The cardiovascular consultation
is your introduction to the cardiologist, who will obtain
a history of your problems and perform a thorough examination
of your heart and vascular system. The history of your problems
will also include learning information about other diseases
and symptoms, a medical history of your close relatives, and
information about the risk factors that lead to coronary disease,
elevated cholesterol, high blood pressure, diabetes, and smoking.
The cardiologist will also want an exact list of your medications
and the frequency that they are taken, as well as any history
of allergies. Please feel free to bring in a list of your
medications, or bring the medicine containers themselves.
Relevant information, especially test results from other doctors
should be sent to our office for review. The cardiovascular consultation
is one of the most important parts of your visit. At its completion,
Dr. Saleemi will have a practical impression about the nature
of the problem and what additional testing will likely be
required to further clarify the diagnosis.
Chest
Pain
Chest pain is one of the most frightening symptoms
a person can have. It is sometimes difficult even for a doctor
or other medical professional to tell what is causing chest
pain and whether it is life-threatening.
Chest pain, regardless of whether it is caused
by a life-threatening condition, needs to be evaluated by
a medical professional. Be reassured that you are making the
right decision and feel comfortable seeking care whenever
you experience chest pain.
Cardiac
Catheterization
A diagnostic procedure used to evaluate the
heart and the coronary arteries. During a cardiac catheterization,
a contrast material is injected into the coronary arteries
to trace the movement of blood. The portion of the test involving
the injection of contrast material and the tracing of blood
is called coronary angiography.
To perform cardiac catheterization, a thin
flexible tube called a catheter is threaded through a blood
vessel in the arm or groin and into the heart. Through the
catheter, your doctor can measure pressures, take blood samples,
and inject the contrast material.
The purpose of cardiac catheterization is to
determine whether the coronary arteries are diseased, and
if so, identify the size and location of plaque that may have
accumulated from atherosclerosis. This is generally done to
determine the need for bypass surgery or angioplasty.
Angina
Angina is chest pain or discomfort that occurs
when an area of your heart muscle doesn't get enough oxygen-rich
blood. Angina may feel like pressure or squeezing in your
chest. The pain also may occur in your shoulders, arms, neck,
jaw, or back. It can feel like indigestion.
Angina itself isn't a disease. Rather, it's a symptom of an
underlying heart problem. Angina is usually a symptom of coronary
artery disease (CAD), the most common type of heart disease.
Not all chest pain or discomfort is angina.
A heart attack, lung problems (such as an infection or a blood
clot), or heartburn also can cause chest pain or discomfort.
All chest pain should be checked by a doctor.
Stenting
A treatment in which a thin metal coil is permanently
placed in the blocked artery at the time of angioplasty. Once
the plaque is compressed using angioplasty, a small expandable
wire tube called a stent is inserted into the artery to hold
it open. Reclosure of the artery is less likely to occur after
angioplasty followed by stenting than after angioplasty alone.
It is also common to use a type of stent coated
with drugs. These drugs help prevent scar tissue from forming
inside a stent. Studies have shown that these new stents are
more likely to prevent restenosis than ordinary, non-coated
stents.
Peripheral
Artery Disease
Peripheral arterial disease (PAD) occurs when
a fatty material called plaque builds up on the inside walls
of the arteries that carry blood from the heart to the head,
internal organs, and limbs.
Although PAD is serious, it is treatable. The
buildup of plaque in the arteries can often be stopped or
reversed with dietary changes, exercise, and efforts to lower
high cholesterol levels and high blood pressure. In some patients,
blood flow in the vessels may be improved by medicines or
surgery.
Holter
Monitoring
The most common type of ambulatory monitoring
is called Holter monitoring. The recording device of a Holter
monitor is worn on a strap at your waist or over your shoulder.
The electrical signals of the heart are picked up by two electrodes
attached to your chest, which are connected to the recorder
by wires. Holter monitoring provides a continuous 24- to 72-hour
record of the electrical signals from your heart. While wearing
the Holter monitor, you will also be asked to keep a journal
of your activities and symptoms each day. After the monitoring
period, your doctor will compare the timing of your activities
and symptoms with the recorded heart pattern.
A standard EKG monitors only 40 to 50 heartbeats
during the brief period you are monitored by the machine.
A Holter monitor records about 100,000 heartbeats in 24 hours
and is much more likely to detect a problem.
Stress
Testing
You will be attached to an EKG machine with
a blood pressure cuff placed on one arm. A clothespin-like
sensor is attached to the finger to measure the amount of
oxygen in the blood. After a baseline EKG is obtained, you
will begin to perform a low level of exercise by walking on
a treadmill. The exercise is "graded" - that is,
every three minutes, the level of exercise is increased. At
each "stage" of exercise, the pulse, blood pressure
and EKG are recorded, along with any symptoms you may be experiencing.
With a "maximal" stress test, the
level of exercise is gradually increased until you cannot
keep up any longer because of fatigue, or until symptoms (chest
pain, shortness of breath, or lightheadedness) prevent further
exercise, or until changes on the EKG indicate a cardiac problem.
Maximal stress tests should be performed when the goal is
to diagnose the presence or absence of coronary artery disease.
With a "submaximal" stress test, you exercise only
until a pre-determined level of exercise is attained. These
tests are used in patients with known coronary artery disease,
to measure whether a specific level of exercise can be performed
safely.
After the test, you will remain monitored until
any symptoms disappear, and until the pulse, blood pressure
and EKG return to baseline.
Stress
Echo
A stress Echocardiogram is a non-invasive test
that combines 2 tests - a treadmill stress test and an echocardiogram.
The echocardiogram is an ultrasound of the heart which enables
us to visualize the heart valves, blood flow through the valves,
and size and structure of the heart.
The test compares the heart’s function
during exercise to its function at rest, and is used to more
accurately determine the presence or absence of blockages
within the heart arteries. Patient may walk on the treadmill
or, if unable to walk, they will have a chemical stress test.
Nuclear
Cardiology
Like a stress echo test, nuclear cardiology
studies produce images of the heart at work (during exercise)
and at rest. During a test, you are given an injection of
a small dose of a harmless tracer. Then you spend
time exercising on a treadmill or stationary bicycle and then
resting. A specialized camera (called a "gamma camera")
detects the tracer as it passes through the chambers of your
heart, creating the pictures. The pictures may reveal problems
in heart muscle and blood vessels, especially when the images
of the heart at work and at rest are compared. We are now offering in-office nuclear stress testing in our Arlington, TX office.
Lipid
Management
Lipid Management helps people with high cholesterol
lower their risk of heart disease. If you already have heart
disease, this program will help to decrease the progression
of the disease. The best ways to lower your cholesterol levels
are through exercise, eating low fat foods, and if necessary,
taking medications.
If you already have heart disease, studies
have shown that cholesterol lowering medication can decrease
your risk of future heart attacks and by-pass surgery. Most
people can lower their risk for heart disease by making some
lifestyle changes.
Hypertension
Blood pressure is the force of blood pushing
against blood vessel walls. The heart pumps blood into the
arteries (blood vessels), which carry the blood throughout
the body. High blood pressure, also called hypertension, is
dangerous because it makes the heart work harder to pump blood
to the body and it contributes to hardening of the arteries
or atherosclerosis and the development of heart failure.
We can tell if you have hypertension by checking
your blood pressure with a special meter called a sphygmomanometer,
which consists of a stethoscope, arm cuff, dial, pump, and
valve. You should have your blood pressure checked at least
once a year to make sure you don't have hypertension.
Pacemaker
Pacemakers are battery-powered implantable
devices that function to electrically stimulate the heart
to contract and thus to pump blood throughout the body. Pacemakers
consist of a pager-sized housing device which contains a battery
and the electronic circuitry that runs the pacemaker, and
one or two long thin wires that travel through a vein in the
chest to the heart. Pacemakers are usually implanted in patients
in whom the heart's own "spark plug" or electrical
system is no longer functioning normally
