good health because it provides energy when the body demands it and provides insulation and protection for vital organs. It is the accumulation of too much fat that poses the health problems of obesity. These health problems include diabetes, hypertension, stroke, heart disease and arthritis.

The United States has one of the highest percentages of obese adults. It is estimated that over 36% of adults in America are obese. Obesity is most common among minorities, especially minority females. Over 50% of African-American and Mexican-American women are obese. Over 20% of children between the ages of 6 to 17 fit in the obese category.

A primary concern of obesity is the risk of developing disease. Obese people are twice as likely to develop high blood pressure and over 70% of heart disease cases are linked to excess body fat. Obese women are twice as likely to develop breast cancer and 40% more likely to develop colon cancer. Close to 80% of Type II or non-insulin dependent diabetics are obese.

Obesity is partially determined by genetic makeup. Research has revealed that basal metabolic rate and the size and number of a person's fat cells help in determining the amount of weight loss that is possible. When calories from food intake equal the amount of energy that the body requires to function the weight remains the same. However, when more calories are consumed than the body needs, the body will store the extra calories, resulting in weight gain.

Diet

Diets are the most common treatment for obesity. There seem to be countless diets that are promoted and it is recommended that your weight control diet be supervised by a your family doctor. Most health care professionals will recommend a diet that consists of 1200 - 1500 calories per day. People who are over 40 pounds overweight may require a more aggressive approach and may be put on a restricted diet of 500 to 800 calories per day.

There many types of weight loss medications on the market today but there are also many side effects that include insomnia, anxiety and irritability. Your family doctor can evaluate your particular condition, health issues and can  recommend weight-loss medications under the right circumstances. Used correctly, they can be very effective in the treatment of overweight people.

Exercise

Exercise should be an important part of your weight management plan. Calorie reduction alone is not a complete plan will not result in long-term weight loss. Regular exercise is a long-term plan for continuing weight reduction. Exercise will also improve some of the medical conditions associated with obesity which include high cholesterol levels, high blood pressure and diabetes.

A long-term exercise plan sometimes requires lifestyle and behavior modification, which can be hard for many obese people to accept. Successful weight management plans require strong discipline to control eating urges and to implement exercise plans. New habits need to be learned and many old bad habits need to changed, such as food types consumed and unproductive eating habits.

When choosing an exercise program, the person should consult their family doctor. The exercise program will be designed around the person's work capacity, which will be determined by your doctor. Exercise tests using the treadmill or stationary bicycle are the most common ways to determine and measure work capacity. Once your work capacity has been determined, an exercise program can be recommended. The formula will include what your training heart rate should be and how much intensity should be expended during your workout.

An exercise program can be the most important part of your weight management program because it will give you so many other added health benefits. Many studies show a direct correlation between physical fitness and mental achievement.


Weight Chart


The following charts provide healthy weight ranges for different body sizes and builds:


WOMEN

Height Small Frame Medium Frame Large Frame
4' 10" 102 - 111 109 - 121 118 - 131
4' 11 103 - 113 111 - 123 120 - 134
5' 0" 104 - 115 113 - 126 122 - 137
5' 1" 106 - 118 115 - 129 125 - 140
5' 2" 108 - 121 118 - 132 128 - 143
5' 3" 111 - 124 121 - 135 131 - 147
5' 4" 114 - 127 124 - 138 134 - 151
5' 5" 117 - 130 127 - 141 137 - 155
5' 6" 120 - 133 130 - 144 140 - 159
5' 7" 123 - 136 133 - 144 143 - 163
5' 8" 126 - 139 136 - 150 146 - 167
5' 9" 129 - 142 139 - 153 149 - 170
5' 10" 132 - 145 142 - 156 152 - 173
5' 11" 135 -148 145 - 159 155 - 176
6' 0" 138 - 151 148 - 162 158 - 176

 

MEN

Height Small Frame Medium Frame Large Frame
5' 2" 128 - 134 131 - 141 138 - 150
5' 3" 130 - 136 133 - 143 120 - 134
5' 4" 132 - 138 135 - 145 140 - 153
5' 5" 134 - 140 137 - 148 144 - 160
5' 6" 136 - 142 139 - 151 146 - 164
5' 7" 138 - 145 142 - 154 149 - 168
5' 8" 140 - 148 145 - 157 152 - 172
5' 9" 142 - 151 156 - 160 155 - 176
5' 10" 144 - 154 151 - 163 158 - 180
5' 11" 146 - 157 154 - 166 161 - 184
6' 0" 149-160 157 - 170 164 - 188
6' 1" 152-164 160 - 174 168 - 192
6' 2" 155-168 165 - 178 172 -197
6' 3" 158-172 167 - 182 176 - 202
6' 4" 162-176 171 - 187 181 - 207


All About High Blood Pressure


Everyone has blood pressure. Without it, blood can't circulate through the body. And without circulating blood, vital organs—like your brain—can’t get the oxygen and food that they need to work.

Your blood pressure measurements consist of two numbers: systolic and diastolic. The systolic measurement is the pressure of blood against your artery walls when the heart has just finished pumping. It is the first or top number of a blood pressure reading. The diastolic measurement is the pressure of blood against the artery walls between heartbeats, when the heart is relaxed and filling with blood. It is the second or bottom number in a blood pressure reading.

Generally, when you get your blood pressure checked, a reading that is less than 140 over 90 indicates that you don't need to worry. If either or both numbers are equal to or greater than 140 over 90 for an extended period of time, you have high blood pressure, or hypertension.

Hypertension is dangerous because it causes the heart to work extra hard. This strain contributes to heart attacks and stroke. When the heart is forced to work excessively for an extended period of time, it tends to enlarge. A slightly enlarged heart can function well, but a significantly enlarged heart cannot. High blood pressure also causes damage to the arteries, causing arterial disease.

Also, untreated high blood pressure can damage the delicate lining of the blood vessels. Once damaged, fat and calcium can easily build up along the artery wall, forming plaque. The blood vessel becomes narrowed and stiff, and blood flow through the blood vessel is reduced. Over time, decreased blood flow to certain organs in the body can cause damage, leading to:

         1 Heart disease, heart attack, and abnormal heartbeat.
2 Stroke.
3 Kidney failure.
4 Peripheral arterial disease.
5 Eye damage.

What causes high blood pressure?

Several factors are known to increase blood pressure, including obesity, heavy alcohol use, family history, high salt intake, and aging. An inactive lifestyle, stress, low potassium intake, low calcium intake, and resistance to insulin may also cause your blood pressure to rise.  Risk factors you can't control include a family history of high blood pressure, your race (being African-American increases your risk), and aging.

Getting diagnosed

Because there are usually no symptoms, diagnosing hypertension can be tricky. The most common symptoms are headaches, dizziness, and lightheadedness, but these usually occur only in severe hypertension and are often so mild that they're ignored. If you are obese and has a family history of hypertension, this should raise a red flag for hypertension. The only reliable way of diagnosing hypertension is with regular blood pressure measurements.

Prevention

Doctors usually recommend six lifestyle changes to help prevent high blood pressure. These six strategies are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, and aging.

         1 Maintaining a normal weight, and keeping a
Body Mass Index (BMI) of 18.5-24.9.
2 Exercising for at least 30 minutes a day.
3 Reducing your sodium intake to 2,400 mg per day,
which is about a teaspoon.  
4 Limiting the amount of alcohol you drink.  
5 Getting 3,500 mg of potassium in your diet everyday.  
6 Eating a diet that is rich in fruits, vegetables, and low-fat
dairy products, with reduced amounts of saturated and total fats.

Treatments

The remedy for high blood pressure depends on the severity of the disease and whether you have other health problems, such as heart failure or diabetes, or you are pregnant. Your doctor may want you to try lifestyle changes first, including losing weight, increasing activity, and eating a balanced diet. If your blood pressure is above a certain level, your doctor may prescribe medication along with the lifestyle changes.

Some people may only need lifestyle changes to control their high blood pressure, while others need medication as well. Either way, treating high blood pressure usually is a lifelong process.


About Cholesterol


Cholesterol is a white-colored waxy substance found in cell membranes and is required for the body to help produce other cell membranes and a variety of hormones. The majority of cholesterol is produced by the liver, and the cholesterol levels found in our blood are affected by the types of foods we eat. Excessive amounts of cholesterol can build up in the arterial walls over time, thus causing hardening and narrowing of the blood vessels. When this occurs it increases the risk of heart disease by reducing the flow of blood.

Causes of high cholesterol include:

         A diet too high in saturated fats
A genetic trait of high cholesterol
Improper liver function
Hormonal problems

Certain foods contain high amounts of cholesterol, and people who are concerned about reducing their cholesterol intake should avoid the following foods:

         Fatty Meats
Full-fat dairy products
Shrimp
Cream, butter, cheese, ice cream, milk
Vegetable fats, shortening and some margarines
Sausage, salami and other similar meats
Cakes, muffins, biscuits
Salted nuts, crackers
Pastry, croissants

Others can be beneficial in striving to reduce cholesterol levels. These foods include the following:

         High fiber foods
Whole grain bread, cereals, brown rice and whole grain pasta
Vegetable skin items, i.e.: potatoes (with skin on)
Whole grain rolled oats, oat bran
Fruits and vegetables
Lean meats , skinned poultry and fish

Most people can reduce cholesterol by 10 to 20% by watching their diet. In many cases this is not enough and therefore other remedies are necessary. Medication may be required and research has shown that new drugs can be very effective in reducing cholesterol levels.

 

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