Category: Cardiology FAQ’s

Cardiology is the term applied to physicians who are internists trained in the diagnosis and management of diseases of the heart and blood vessels. Diseases of the heart can include all aspects of the heart structure, including the electrical system. Electrophysiologists are subspecialists within cardiology who deal almost exclusively with the electrical abnormalities of the heart. This includes the diagnosis and management of arrhythmias, including the insertion of pacemakers and sophisticated defibrillator devices. Many times, medical therapy is an important part of the treatment. Electrophysiologists also have the capability of manipulating the electrical system by a process called ablation so that certain types of fast heartbeat abnormalities of the heart can be fixed permanently.

Arrhythmia refers to any abnormality of the heartbeat, including too slow, too fast, and/or irregular. The most common symptom associated with an arrhythmia is palpitations or an awareness of the heartbeat.  A more serious symptom is actual passing out (syncope). Evaluation of an arrhythmia usually includes some form of monitoring device.  It is also very important to determine if the heart is structurally normal. How arrhythmias are managed  is determined by the status of the heart structures and the extent of the symptoms. The most advanced treatment includes pacemakers and defibrillators but medical therapy is frequently all that is necessary. 

Syncope is a technical term for “passing out”. Over 90% of all situations involving syncope in the adult are related in some way to the cardiovascular system. Fortunately, rarely it is a significant problem. A minor nervous system imbalance is the most common cause and is tested using what is called a tilt study. More serious problems can exist and usually involve rhythm disorders of the heart or significant types of valvular disease. Fainting or syncope is a serious problem in the adult and should be evaluated thoroughly.

The heart has four valves within it that control blood flow, two on the right and two on the left. Most common adult valve problems arise from those on the left side of the heart, called the aortic valve and mitral valve. These valves can either develop narrowing or stenosis or leak significantly. Abnormalities of the heart valves can present in various ways, including chest pain, passing out, shortness of breath, irregularities or arrhythmias of the heart. Diagnostic techniques used for evaluation include echocardiography and cardiac catheterization. Both mechanical or tissue valves can be used as part of surgery and more and more technical repairs are possible, particularly of the mitral valve.  

In spite of the advances that have occurred with the use of balloon angioplasty and stents in the coronary arteries, there still are situations in which direct bypass or myocardial revascularization are required. Frequently this type of surgery combines the use of the mammary arteries from inside the chest and veins harvested from the legs or arms. This type of surgery is used in patients in whom the disease involves many vessels and it would be the best long-term approach or in situations where angioplasty and stenting have not been successful over time. Lastly, of course, open heart surgery is frequently used in many types of valve disease. Surgical techniques are becoming less and less invasive so that the associated discomfort and disability is much less. 

Nuclear cardiology is a technique for noninvasive evaluation of the heart, usually related to assessment for coronary artery disease and the pumping function of the heart. It is most commonly associated with stress testing, either exercise or with medication. With the use of Cardiolite, which is a common form of what we call perfusing agents, given with exercise and at rest, we are able to assess if any coronary artery blockages are present and how significant they are. We are also able to determine the pumping function of the heart at rest and following exercise. The radiation exposure involved is not felt to be a cause for concern. 

A stroke is death of brain tissue due to either bleeding into the brain or interruption of blood flow to an area of the brain. In the adult, the most common cause of stroke is the interruption of blood flow. This can occur in situ at the location of the stroke within the brain due to vascular disease or it can be a result of the passage or embolization of particulate matter from arteries in the neck, the large aorta within the chest, or the heart itself. This particular matter can be clotted blood or fragmented bits of cholesterol. Stroke is the most common complication related to longstanding, poorly controlled high blood pressure or hypertension.

An echocardiogram is a study which uses reflected sound waves to reconstruct the heart and all of its valves. It is usually performed with a probe through the chest wall but under special circumstances, the information can also be obtained using a probe which is passed down the esophagus, positioning it very close to the heart. Using the reflected sound waves, the chambers of your heart can be analyzed in terms of size and function. With the addition of Doppler techniques, very precise information can also be obtained about the valves of the heart. Echocardiography is also frequently used in conjunction with stress testing to allow the analysis of heart function at rest and in response to stress, usually exercise. 

Cholesterol is a fatty substance in the blood which is deposited within the arteries, producing progressive obstruction to many different organs, particularly the heart. Cholesterol has two components, HDL (good) and LDL (bad). The total numbers and the relationship of these components determine their predisposition to the development of plaques within the arteries to your heart. Triglycerides are another fat which exists within your body and their elevation can result in the formation of the worst type of cholesterol and fat particles. A lipid profile allows us to examine all of these components in detail. 

Stress testing is a method by which your heart can be examined for the possibility of coronary artery blockage. The test involves a progressive increase in workload under continuous electrocardiographic monitoring conditions. The test is carried out to a predetermined level based primarily on heart rate. Frequently, stress testing is performed in conjunction with echocardiography or nuclear scanning of the heart muscle. These methods increase our ability to make an appropriate and correct diagnosis. The test is usually performed in patients who have symptoms or in whom there is a strong suspicion of the possibility of coronary artery disease, such as individuals with multiple risk factors.