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A heart attack is when one of the arteries (blood vessel) to the heart muscle is blocked leading to damage to the heart muscle itself.
Angina is the feeling of discomfort/pain in the chest and/or adjacent parts of the body including the shoulders, arm, neck or in the jaw
Coronary arteries are the blood vessel that carry blood to the heart muscle. A build-up of fatty material called plaques is called coronary artery disease. It can lead to the obstruction of proper blood flow to the heart muscle.
The most common risk factor for coronary disease is age, male gender, family history, high blood pressure, diabetes, high cholesterol, tobacco use.
A study done many decades back called the Framingham Study clearly showed a consistent association/relationship between high cholesterol levels and the development of coronary artery disease.
There are multitude of tests available to test for the presence or absence of CAD. The most common non-invasive way to test it is what is called the exercise stress test. Often the stress test is combined with an imaging modality including nuclear perfusion or echocardiogram. This will enhance the detectability of the disease. Other tests include a CT scan for the presence of calcium in the arteries or an angiogram. The gold standard for the detection of CAD is still cardiac catheterization or coronary angiogram.
This is a painless tracing of electrical signals that emanate from the surface of the heart and can be captured by placement of certain electrodes on the chest wall. It gives valuable information of the heart include the presence or absence of heart rhythm disturbance, electrolyte imbalances, presence of any previous heart attack etc.
A stress test is a test to help diagnose the presence or absence of CAD. This is usually performed by walking on a treadmill to capture any electrical signal changes and also test the amount of walk achieved. Sometimes a patient is unable to walk on the treadmill due to functional difficulties in which case a chemical stress test with imaging is performed. Typically the chemical given to challenge the heart is called Lexiscan and occasionally dobutamine.
No special preparation is needed. If a patient will walk on the treadmill, it is preferred not to eat for 3 hours prior to the walk. Certain drugs what are called beta blockers should be held that morning in order to get a good heart rate response.
In case of a chemical stress test it is recommended not to take caffeinated products for 24 hours prior to the test.
Echo is an ultrasound test of the heart. It is a simple test where a technician will put a probe on the chest to image the functioning of the heart walls, valves and also assess pressures inside the heart chambers. It is a non-invasive way of assessing the working of the heart.
This is an ultrasound study of the arteries (blood vessels) that carry blood to the brain. Development of disease in these vessels can be associated with the development of stroke.
This is a test which is usually performed in a hospital or ambulatory surgical center with special imaging equipment to detect the presence of heart disease. Typically a tiny catheter with a size of approximately 2mm is inserted in the body via a major blood vessel and taken to the heart. Dye is then injected via this catheter and images captured by passing x-rays to discern the presence of blockage in the coronary arteries or assess the motion of the heart muscle.
It is the act where via similar tiny catheters any blockages in the heart can be unblocked utilizing balloon catheters or placement of metal tubes called stent to keep the coronary arteries propped open. It is usually performed in the same setting as a cardiac catheterization.
Once it is determined that the coronary arteries that have blockages that are not amenable to angioplasty or stent, a heart surgeon will take the patient to the operating room. The chest wall is opened and the heart is exposed. The surgeon will then take veins from the legs or an artery from the chest wall called the mammary artery and place these beyond the previous coronary obstruction and create new pipelines to feed blood to the heart muscle.
There usually 3 options once a diagnosis of CAD is made. This includes placement of patient on “medical therapy”. Medical therapy includes a host of different medications to retard the development and progression of CAD. The second option is “angioplasty”, as explained earlier in #13. The third option is “bypass surgery”. This was explained in #14.
It may be okay to take up to 3 pills under the tongue over a 15 minute period, at least 5 minute apart from each other.
A tissue heart valve is a valve constructed from material obtained from a pig or cow. On the other hand a metallic valve is constructed from metal. The long term durability of the valves based differ due to the nature of material.
Most dental procedures do not need any antibiotic prophylaxis. However in certain conditions where there is an artificial valve or a diseased valve it may be necessary to take antibiotic prophylaxis. A doctor can determine such a necessity.
Heart is typically in a very regular consistent rhythm often referred to as normal sinus rhythm (NSR). However occasionally the alteration of this normal rhythm can be altered by development of irregular beating can happen. This may include such a thing like extra beats or the development of an irregular rhythm from the upper chambers (atria) of the heart called atrial fibrillation. Occasionally abnormal rhythm development from the lower chambers (ventricle) of the heart called ventricular arrhythmia can also develop. This can sometimes be a more serious condition.
A holter is a test where a recording device is placed on the chest for usually 24 hours. This recorder will record every beat of the heart for the time it is placed on the chest. It is a valuable test to detect the presence of arrhythmia.
A patient may need an artificial pacemaker due to the native pacemaker of the heart not beating consistently. These symptoms are usually from an inappropriate low heart rate which may include weakness, fatigue, dizziness and sometimes fainting.
A doctor may recommend a defibrillator therapy if the patient has a poorly functioning heart muscle or has a serious rhythm disturbance. This is a lifesaving therapy similar to if the patient received shock with an external defibrillator.
The current devices have no limitations to the use of microwave.
An EPS is performed by a physician with special training in detecting the electrical system of the heart. It may be necessary to do a study to assess patient for the presence of a particular rhythm disturbance.
Some rhythm disturbances can cause significant symptoms that may not be adequately treated with medicine, therefore an electrophysiologist will first try to understand the rhythm disturbance and then treat the arrhythmia with a special catheter and either burn or freeze the area of the heart where this abnormal rhythm is originating.
Similar to blockage in the arteries of the heart and neck, narrowing of the arteries to the legs and arm that carry blood to the tissue can cause the development of PAD. Symptoms of PAD may include painful walking or pain in the arms with activity. Occasionally more advanced cases of PAD may include loss of tissue or even gangrene due to complete absence of circulation.
Veins are the blood vessels that carry blood back towards the heart. This is different compared to PAD. Venous disease typically develops due to disease in the one-way valve that become incompetent and allow blood to reflux/pool in the legs while walking or standing. Long standing untreated venous disease can sometimes have adverse consequences similar to that of PAD.
Hurting in the legs can be due to disease of the arteries or veins. It can also be related to the nerve tissue in the legs. Occasionally if this is in the joints or muscles then it may be related to muscular or skeletal tissue disease/changes. Pain due to PAD is related to lack of blood reaching the exercising muscles and tissues starving it off important oxygen temporarily. In venous disease the pain is due to veins getting overly distended with blood refluxing back in the legs.
Compression stockings help keep the distended veins from refluxing back and avoid pooling of blood in the legs.
High blood sugars as in the presence of diabetes may lead to adverse effects in blood vessels, heart, kidneys, and eyes leading to various disease states.
As explained earlier the presence of high cholesterol may lead to heart disease. Doctors may prescribe drugs to lower cholesterol levels if diet and exercise cannot bring a meaningful change. The addition of a class of drugs called “statins” have shown remarkable benefits in the long term survival of patients and avoidance of heart attack and strokes. These are an important class of drugs with significant benefit in the long term.
Warfarin or Coumadin is a true blood thinner. It works by preventing the liver from making certain proteins in the body which help in the process of thickening (coagulating) of the blood. It’s action is derived by affecting the vitamin K in the gut. Diets that are high in vitamin K will therefore decrease the effectiveness/potency of this drug.
In most cases physicians will prescribe generic drug. These agents are appropriate and usually work as well as similar class of brand drugs. However in certain circumstances a physician may need to prescribe a brand drug if no generic equivalent is available.
In most circumstances medicine prescribed for ED are safe and effective. However in certain conditions there may be some restrictions but usually not permanent.