Q: What does a Holter monitor tell me about my heart?
A: 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.

Q: What is an echocardiogram of the heart?
 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.

Q: What is coronary artery disease?
A: 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.

Q: What is a drug-coated stent?
A: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.

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

Q: I have heard that red wine can help your heart. Is that so?
A: 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.

Q: What is atrial fibrillation?
A: Atrial fibrillation (A fib) is one of the most common heart rhythm disorders, affecting more than two million people in the United States. In A fib, the heart beats rapidly and irregularly. Although not directly life threatening, A fib can cause palpitations, other rhythm problems, chronic fatigue, shortness of breath, chest pain, dizziness and stroke. The chance of a stroke is increased five-fold in patients with A fib.

The likelihood of developing A fib increases with age but can occur in young patients as well. Treatment of A fib includes medications to establish normal rhythm, medications to slow the heart rate during A fib, and medications that thin the blood. Often A fib can be difficult to control. New procedures are now available which can cure A fib in selected patients.

Q: I often feel like my heart skips a beat. Is this normal?
A: One of the most common presenting complaints to a cardiologist is the complaint of a “skipped heartbeat.” Normal heart rhythm is dictated by the sinus node, the pacemaker of the heart, which resides in the top right cardiac chamber. The sinus node sends electrical impulses to the bottom chambers of the heart, the ventricles, through specialized conduction tissue. The resulting rhythm is regular – the top chambers, the atria, beat first followed by beating in the ventricles.

The sensation of skipped beats usually comes from extra electrical beats originating in the atria or ventricles. These extra beats are very common and can increase with stress or increased caffeine intake. As we get older, the frequency of these extra beats tends to increase. Generally, these extra beats do not represent a serious problem, but if they persist consultation with a physician is recommended.

Q: What is a pacemaker?
A: A pacemaker is a small device that is implanted in the upper chest region for prevention of an abnormally slow heartbeat. A slow heartbeat develops when the heart's natural pacemaker slows down with age or when the heart's natural electrical conducting fibers wear out. Patients requiring pacemaker implantation often complain of dizziness, lightheadedness, fatigue and/or fainting associated with a slow pulse.

Not uncommonly, patients who need pacemakers are on necessary medications that result in excessive heart rate slowing. A pacemaker system generally consists of a pulse generator, which houses the pacemaker battery and circuitry, and two pacemaker leads. The leads are inserted through the veins into the top and bottom chambers of the heart.

A typical pacemaker implantation is done under local anesthesia with light sedation and can be completed in 60 to 90 minutes. Patients with pacemakers can enjoy active, normal lifestyles with minimal restrictions. Most electronic devices in the environment, including microwave ovens, have no effect on pacemakers.

Q: Is it normal to feel irritable or depressed after suffering a heart attack?
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.

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