Cardiologist FAQ

Time is short when a patient is having a heart attack. Accessing the heart through the femoral artery in one's leg is not always the best option. Our hospital can utilize the radial artery in the wrist to provide swift, lifesaving treament for STEMI

Robert Schiller is the first patient to receive Radial STEMI at CFCVI. He shares his expereince.

A heart attack is in some ways a complex situation in terms of the entire body. But the cause is very simple. The cause of a heart attack is a clot forming in a narrowing in one of the arteries to the heart and the clot obstructs the vessel and prevents blood supply to the heart muscle. As a result of that a part of the heart begins to die. There has been tremendous progress in preventing damage to the heart and preventing that part of the heart muscle from dying.

Lifestyle changes after a heart attack are vital. Adequately changing lifestyle can definitely prevent a second heart attack. The only factor that puts a person at risk for a heart attack is our family history that we cannot change. Everything else can be changed. / We can lose weight and thereby reduce our blood sugars and blood pressure. We could quit smoking, we could take medications faithfully to lower cholesterol, take blood thinners, and we could exercise regularly.

Let's breakdown what exactly cholesterol results mean, when you have your blood work drawn, you always want to make your blood fasting at a minimum of 12 hours. With those lab results you will have goals according to the American Heart Association for some range of numbers. Let's go over some of those numbers. Your total cholesterol range should be under 180 and Triglycerides under 150. Your HDL or good cholesterol s for men should be greater than 40. And for women it should be greater than 50. The bad cholesterol or LDL this is the cholesterol this bad cholesterol component that builds the blockage in our heart arteries and other vascular parts of our bodies such as the leg arteries, the brain arteries. This number needs to be less that 100 as an ideal range. Now once you have diabetes diagnosed or you have a documented blockage in your artery that number needs to be under 70.

CAD stands for Coronary Artery Disease and it's a process whereby the arteries that supply the heart get diseased. The commonest cause of CAD is a process called atherosclerosis which is a disposition of plaque cholesterol plaque at the coronary arteries. This plaque can clog the arteries and prevent flow of blood to the arteries, this plaque can also cause heart attacks.

The most important thing for blood pressure control especially if you do not want to take any medication is why you have high blood pressure. Is it because you are overweight, lack of exercise, eat a lot of salt which turns out to be the main reason why, once you define why you have hypertension then you need to address that. / In the case that you cannot just do it by yourself, by losing weight, doing exercise regularly, controlling your salt intake, definitely blood pressure medication is our number one choice because we need to control the blood pressure before you get a stroke or any other problems.

Plaque that produces coronary artery disease, arises in the vessel in the artery, but it's related to certain risk factors. Factors like high cholesterol, diabetes, high blood pressure, smoking.

It is very important to know the difference between the signs and symptoms of a heart attack, chest pains and abdominal pains to make sure we are not either missing the symptoms for a gallbladder attack for a heart attack or a heart attack for a gallbladder attack. / So there are different ways that we can differentiate those, that is why we do a stress test when signs and symptoms are non-specific and we are not so sure. And the patient has enough risk factors being diabetic, smoker, high blood pressure, obesity. Then we tend to pursue more towards heart disease and do a specialized stress test with additional nuclear a to see if it is additional blockage in the arteries that is causing the symptoms. / If we are not convinced and we think it is abdominal pain we can always offer ultra sound and surgical consultation and find out what it is.

TEE (trans-esophageal echocardiogram) is very valuable when it comes to looking for clots in the heart, looking at the valves of the heart to make sure that they are not infected and don't have a condition called endocarditis. Looking for leaking heart valves or heart valves that don't open properly and that are stopped up. / Diet is extremely important, and includes weight loss, restriction of animal fats, consumption of sufficient amounts of fiber and restriction of amounts of refined carbohydrates.

TEE (trans-esophageal echocardiogram) what we prefer to in the hospital as TEE is a process whereby we make a patient swallow a probe and the probe takes breathtaking pictures of the heart from the esophagus, from the food pipe the esophagus sits right behind the heart and the probe is very to the cardiac structures so we see surprising detail and TEE is invaluable when it comes to diagnosing certain conditions.

Most people don't realize how significant heart disease is among women. Most women fear cancer or breast cancer or other diagnosis like the number one cause of death. But heart disease is much more prevalent than people think in women. But much more women die of heart disease or become disabled like having heart failure after a heart attack. / Because we or the patient miss the symptoms or the presentation might be late when in fact heart attack is much more common than people think.

I have seen woman confusing anxiety with heart attack or angina but I have seen also with is pretty typical woman confusing acid reflux with heart disease and in fact they may be having a very significant coronary lesion after we do the cardiac catheterization so it is very important that the woman if she has high risk factors like diabetes, hypertension, lymphedema and they have symptoms that may or may not be heart disease, better to err on the side of testing that woman because we may miss an important diagnosis because we may be missing a heart attack if we just attribute that the patient has anxiety or acid reflux.

Lung Cancer in the United States kills more people than breast cancer, colon cancer and pancreatic cancer combined. It has a very poor survival characteristic and fortunately is linked to smoking in a large majority of the cases. / Here at Osceola Regional we do non-cardiac thoracic surgery when I am unfortunately seeing the end product of smoking which involves both early and sometimes late stage lung cancer. We do know that stopping smoking makes a difference even for a short time. But patients have to stop smoking for almost 10 years to have the same risk characteristics as a non-smoker.

There are studies that have shown that estrogen replacement in women may actually increase the risk of heart disease and that is no longer recommended. It used to be that woman may take estrogen replacement for menopause thinking that it had a protective factor in the terms of heart attacks is no longer the case and it is important to take that message to the community so those people taking estrogen replacement pills stop doing it, because there are studies that have shown to increase morality in those patients.

For us in cardiology time is muscle so the time we lose by not diagnosing something is time that patient loses and its cells that die and that heart gets weakened by that loss of time and loss of cells. So it's important to realize that woman in fact may have a typical presentation and not contributes it to something else and it's safer to have it checked out if you think something is wrong. Don't just think its anxiety, because if it's anxiety and we diagnose that it's not heart is fine, we can say its anxiety. But if we test the person and we realize it is truly heart disease then we can do something about it.

A well-toned athlete can have a heart rate in his 50s and 60s and he is exercising, because of you---when you run when you exercise your heartbeat goes up to 120-150 because of---ataxia. / But if you do have a heart rate out of the blue that is suddenly starts pounding, is going too fast, you feel dizzy or your symptomatic you have blurry vision or whatever happens that way, then it is a case for concern. / What that means is that the electrical signals of your heart are actually going through a different to keep it very simple going through a different electrical circuit where your heart rate is beating anywhere from 130-140-150 to 200 beats a minute. That is what is called a arrhythmia, there are 3 or 4 different types of it based on an EKG which is an electrocardiogram or based on a holder monitor which is an extended period of an EKG which you wear for a couple of days, we will be able to have a rough idea as to where that short circuit is based. / Treatment options for these vary; always the basic rule is you try noninvasive factor trying simple medications but as electrophysiology and a physician of the heart a lot of these things have evolved quite a bit right now in the terms they can be safely and effectively ablation.

It used to be and I have been doing this for 30 years and it used to be that patients didn't take their medications because of side effects. I remember there were only 3 blood pressure medicines available and all 3 produced nasty side effects people felt bad, tasted bad, felt sleepy couldn't take them for various reasons that's changed. The majority of medicines non days have minimum or no side effects. And frequently the patient thinks that the medicine is producing a side effect but that's just may be a coincident. / I have a patient come to me just about every day and say that the cholesterol medicine is making their knees hurt, or their hips hurt or their back ache, yes cholesterol medications can cause muscle pains in the large muscles of the body but cholesterol medications do not cause joint pains. These are people that are getting old and have arthritis and blaming their arthritis on their cholesterol medicine. And that is a big mistake because their cholesterol medicine can reduce your risk of having a heart attack by over 30 percent.

Most patients after an open heart surgery are in the ICU for one day, most patients are back up to the floor for 2-3 days most patients after standard open heart surgery are home by post op day 3 or 4. At home they are home taking care of themselves. Their major limitation is using their arms for lifting. But they are walking, exercising otherwise. We see them back in the office after 3 weeks and that that time most patients after a standard open heart surgery are asking to get back to driving, get back to work and golf get back to things. We do ask that they hold off to any strenuous activity for a total of 4-6 weeks.

We all have natural pacemakers in our heart; the function of the natural pacemaker is to provide electrical impulses that are generated at different levels in the heart to keep the heart pumping from an electrical standpoint. There are various reasons why the natural pacemakers of the heart fail and one of the most common reasons is that we grow old. And we tend to have what the scientific and technical reason is sick sinus syndrome or heart attack or you have a heart block or you have sustained trauma to your heart. There are a variety of reasons and once these reasons are determined that a low heart rate is actually causing symptoms for you then a pacemaker is indicated. / A pacemaker is probably one of the most commonly used devices that are implanted; it is almost like skin surgery these days. It takes about an hour or so to do, and the technology has gone better that the batteries and wires that are placed inside your heart have gotten so small that you barely feel them once you put them in. The battery life last about 8 years or so and the mortality or the risk associated with this procedure is relatively low.

ICD is a fancy kind of a pacemaker in other words it delegates a shock at a various set energy and if your heart what it does is an insurance policy really. The placement of an ICD is just similar to a pacemaker; the difference only being it's slightly bigger in size but it detects your heartbeat for the rest of your life. And if your heart beat were to go dangerously fast your cardiologist or electro physiologist would program it appropriately on an individual basis and it will shock you and save your life. Time is muscle and if you did have a cardiac arrest with the appropriate ICD in place at home it would shock you and save your life. You would probably need that once in your life but that would be the time that it works the most.

Osceola does have a very busy nuclear program where we stress tests including stress tests for people who can't walk. And we use a substance that has a small amount of radioactive activity in it to take pictures of the heart. So the substance goes to the heart muscle in direct proportion to the blood flow and we can detect areas of the heart where there is insufficient blood flow. This is called nuclear stress testing and basically we do it dozens of time every day at the hospital here.

The is called aortic stenosis and because the aortic valve doesn't open properly the left ventricle the main chamber of the heart has to work harder to squeeze blood thru a smaller and smaller orifice. And eventually when the valve gets really small the left ventrical finds it difficult to cope and begins to fail. / In that situation the treatment is to surgically remove the valve and replace it, and the surgeons at our hospital are very good at doing that. We have the only surgeon in Central Florida that is able to do it with a minimally evasive incision, a small incision on the right side of the chest which is a unique skill.

What ablation is practically it can mean two things, exactly you burn the electrical circuit or you freeze the electrical circuit. I give my patients examples of soldering it's like when you solder to metal, you hold it together. So it's pretty much a specialized wire. / The way the procedure is once the you are past the simple stuff, taking medication, you re-do an electrical study of the heart what is called an EP study an Electrophysiology study where this is normally done under an conscious sedation through your groin ,a couple of wires are placed in your heart in strategic locations basically we look to find out where is the short circuit and if we prove what the different areas it can be based on its location it can be burnt. / What it is, is a special kind of wire where we heat and burn the tissue there distorting the short circuit, we can also freeze it using a cooling technology.