Frequently Asked Questions

• What is involved in a basic office visit?

• What are some cardiac warning signs?

• What is an EKG?

• What is an Echocardiogram?

• What is a TEE?

• My doctor told me I need to have a stress test.  What does this mean?

• How should I prepare for the Stress Test?

• What is a Tilt Table Test?

• What is an Angioplasty?

• Why do I need an Angioplasty?

• What is the difference between an Angioplasty and a Stent?

• What is a heart attack?

• What is the difference between typical and atypical angina?

• What is Congestive Heart Failure (CHF)?

What is involved in a basic office visit? 
The cardiac work-up involves two parts: a history and a physical (H & P). The physician asks the patient a series of questions in order to obtain information that could be relevant to underlying symptoms of cardiac disease. Some of these questions include:

• chief complaint,

• other heart related complaints or past "incidents",

• current medications,

• past illness,

• prior surgeries,

• family history,

• non-cardiac complaints,

• social history (smoking, drinking, etc. )

The history dictates whether or not the patient needs to have further testing for specific illnesses and the urgency with which they need to be performed. 

The second part of the office visit is a physical where the physician gives you an examination. He or she will listen to your chest with a stethoscope. The physician will be able to listen to the patient's heart beat, lungs and blood vessels of the neck and groin. Abnormal heart sounds, a clue to heart disease will be noted. He/she will also take your pulse rate, check your extremities for edema and feel your abdomen for tenderness or swelling.

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What are some cardiac warning signs? 
If you experience symptoms such as shortness of breath, angina (pain in the chest or other areas), dizziness, black out spells, palpitations, fatigue, swelling of the extremities (especially the legs and feet) contact your physician and schedule an appointment as soon as possible.

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What is an EKG? 
An Electrocardiogram is a non-invasive test that can provide information about the patient's heart rhythm, whether it is regular or irregular.  An irregular rhythm is known as arrhythmia or fibrillation.   Furthermore, it can tell the doctor whether the patient has had a heart attack in the past and whether there are signs of decreased oxygen to the heart. 

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What is an Echocardiogram? 
An echocardiogram is a non-invasive test where your heart is examined through the use of ultrasound.  The echocardiogram offers advanced imaging of your heart in both single and two-dimensions. (M-mode and 2-D echocardiogram). The M-mode and 2-D echo lets the physician measure the size, thickness and movement of the heart chambers and valves.  The echocardiogram is also capable of displaying a cross-sectional view of the beating heart. 

An additional part of the echocardiogram is the Doppler examination.  Doppler can assess blood flow as it circulates in and out of the heart to the rest of your body.  For example, Doppler is used to identify abnormal leakage across heart valves, known as stenosis, insufficiency, prolapse or regurgitation.  

Finally pumping function, (also known as ejection fraction) of the heart can be assessed by echocardiography.  The physician will be able to tell if the ejection fraction is normal or reduced and to what degree it is reduced.

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What is a TEE? 
A Transesophageal Echo (TEE) is a procedure similar to an echocardiogram except the echo transducer is placed in the esophagus.  A TEE is used to help determine the severity of certain valve problems and help detect infection of heart valves.  The procedure also may detect any blood clots inside of the heart.

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My doctor told me I need to have a stress test.  What does this mean? 
Patients may benefit from a cardiac stress test during which exercise or a chemical substance is used to stress the heart and to help identify or rule out underlying cardiac disease.  There are different types of "stress tests". 

A treadmill stress test consists of a patient exercising on the treadmill while his/her blood pressure and heart rhythm is monitored by the exercise technician or physician.  The treadmill is started at a slow pace whereby the incline and speed are increased every three minutes according to a protocol. 

A regular stress test is considered for patients with symptoms that could indicate coronary artery disease, patients who have consistent fatigue and shortness of breath or dyspnea on exertion.  If you are unable to exercise, you will be given an injection of a substance that exercises your heart muscle without you having to physically exercise. 

The desired result of taxing the heart is still obtained in this way. Stress tests can also be helpful to evaluate a patient's blood pressure response to exercise if they have blood pressure abnormalities.  Finally, a stress test can help point out exercise induced arrhythmia (irregular heartbeats).  If you are having a nuclear test, you still have the regular stress test but in addition nuclear images using either Cardiolite or Myoview isotopes are obtained both before the test (at rest) and after exercise (stress). 

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How should I prepare for the Stress Test? 
No matter what type of test you have, these recommendations hold true for all cardiac stress tests: Do not eat or drink for three hours prior to the procedure (If you are diabetic, please consult your physician), wear comfortable clothing and shoes that are suitable for exercise, and any other information will be provided to you by the physician scheduling the test.  The entire test takes about one hour for a regular stress test, and two to four hours for a nuclear stress test.

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What is a Tilt Table Test? 
A Tilt Test is used to explain a patient having syncopal episodes, or sudden fainting spells. Basically, the test is almost as it sounds. The patient is hooked up to an EKG machine and BP monitor and is placed supine (laying down) on a motorized table.  The table is tilted up to an angle of 80 degrees which stimulates going from a flat to a standing position which can be a cause of a syncopal episode (when your heart rate and blood pressure rise).  The patient can then be given an injection of a substance that stimulates the heart rate and blood pressure and the procedure is repeated. 

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What is an Angioplasty? 
Angioplasty is a technique that physician interventionalists use to dilate an area of arterial blockage with a catheter.  A catheter is a balloon like substance (but it is stronger and more pliable than an actual balloon) that has an inflatable tip.  A common type of angioplasty is a PTCA, or percutaneous transluminal coronary angioplasty. 

The catheter inserted through the skin of the groin and the physician guides in through the coronary arteries to the area that needs to be dilated.  The patient is awake and generally alert thoughout the procedure and a mild sedative is usually given for the patient's own comfort and relaxation. 

The procedure can take anywhere from 30 minutes to three hours depending upon the number of catheters that are used, and the severity/difficulty of the case.  Angioplasty has been shown to be beneficial in that it can relieve recurrent angina in the chest.  It is much less invasive than surgery and can be repeated in the same or other arteries. 

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Why do I need an Angioplasty? 
You may have arterial calcification or atherosclerosis where the walls of the heart can become hardened and narrowed with plaque restricting the passage of blood throughout your arteries. 

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What is the difference between an Angioplasty and a Stent? 
A stent takes the angioplasty a step further.  A stent itself is a stainless tube with holes in it.  The stent is placed on the tip of the catheter that expands and pushes against the inner wall of the coronary artery once the balloon is inserted and inflated.  Coronary artery stents usually open up the diseased area of the artery into a smoother and bigger opening compared to angioplasty reducing the risk of restenosis (re-blockage). 

In most cases though, stenting is preceded by angioplasty ("predilation" because the angioplasty opens the blockage area so the stent can be employed.  Keep in mind however, that angioplasty is a more common procedure because stents are hard to deliver across very small blood vessels whereas a plain catheter can maneuver through them.

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What is a heart attack?  
A heart attack is a result of a temporary decrease in blood supply to the heart muscle that can cause it to have a lack of oxygen. If the episode is very short-lived, it can produce angina.  However, if there is a prolonged or total loss of supply, the heart muscle gets damaged and produces a heart attack.

The symptoms of chest pain preceding a heart attack can last from several minutes to a few hours so it is essential to call your physician immediately if you begin to have any atypical chest pain.  The majority of heart attacks occur as a result of plaque on the coronary arteries.  If there is significant blockage, the plaque can sometimes cause a crack in the vessel. 

A clot can then develop at that site and can completely block the passage of blood in the artery thereby cutting blood supply to the heart muscle fed by that artery resulting in a heart attack. 

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What is the difference between typical and atypical angina? 
First we should define angina.  Angina or angina pectoris (chest pain) can be reported when the supply of oxygen that is carried by blood is unable to reach the heart muscle adequately.  Angina pectoris can be a recurring symptom and can be described as a feeling of (tightness, fullness, squeezing, heaviness, burning or pain) in the center of the chest.  Angina can also be transferred to the left breast, left shoulder, arm, throat, jaw and or even the upper abdomen. 

Patients may experience shortness of breath, sweating, weakness, dizziness, or numbness in the upper extremities with symptoms of nausea.   If the build up of plaque in the arteries is gradual, patients usually experience typical angina.  Typical or stable angina is reported in patients who usually have symptoms that are provoked by specific level of exercise. 

The episode is usually brief, lasting only a few minutes and subsides promptly with cessation of exercise or taking a nitroglycerin tablet which can be prescribed by the physician.  This partial and temporary decrease in oxygen supply to the heart does not generally cause permanent damage as a heart attack would.  This brings us to atypical chest pain.  These symptoms are usually not like typical chest pain.

The pain may be more severe and more isolated to a specific spot in body such as the throat, shoulder, arm, jaw or chest.  Some patients attribute atypical chest pain to indigestion (gas), heart burn, a gall bladder attack, etc, but atypical chest pain can be a warning sign of an impending heart attack so it's best to consult your physician about your symptoms.

What is Congestive Heart Failure (CHF)? 
One of the reasons your physician would check for edema (fluid around the extremities) during an office visit is to assess the level of excess fluid not circulating through your body.  Heart failure occurs when the heart is unable to pump enough blood to meet the usually demands of the body.  This can cause back pressure of blood flow to other parts of the body.  Once this happens, the organs in the body get (congested) with fluid as a result of backpressure, known as congestive heart failure.