I am a 55 year-old woman and have recently noticed chest pressure during my 1 mile walk. What should I do?
What is an angioplasty and when are stents used?
I have atrial fibrillation. Do I need to take coumadin?
Does coffee of caffeine cause the development of heart disease?
What is a heart catheterization? Is it the same thing as an angiogram? What is involved, and is it very painful?
I already have heart disease. Is it too late to lower my cholesterol to reduce my risk?
I don't have time for exercise. Is it really that important for my heart health?
Are there different types of heart attacks and are the treatments the same?
My husband had a heart attack. Can you tell me exactly what a heart attack is?
How do I know when I am having a heart attack?
What is high blood pressure, and why do we treat it?
I have an implantable defibrillator to shock my heart back to normal rhythm. Should I drive?
I have been told that I need a pacemaker to treat my heart failure. Are they useful for this indication?
I have been told I have a slow heart rate. Do I need a pacemaker?
How will I know if my pacemaker isn't working properly?
What are the risk factors for coronary heart disease (disease of the hearts arteries)?
Is smoking bad for my heart?
Are statins dangerous?
My husband had a stent placed and is on aspirin and plavix. Why is he on these medications, what are the risks, and how long does he need to remain on them?
What are drug eluting stents?
Can a patient who has had a stent implanted ever have an MRI? Can they return to leading a normal life?
I have read that stents are no better than medications. Is that true?
I am coming into the hospital for a possible stenting procedure. I've read that drug eluting stents are risky. Should I request a non drug eluting stent?
My doctor has recommended a stress test, are there different types of stress tests?
Angina
I am a 55 year-old woman and have recently noticed chest pressure during my 1 mile walk. What should I do?
 | Dr. Marc J. Schweiger says: |
Symptoms of chest pressure, burning, heaviness, tightness or shortness of breath that occur in a predictable fashion with physical exertion could represent a narrowing a one of the heart's arteries (coronary artery).
The term angina is a Latin word used to describe this symptom. Typically, the symptom appears in a gradual fashion during exertion and is relieved with rest. The symptoms may be located in the chest, back, neck/throat/teeth, or arms. Individuals with these symptoms should be evaluated by their physician.
Return to top
Angioplasty and Stenting
What is an angioplasty and when are stents used?
| Dr. Marc J. Schweiger says: |
Angioplasty and stenting fall under the category of percutaneous coronary intervention (PCI).
PCI is a procedure in which catheters are manipulated through an artery (usually in the groin) in order to open up a narrowed coronary artery. This procedure can involve techniques including balloon angioplasty, in which a balloon is used to open up a narrowed artery, and/or coronary stenting in which a metal scaffold is placed with an inflated balloon to achieve an optimal result.
Stents are utilized in greater than 95% of cases as they lead to a more stable results, and the artery is less likely to renarrow than with balloon angioplasty alone. In general, patients are able to leave the hospital the following day.
At Baystate Medical Center, we perform approximately 1600 PCI's annually.
Return to top
Atrial Fibrillation
I have atrial fibrillation. Do I need to take coumadin?
| Dr. Marc J. Schweiger says: |
Atrial fibrillation is the most common rhythm disorder in elderly patients but certainly is seen in younger patients as well. It is an irregular and often rapid heart rhythm. This causes the upper chambers of the heart to slow down blood flow that can increase the risk of blood clot formation.
Patients over 65 years of age and those younger who have certain valvular heart diseases, abnormal heart function, history of prior stroke, congestive heart failure or history of hypertension -- all are at increased risk of stroke with atrial fibrillation. They are candidates for coumadin if their bleeding risk is not felt to be excessive.
Return to top
Caffeine and Heart Disease
Does coffee of caffeine cause the development of heart disease?
| Dr. Marc J. Schweiger says: |
Whether coffee and specifically caffeine is bad for people has been studied over a number of years. Recent reports do not suggest a link between caffeine intake and the development of heart artery disease.
Coffee consumption has, however, been linked to elevated blood pressure. Heavy coffee consumption is generally not recommended. Heavy coffee consumption is defined as more than four cups per day.
It is known that caffeine can definitely increase heart rhythm disturbances. People who already have problems with irregular heart beat or arrythmias should attempt to minimize caffeine intake.
Return to top
Catheterization and Angiogram
What is a heart catheterization? Is it the same thing as an angiogram? What is involved, and is it very painful?
| Dr. Marc J. Schweiger says: |
A heart catheterization is when a catheter (thin tube) is inserted into the heart by way of an artery and or vein (usually in the groin but occasionally the arm) to detect and determine the severity of problems in the heart's arteries and to determine whether there are problems with the heart's valves or muscle. It is also used to look for congenital (born with) heart problems. Pressures in the different heart chambers are frequently taken.
An angiogram is when dye is injected to look at the heart's arteries (coronary arteries) or heart chamber.
The terms angiogram and catheterization are often used interchangably. Patients are awake for these procedures although they generally are sedated. In most instances the procedure is not very painful.
At Baystate Medical Center we perform approximately 3500 diagnostic heart catheterizations a year.
Return to top
Cholesterol
I already have heart disease. Is it too late to lower my cholesterol to reduce my risk?
| Dr. Marc J. Schweiger says: |
No, it's not too late to help your heart. Most coronary heart disease patients will benefit from cholesterol lowering.
In fact, if you already have heart disease, you should pay even more attention to your cholesterol level, because you stand to benefit even more.
A person with heart disease has a much greater risk of having a future heart attack than a person without heart disease. If you lower your blood cholesterol level, you will reduce your risk of future heart attack, and you may prolong your life.
Return to top
Exercise and Heart Health
I don't have time for exercise. Is it really that important for my heart health?
| Dr. Marc J. Schweiger says: |
Physical exercise is extremely important to one's heart health. In fact, the absence of physical activity raises the risk of heart disease.
This is in part due to the ability of exercise to:
- Reduce blood pressure
- Assist with weight control
- Positively influence both the "good" and "bad" cholesterol.
Exercise does not have to be painful in order to be beneficial. Walking at a brisk pace for 30 minutes a day on most days of the week is both productive and protective. Taking the stairs at work (give the elevator a break) or walking during the lunch break are good ideas. Exercise also improves people’s sense of well being and reduces stress. The important point is that a sedentary lifestyle has a detrimental impact on one's health.
Return to top
Heart Attack
Are there different types of heart attacks and are the treatments the same?
| Dr. Marc J. Schweiger says: |
Heart attacks (myocardial infarction) are categorized as ST segment elevation heart attacks (STEMI) or non ST segment elevation heart attack (non STEMI).
The ST segment is seen on the electrocardiogram.
- STEMI occurs when a plaque in a coronary artery (heart artery) ruptures and a blood clot forms which totally blocks the blood vessel.
- In a non STEMI the blood clot only partially blocks the blood vessel.
The treatment for a STEMI generally is thrombolytic therapy (clot busing medication) or for hospitals with interventional cardiology facilities (such as Baystate), an emergant angioplasty and stent placement.
Non STEMI's are treated with different blood thinning medications and most of those patients ultimately undergo a heart catheterization to define the problem and determine the best treatment.
Return to top
My husband had a heart attack. Can you tell me exactly what a heart attack is?
| Dr. Marc J. Schweiger says: |
A heart attack, also known as a myocardial infarction, occurs when one of the coronary arteries going to the heart gets acutely blocked, resulting in no blood flow to an area of the heart with subsequent death of the heart muscle in the area supplied by that heart blood vessel. These vessels, called coronary arteries, sit immediately above the heart, wrap aroound the heart, and provide blood flow and nutrients (including oxygen) to the heart muscle. Plaque (consisting of cholesterol and other deposits) can build up in the coronary arteries. When a plaque ruptures or cracks, a blood clot (thrombus) can form on top of the plaque and either partially or completely occlude the coronary artery, resulting in heart damage.
Return to top
How do I know when I am having a heart attack?
| Dr. Marc J. Schweiger says: |
A heart attack occurs when blood flow to the muscle of the heart is reduced to the point where heart muscle begins to die.
The symptoms of a heart attack often include, chest and or arm and or jaw pressure or discomfort, shortness of breath, nausea, vomiting and sweating. If a true heart attack is occuring, these symptoms usually last longer than 20 minutes and can go on for several hours if treatment is not sought.
Similar symptoms, which occur during or after exertion and typically last 20 minutes or less may be a warning sign of a heart attack to come and one should seek prompt medical attention.
Return to top
High Blood Pressure
What is high blood pressure, and why do we treat it?
| Dr. Marc J. Schweiger says: |
High blood pressure (hypertension) is a major risk factor for the development of cardiovascular disease.
When your heart squeezes, it forces blood into the major blood vessels. When this occurs, the pressure in your arteries increases. When your heart finishes squeezing, it "relaxes", fills with blood, and the pressure falls.
We measure the highest pressure and call this systolic blood pressure. The lowest measureed pressure is called diastolic blood pressure.
The risk of developing cardiovascular disease increases markedly as both systolic and diastolic blood pressure increase. Recent studies have shown that lowering the systolic blood pressure to less than 130 produces a major reduction in stroke and heart attacks.
Return to top
Implanted Defibrillator
I have an implantable defibrillator to shock my heart back to normal rhythm. Should I drive?
| Dr. Marc J. Schweiger says: |
A defibrillator is a device implanted to shock or pace the heart out of a potentially serious abnormal heart rhythm.
Recently, studies have shown that implantation of a defibrillator as a preventive treatment is beneficial in individuals who are at increased risk for a serious abnormal heart rhythm. It is usually recommended that people with a defibrillator not drive for a period of time after the device is implanted (often six months) as there is a risk of loss of control of the vehicle if an abnormal heart rhythm occurs.
The length of driving restriction varies by state. You need to discuss this with your cardiologist.
Return to top
Pacemaker
I have been told that I need a pacemaker to treat my heart failure. Are they useful for this indication?
| Dr. Marc J. Schweiger says: |
The standard pacemakers that have been used for many years pace the right ventricle and often the right atrium; this type of pacemaker would only help congestive heart failure if it is due to a very slow heart rhythm.
Congestive heart failure is commonly due to weakness of the left ventricle. Placing a lead that paces the left ventricle along with the right ventricle can help the heart beat more efficiently.
This type of pacemaker, called a biventricular pacemaker, has been shown to help people who meet certain criteria to have less shortness of breath, less fatigue, and to be able to be more active.
Return to top
I have been told I have a slow heart rate. Do I need a pacemaker?
| Dr. Marc J. Schweiger says: |
In the majority of people, a slow heart rate is unlikely to be serious; whether or not is may be serious can usually be determined by a recording of the heart rhythm when it is slow and particularly when patients are having symptoms such as lightheadedness. A pacemaker would be indicated if the slow heart rate is due to a potentially serious cause, or if it results in symptoms , such as lightheadedness, fainting, near fainting episodes, or limited activity tolerance.
Return to top
How will I know if my pacemaker isn't working properly?
| Dr. Marc J. Schweiger says: |
Pacemakers are highly reliable; the risk of a pacemaker malfunctioning to the point where is stops working altogether is extremely small.
There is a small incidence of problems occurring with the leads, and the battery voltage gradually decreases to where the pacemaker would need to be replaced (in approximately 8 to 10 years).
For these reasons, pacemakers are checked reguarly in person or by telephone monitoring. Regular follow up will detect a problem before it is noticed by the individual.
Return to top
Risk Factors
What are the risk factors for coronary heart disease (disease of the hearts arteries)?
| Dr. Marc J. Schweiger says: |
The well known risk factors for coronary heart disease include:
- Cigarette smoking
- Elevated blood pressure
- Diabetes mellitus
- High cholesterol
- Positive family history of early coronary heart disease (before 55 years of age).
Other predisposing factors include:
- Age
- Male gender
- Obesity (more than 30% overweight)
- History of stroke or other peripheral vascular disease
- Low levels of HDL cholesterol (good cholesterol).
Obviously age, gender, and family history can not be altered. Risk can be lowered by:
- Quitting smoking
- Eating an appropriate diet
- Exercising
which can help maintain an ideal weight, blood pressure and cholesterol levels.
Return to top
Smoking and Heart Disease
Is smoking bad for my heart?
| Dr. Marc J. Schweiger says: |
Absolutely! Cigarette smoking is a major cause of heart and blood vessel disease.
- Nicotine, in cigarettes, increases the heart rate and blood pressure.
- Smoking also causes the platelets in the blood to become sticky.
- Smoking damages the layer of cells that line the arteries of the heart and other blood vessels (known as endothelium) , causing constriction and inflammation.
- People who smoke a pack of cigarettes daily have more than twice the risk of heart attack than people who have never smoked.
Baystate Health offers programs and information to help you stop smoking.
Return to top
Statins
Are statins dangerous?
| Dr. Marc J. Schweiger says: |
The statins (crestor, lipitor, pravachol, vytorin, zocor, etc) are a class of cholesterol lowering medications that significantly reduce levels of bad cholesterol (LDL) and triglycerides in blood.
High levels of cholesterol, triglycerides and other fats in the bloodstream increase the risk of developing hardening of the arteries (atherosclerosis), heart attack, stroke and premature death.
Use of statins, in appropriate patients, can markedly lower the risk of developing these conditions.
These drugs sometimes cause muscle aches and pains, liver inflammation or rarely severe muscle damage. However, the benefits of statins far outweigh their occasional side effects and should be used when needed.
Return to top
Stents
My husband had a stent placed and is on aspirin and plavix. Why is he on these medications, what are the risks, and how long does he need to remain on them?
| Dr. Marc J. Schweiger says: |
All stents pose a small risk of closing up entirely which is markedly decreased by an appropriate technique at the time of the procedure and by patients' taking aspirin and a medication called plavix on a daily basis.
The risk of non-drug eluting stents closing up entirely lasts for about one month while with drug eluting stents it lasts for approximately one year, occasionally longer.
All patients with heart vessel disease should be on aspirin indefinitely. Patients with non-drug eluting stents have to be on plavix for at least one month, but ideally should be on plavix for one year.
Patients with drug eluting stents should remain on plavix for at least one year. The risk of bleeding with this combination is low, particularly if patients take low dose aspirin (i.e. 81 mg). Plavix and aspirin do increase bleeding risk at the time of operative procedures, and patients on these medications need to discuss with their cardiologist what they should do if they need an operative procedure.
Return to top
What are drug eluting stents?
| Dr. Marc J. Schweiger says: |
Stents are metal devices that keep heart arteries open.
However, renarrowing can occur in up to 33% of patients within the first six months, usually necessitating a second procedure. Drug eluting stents inhibit renarrowing by releasing drugs which prevent growth of tissue. In clinical trials the incidence of renarrowing with drug eluting stents was reduced by approximately 70% compared to bare metal stents (stents not coated with a drug to inhibit renarrowing).
Not everyone can, or should, receive a drug coated stents. They are limited in their available sizes and there are clinica situations where drug eluting stents are inappropriate.
Return to top
Can a patient who has had a stent implanted ever have an MRI? Can they return to leading a normal life?
| Dr. Marc J. Schweiger says: |
The American Heart Association recommends that people who have just received a stent not have an MRI for the first four weeks after the stent insertion. After this period of time, an MRI should pose no further threat.
Most patients who have received stents return to leading a normal life, provided their heart function was normal prior to the procedure.
Return to top
I have read that stents are no better than medications. Is that true?
| Dr. Marc J. Schweiger says: |
Stents have been shown to decrease mortality and recurrent heart attacks when placed following a heart attack.
In patients who have stable chest pain, stents, as part of an angioplasty procedures, reduce symptoms and improves quality of life.
Medications, such as aspirin, medications that reduce blood pressure and medications that reduce bad cholesterol, are important for all patients with heart disease, when appropriate, whether they are treated with angioplasty, bypass surgery or only with medications.
Return to top
I am coming into the hospital for a possible stenting procedure. I've read that drug eluting stents are risky. Should I request a non drug eluting stent?
| Dr. Marc J. Schweiger says: |
Drug eluting stents appear to have a very low rate of very late (beyond one year) thrombosis which often causes a heart attack. We think this rate is approximately 1 in 500 patients per year.
Drug eluting stents prevent the need for repeat procedures, as compared to non drug eluting stents, for renarrowing of the artery within the stent. When stents renarrow, patients sometimes (approximately 10% of the time) present with heart attacks.
Therefore, there are small risks involved with both kinds of stents. There are certain types of patients and certain types of narrowing which are more prone to renarrow, and in general we believe those patients are good candidates for drug eluting stents.
Return to top
Stress Test
My doctor has recommended a stress test, are there different types of stress tests?
| Dr. Marc J. Schweiger says: |
Stress testing is a cardiac risk stratification tool used to evaluate symptoms such as chest pain or shortness of breath during exercise.
Stress tests help measure whether your heart is getting an adequate blood supply.
There are serveral types of stress tests:
- During an exercise stress test, you walk on a treadmill while an ECG records your heart's response to the increasing workload.
- For those who cannot exercise, a medication may be used to "stress" the heart.
- Imaging tests such as an echocardiogram or a nuclear scan are often used to obtain information by generating pictures of your heart before and after exercise of pharmacologic (medicine) stress.
Return to top
