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Frequently Asked Questions

A Holter monitor is a portable electrocardiogram (EKG) that monitors the electrical activity of an ambulatory patient’s heart for a 24-hour period. It is most often used when your physician suspects an abnormal heart rhythm, often based on complaints of a sensation of a beating heart, a fast heartbeat, or palpitations.
There is no special preparation for this painless test. Wires from the monitor are taped to the patient’s skin, and he or she is asked to go about usual daily activities. The patient keeps a diary so the physician can correlate the monitor’s results with the patient’s reported symptoms.

Also known as transthoracic (across the chest) echo, it is a painless test used to observe the heart chambers and valves. Not an x-ray, it uses ultrasound high frequency waves to get a picture of all four heart chambers and valves. The sound waves bounce back and produce images and sounds that can be used by the cardiologist to detect damage and disease.
An echocardiogram is a safe, noninvasive test, and in fact, is the same technology used to image a fetus before it is born. To perform the test, a special gel is placed on the chest wall and a transducer is then moved over the gelled areas to produce images for interpretation.

Coronary artery disease is a chronic condition that leads to the narrowing and hardening of the arteries that supply blood to the heart muscle. This narrowing leaves less room for blood flow, depriving the heart muscle. Many risk factors, smoking, diabetes, high cholesterol, high blood pressure, lifestyle, and family history, can contribute to the development of coronary artery disease. Aside from inherited factors, any of the risks can be modified and the chance of developing heart disease reduced.

The newest type of metal struts used to expand blockages in heart arteries look like small springs found in pens. They help relieve chest pain or stop heart attacks. The older, bare metal stents eventually reblocked with scar tissue 15% of the time. With the new coated stents releasing very small doses of a chemical similar to chemotherapy, scar tissue is prevented and the risk of reblocking is now down to less than 2% in patients followed for over three years.

Consuming monounsaturated fats can improve your HDL as well as reduce triglycerides and bad cholesterol (LDL). These include olive oils and other vegetable oils, nuts and avocados. Some foods such as peanuts, green peas, sunflower seeds and corn can also raise HDL. Other important strategies to raise HDL include a regular exercise program, alcohol in moderation and the cessation of smoking. Calcium supplements have also been shown to increase HDL levels.

Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.

If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.

Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.

Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.

It is not uncommon for persons to have strong emotional feelings after going through an ordeal such as a heart attack. Many times heart attacks occur suddenly in otherwise healthy people who aren’t accustomed to the idea to having to deal with any illness. Sometimes it triggers feelings of depression, hopelessness, irritability and fear.
Any patient struggling with these emotions after a heart attack should discuss them frankly with his or her physician. Counseling and medication can help remove this obstacle to good health. Enrolling in supervised cardiac rehabilitation after a heart attack can also be quite beneficial.

Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. Perhaps I should explain that LDL cholesterol is the "bad" cholesterol component.

If you have a family history of heart disease, it is wise to have your blood cholesterol checked after the age of 18 and regularly thereafter. The patient should also have their blood pressure checked annually as well as tests for diabetes. Perhaps more importantly, one should maintain a healthy lifestyle at any age. That includes no cigarettes, a heart-healthy diet, and regular exercise.

I would suggest a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. I would not advise patients to eat a diet that is restricted in carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.

Being overweight can increase the risk of heart disease in several ways. There can be a ten-fold increase in risks of high blood pressure and diabetes. In addition, being overweight will decrease the HDL or "good" cholesterol, which is now recognized as a major risk factor. If you are overweight, it is important to diet and exercise in order to lose weight and reduce these risk factors.

Stress can increase the risk of heart disease, although we still do not know how this happens. A sudden physical or emotional stress can certainly lead to an episode of angina or even a heart attack.

Heart disease can manifest as chest pain, tightness or discomfort. Sometimes even shortness of breath can be a symptom of a heart attack. Any unusual restriction in your activity could be a warning sign of heart disease. Dizziness or a fast or irregular heart beat is another symptom.

Vitamin E is taken by many people; however, recent clinical trials have suggested that it is not effective in reducing the risk of heart disease, at least in patients who've already had one heart attack. There have now been two clinical trials involving more than 20,000 patients with placebo or 400 units of vitamin E a day. There was no benefit of vitamin E in either trial. For that reason, I do not normally recommend vitamin E.

There are some kinds of diet pills that have been shown to cause damage to the valves of the heart. This is a different kind of heart disease from a heart attack, and the pills responsible have been withdrawn from the U.S. market. There are some newer treatments that do not affect the heart, and these can be useful in reducing body weight.

Valvular heart disease is where the valves of the heart that are responsible for maintaining one-way blood flow through the heart become thickened or weakened. This can lead to shortness of breath, dizziness, fatigue, and even stroke.

A stress test is a test where the electrical activity of the heart is monitored using an electrocardiogram (ECG or EKG), while the patient exercises on a treadmill. It can give information about blood flow to the heart and can suggest whether there are narrowed blood vessels. However, it is important that this test be performed only in patients who are at high risk of heart disease or who have symptoms to suggest heart disease, because there can be a false-positive test that may lead to worry and further unnecessary tests.

Salt in the diet can cause an increase in blood pressure in some patients. For that reason we usually recommend that salt intake be restricted to moderate levels. It is particularly important to watch salt intake if a patient has high blood pressure that is not controlled with usual therapy. Many foods, such as potato chips, peanuts, and ready-made meals, have very high salt content.

he most commonly performed heart surgery is coronary artery bypass grafting. It is used to redirect blood around blocked coronary arteries to allow the heart to function normally. In patients who have had this surgery, we are very aggressive in controlling all of their risk factors. This is necessary because vessels used for surgery are more sensitive to risk factors like cholesterol.