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The Heart House Frequently Asked Questions

What are the most common symptoms of a heart attack?
Symptoms of a heart attack can include: (1) discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone, (2) discomfort radiating to the back, jaw, throat, or arm, (3) fullness, indigestion, or choking feeling (may feel like heartburn), (4) sweating, nausea, vomiting, or dizziness, (5) extreme weakness, anxiety, or shortness of breath, and (6) rapid or irregular heartbeats. During a heart attack, symptoms typically last 30 minutes or longer and are not relieved by rest or oral medications. Initial symptoms may start as a mild discomfort that progresses to significant pain. Some people have a heart attack without having any symptoms, which is known as a "silent" myocardial infarction (MI). It occurs more often in people with diabetes. If you think you are having a heart attack, DO NOT DELAY. Call for emergency help (dial 911 in most areas). Immediate treatment of a heart attack is very important to lessen the amount of damage to your heart.

What do I need to do to see a cardiologist for the first time?
Heart House NJ prefer that patients coming in for the first time have been properly screened by their primary care physicians. Many other medical conditions can mimic heart disease/pain. Patients can save time and money by being properly screened.

What is atrial fibrillation?
Atrial fibrillation is an irregular and rapid heartbeat caused by a faulty electrical flow in the heart, It does not allow blood to move through the heart in a normal way which may increase the risk of blood clots and stroke. Symptoms may include shortness of breath on exertion, palpitations, and episodes of dizziness or fainting. Appropriate treatments include medications to control the heart rate, pacemaker therapy, catheter ablation, or cardioversion which uses electric shock to restore a normal rhythm

What is a PTCA, and why do I need one?
A PTCA or an angioplasty is a non-surgical procedure where a special balloon tipped catheter is inserted into the coronary artery through the groin. The procedure is used to open an area of the artery that has a narrowing due to a build up of plaque. Once in place at the sight of the narrowing, a balloon is inflated to flatten the plaque against the artery walls to restore normal blood flow to the heart muscle. Depending on the size and location of the blockage, a stent may also be inserted to help provide support for the artery.

What is a stent, and why do I need one?
A coronary stent is a tiny, flexible wire mesh tube. It is permanently placed at the sight of a narrowing of the artery to help keep it open. Some stents are drug-eluting (coated). These stents slowly release medication over a period of time to reduce scar tissue that forms inside the artery. This helps prevent restenosis or a reoccurrence of the build up plaque.

What is an EP procedure, and why do I need one?
An EP study is a non-invasive procedure that provides information in treating heart rhythm disorders. The data collected provides your physician the information needed in diagnosing the source of the arrhythmia and in developing the best treatment plan for your condition. An EP study is performed by a specialist (an electrophysiologist) under conscious sedation in a hospital setting. A catheter is inserted in through the groin or neck into a blood vessel and navigated to the heart with the aid of a fluoroscope. Electrodes at the tip of the catheter gather data and may also be used to induce the arrhythmia that is the cause of the heart rhythm problem. The procedure can take anywhere from 1-4 hours

Why do I need to take coumadin?
Coumadin is an anticoagulant or blood thinner, which helps prevent clots from forming in the blood. It is used to help prevent and treat blood clots in the legs and lungs, as well as those associated with an irregular heartbeat (atrial fibrillation) and heart-valve replacement. The most common side effect of Coumadin is bleeding. Therefore, careful monitoring of the drug's level in the bloodstream is required. Frequent blood test called INRs (international normalization ratios) will assist your physician in the proper dosing of this medication.

Why will follow my coumadin levels?
Coumadin levels will be closely monitored by your Heart House cardiologist.

What is an ablation?
A cardiac ablation is a non-surgical procedure used to destroy the sight of abnormal electrical pathways that may be causing an irregular heartbeat. A specialist known as an electrophysiologist inserts a catheter into a blood vessel, usually through the groin or neck. The wire is then threaded through the blood vessel into the heart. Once the location of the faulty electrical sight is pinpointed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical flow and restoring a healthy heart rhythm.

What is a heart catheterization, and why do I need one?
A heart catheterization — otherwise known as heart cath, coronary angiogram or coronary arteriograms — is an invasive test done to determine whether there are any blockages in the coronary arteries or valvular heart disease. A small plastic catheter is inserted into the femoral artery and threaded up to the heart. X-ray dye is then injected into the coronary arteries and an x-ray is taken to show whether there is any narrowing or blockage of the artery. If valvular heart disease is suspected, pressure readings are taken within the heart to determine how severe the problem is. This information enables your cardiologist to appropriately treat you either with invasive therapy or with medications.

How do I prepare for a heart catheterization?
Patients having heart catheterization are asked to fast from midnight the night before their test. We want you to take your usual morning medications, however, we ask that you do not take any medication for diabetes that morning. If you take coumadin, you will need to be off this medication for three full days prior to the procedure. If you are allergic to iodine, be sure to let your physician or his nurse know as the "dye" does contain iodine. You may be asked to take additional medications to block this reaction, or medication may be given to you through the IV. Please bring your medications with you when you come for your cath. Following the procedure you will be instructed about what medicine to take and when to start taking them.

Is it normal for there to be some bruising at the site of my heart cath?
It is not uncommon for patients to notice a small amount of bruising at the cath insertion site. The catheter enters an artery where the pressure is high and there is always a small amount of blood that escapes into the tissue. If there is a large, painful area around the cath site that worsens or becomes more painful with time, notify your cardiologist.

After catheterization, can I travel or drive a car?
Generally speaking, after catheterization you should allow 48 hours to pass before driving or travelling to make sure you are back to your usual level of coordination and alertness. Each patient is a unique individual, so the extent of your other post-procedural activity will be determined on a case-by-case basis.

How do I prepare for an echo test?
There is very little prep for an echocardiogram. You will need to get undressed from the waist up. Women will be given hospital gowns to wear. You will lie on a table on your left side. Images of your heart will be taken with an ultrasound machine. You will be able to hear the sound of your blood as it goes through your heart. There may be a 20% chance that you would need a contrast echo, which would involve starting an IV. We would then inject a contrast agent through the IV to better see the lining of the heart.

How long will my echo test take?
We schedule an hour for an echocardiogram. It can sometimes run a little longer or a little shorter depending on the images we obtain.

How do I prepare for a stress test?
You may be asked to hold certain medications, usually beta blockers. You will be asked to have a light breakfast or lunch depending on the time of your stress test. You will need to wear rubber soled shoes, sneakers are great. You will have to get undressed from the waist up. Women will be given hospital gowns to wear.

How long will my stress test take?
A regular stress test takes about a half an hour. A nuclear stress test takes about three hours. A stress echo takes about one hour.

What if I can't walk on a treadmill?
For patients who are unable to walk on a treadmill, a chemical stress test may be performed and the same results will be achieved.

How do I prepare for a nuclear stress test?
Patients must be fasting for three hours prior to the test. Patients must also be free of caffeine of any type for 24 hours prior to testing. This includes coffee, tea, chocolate, white chocolate, aspirin compounds that contain caffeine, decaffeinated coffee or tea and other sodas which contain caffeine. Patients who are taking medications for lung problems, diabetes mellitus, congestive heart failure and persantine may need to alter their medications. A complete set of written instructions will be given to patients when the test is scheduled.

Is the dye used in nuclear stress tests the same as the dye used for caths, and will I be allergic to the dye?
The dye used in nuclear stress tests is not the same as the dye used for heart caths. The dye used for nuclear testing is a solution of salt water and a nuclear isotope. It is very unusual for patients to be allergic to this substance.

How long will my nuclear stress test take?
Nuclear stress testing can take anywhere from 2-4 hours to complete.

How long will it take for me to get my test results?
Heart House NJ attempts to have your test results ready for reporting within two working days.

I have had a permanent pacemaker implanted. May I use a cell phone, and what about going through a metal detector?
There is no hard and fast rule about cell phones and pacemakers. It is felt that you can use a cell phone, but use the ear opposite the pacemaker or defibrillator. Metal detectors will not harm a pacemaker or defibrillator as long as you are passing quickly through the detector. If you are concerned you can notify the people at the detector, and they will usually allow you to pass around the detector.

After pacemaker implantation, can I travel or drive a car?
Generally speaking, after pacemaker implantation, you need to keep the arm on the pacemaker-side of your body below shoulder-level for 30 days, although driving is generally permitted after 48 hours. In addition, do not lift anything heavier than 10 pounds for 30 days following implantation. Each patient is a unique individual, so the extent of your other post-implantation activity is determined on a case-by-case basis.

Why does my dentist want to know if I need antibiotics before dental work?
Patients who have valvular heart disease or have had a valve replaced are at increased risk for infection of the heart valve. Any manipulation of the gums may cause release of bacteria into the blood stream and set up the risk for infection. Guidelines have recently changed. Our physicians determine if this is necessary for each patient with these medical conditions.

Why is it important to control hypertension?
Hypertension is the term used to describe high blood pressure. It is important to control blood pressure because it has been associated with worsening heart problems, strokes and increased hospitalizations. There are several ways that patients can actively participate in controlling their blood pressure better. The first thing to keep in mind is that they should watch the amount of fluids they drink and the salt (sodium) content of the foods they eat. Regular exercise, maintaining a healthy balance diet, quitting smoking, limiting alcohol and reducing stress are common ways to getting on the path of controlling your blood pressure.

Are the commercial blood pressure machines in stores accurate?
Blood pressure machines in large stores are okay for screening purposes and are usually fairly accurate, however, if your blood pressure reads high, you should have it checked by your physician to be sure of the accuracy.

What is hyperlipidemia and how do you treat it?
Hyperlipidemia is a condition characterized by abnormally high levels of lipids in the blood. It is commonly referred to as "high cholesterol." There are different types of cholesterol. The two main types are often called "bad (LDL)" and "good (HDL)." The bad cholesterol can damage the heart and arteries, but good cholesterol does not cause damage. The goal is to keep the bad cholesterol in a low range (70-130mg/dL) and the good cholesterol in a high range (40-60mg/dL). Most people do not know they have high cholesterol unless they get tested. Having a blood test to check your cholesterol will tell you if your levels are on target. Daily exercise and diet low in fat can reduce the risk of hyperlipidemia, however, in some patients there is a need to prescribe cholesterol-lowing drugs.

How can I improve my HDL, or "good cholesterol," without taking medications?
A: 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.

May I use the little nitro pills under my tongue if I am using the nitro patch?
Yes, you may use nitro pills under your tongue for chest pain while you are wearing a nitro-patch. The pills are fast acting and rapidly dilate your blood vessels to allow more blood to pass through the vessel. Nitro-patches are long acting and do not cause the rapid dilation needed for relief of chest pain.

If I have chest pain, how many nitro pills may I take at once?
Nitroglycerine tablets under the tongue are usually taken, one tablet, every five minutes up to a total of three tablets. If the patient is still having chest pain, they are instructed to take the fourth tablet and go to the nearest emergency room for treatment.

Why do I have to weigh myself every day with congestive heart failure?
Congestive heart failure, or CHF, is a condition in which the heart muscle is weak and cannot pump effectively. If the heart is not able to keep up with the amount of fluid it has to pump, the fluid will escape into the tissue causing swelling. The earliest sign that this is occurring is weight gain because of the extra fluid.

Will my cardiologist refill all my medications?
Heart House NJ cardiologists prefer to refill only those medications having to do with your heart. Medications for conditions such as elevated blood pressure, elevated cholesterol, blood thinners or other medications which our doctors prescribe will also be refilled. Medications having to do with other conditions which have been prescribed by your primary care doctor should be refilled by that doctor.

May I take generic brand medicines?
Most generic medications are fine for you to take. There are a few medications that we prefer be given as name brand. Your cardiologist will indicate this, if necessary.

May I take over-the-counter medications for cold and sinus problems?
Over the counter medications for colds and sinus may contain medications that act as cardiac stimulants and/or cause constriction of your blood vessels. It is best to call and ask what medications you may take.

May I take viagra?
Viagra is a medication that also causes a drop in the patient's blood pressure. It is important for patients to ask on an individual basis whether it is a medication that they can safely take with their other medications. If you are taking a nitroglycerin preparation, Viagra is NOT allowed.

I have heard that red wine can help your heart. Is that so?
Observational studies have shown lower risk of cardiovascular events in patients who regularly drink red wine. Since these early observations, several studies have suggested that it may be just the alcohol that confers these benefits, although there may be some benefit in the grape as well. Males who have two drinks a day and women who have one drink (beer — 12 ounces, wine — 5 ounces, liquor — 1 ounce) had a heart disease risk reduction of 30 to 50%. Still, the American Heart Association does not recommend alcohol as a means of risk reduction. Alcohol consumption has been attributed to raising the "good cholesterol," the HDL. Other beneficial effects may be blood thinning and, in certain patients, lowered blood pressure. Of course, in other people, blood pressure can be raised by drinking alcohol. Whether alcohol is good for you should be decided on a case-by-case basis with your physician. For people who do drink, the benefits seem be related to having their alcohol on a regular basis with a meal and not episodically. Moderation is the key — no more than two drinks for men and one drink for women, and regular follow up with your physician.

Can a Mediterranean Diet ward off heart attack and stroke?
Yes. About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables. Published on The New England Journal of Medicine's website on February 26,2013, these findings are based on the first major clinical trial to measure the diet's effect on heart risks. The magnitude of the diet's benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue. The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk. Heart disease experts consider this study to be a triumph because, using the most rigorous methods, it showed that diet is, indeed, a powerful weapon in reducing heart disease risk.

Can you explain the revised national dietary guidelines regarding cholecterol.
Every five years, officials from the USDA and the U.S. Department of Health and Human Services meet to review and revise national dietary guidelines. This year, the recommendation regarding the consumption of high-cholesterol foods has changed. The advisory panel stated that "cholesterol is not considered a nutrient of concern for over-consumption." But what does this mean in practical terms? Plainly stated, it means cholesterol consumed in food is now thought to play a relatively insignificant role in determining blood levels of cholesterol. That said, serum cholesterol — cholesterol in your bloodstream — is still considered an important risk factor for heart disease. As a result, people still need to limit foods with heart-damaging saturated fats and trans fats, the two leading dietary contributors to high blood cholesterol. Only a handful of common foods are high in cholesterol but low in saturated fat — eggs, shellfish and liver. People looking to eat a heart-healthy diet should still avoid foods such as fatty cuts of meat, and cheese or ice cream made from whole milk, because those are high in saturated fat. Same goes for bacon, fried chicken, hot dogs and cheeseburgers. They also will have to avoid processed foods high in trans fats due to ingredients like partially hydrogenated vegetable oils -- think packaged cookies and cakes. Trans fats have been shown to simultaneously increase levels of "bad" LDL cholesterol in the blood and decrease levels of "good" HDL cholesterol.