Learn About Your Heart...
Made Simple

By Nicolas Shammas, MD

A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics

Statistics about Heart and Blood Vessel Diseases in the United States
Structure and Function of the Heart and Blood Vessels
Diseases of the Blood Vessels of the Heart
Surgical Therapies for the Cardiovascular Patient
Peripheral Vascular Disease
Diseases of the Blood Vessels of the Head and Neck
Strokes: How to Survive Them and How to Prevent Them
Valvular Heart Disease
Heart Rhythms: How to Recognize Them and Treat Them
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test

Are there any side effects of the drugs used to stress the heart?

The drugs commonly used to stress the heart are either dobutamine or adenosine.

Dobutamine, which stresses the heart by increasing heart rate and contraction of the heart, can cause a fluttering in the chest as heart rate increases. Also, some patients might experience a headache or nausea from the medicine. Patients also can report chest pain and shortness of breath. All these symptoms usually resolve within 5–10 minutes of stopping the infusion of the medication.

Adenosine stresses the heart by diverting blood away from a narrowed area in the coronary arteries, worsening the lack of blood supply to this area. During the 4- to 6-minute infusion, the patient's heart rate can slow down. Also, the patient might feel nausea, headaches, shortness of breath, flushing, and chest pain. Adenosine lasts only for a few seconds in the body after the infusion is terminated. Symptoms usually subside quickly, often within a minute of stopping the medication.

What is an echocardiogram?

An echocardiogram is a test that evaluates the heart muscle and heart valves by using ultrasound pulse waves to record heart images, structure, and function.This test can observe any damage to the heart muscle or any leakage or narrowing of the valves. The ultrasound can see inside the chambers of the heart and therefore can detect blood clots in the heart or birth defects.

What is an echocardiogram stress test?

An echocardiogram stress test is done in 3 stages. First, baseline pictures of the heart are obtained by using an ultrasound machine without the patient being under stress. Next, the patient exercises on a treadmill or is given a medicine to stress the heart. Then, immediately after the stress, pictures of the heart are obtained again, and the motion of the heart muscle at rest and under stress is then compared. If parts of the heart weaken under stress, the test will then be abnormal and suggest the presence of blockages in the coronary arteries.

What is a transesophageal echocardiogram (TEE)?

A transesophageal echocardiogram (TEE) of the heart is a technique by which ultrasound images of the heart are obtained by inserting a probe into the food pipe (esophagus) and stomach. The images are obtained from these locations because of their close proximity to the heart. Usually, clear images are obtained with TEE. Since this technique is partly invasive, it is done only when the question in place cannot be answered by the regular ultrasound.

During this procedure, the patient is sedated through an intravenous line and the throat is sprayed with a local anesthetic agent to numb the gag reflex. Usually, this procedure takes about 10–15 minutes.

What is a cardiac angiogram?

A cardiac angiogram or cardiac catheterization is an invasive procedure that allows the cardiologist to see the coronary arteries under x-ray. An angiogram is done under local anesthesia and light sedation. A plastic tube (or catheter) is inserted into the patient's femoral artery (located in the groin area). Through this catheter, plastic tubes are directed under x-ray to the heart where they directly engage the coronary arteries. A contrast dye is then injected into the coronary arteries and pictures are obtained.

The arteries of the heart are then visualized, and narrowings in these arteries are identified if present. The angiogram is often called the "gold standard" to diagnose significant narrowings in the arteries because it carries a high level of accuracy.

The risks of a cardiac angiogram are low in frequency but can increase in the elderly person or patients with heart failure, kidney disease, or vascular disease. The risks, among others, can be death in less than 1 in every 1,000 people, stroke and heart attacks in less than 1 in every 500 people, bleeding, infection, nerve damage, electrical disturbances, or kidney failure.

What is a significant blockage on an angiogram?

Blockages are classified as mild (less than 50% in severity), moderate (between 50 to 70%), and severe (more than 70%). After the cardiologist defines the location and severity of the blockages in the arteries, the decision to treat the blockages will be based on many factors. Again, it is important to note that identifying a blockage and treating it does not prevent a heart attack from happening. The primary purpose of treating a blockage is to reduce symptoms of chest pain or shortness of breath, assuming there is a high suspicion of a link between a blockage and the symptoms.

What is an electrophysiology test?

An electrophysiology test is an invasive procedure aimed at testing whether the heart is at high risk of developing an electrical disturbance. The test is done under local anesthetic and light sedation. It is usually reserved for high-risk electrical abnormalities that are symptomatic or life threatening. During this test, the electrophysiologist inserts catheters into the heart and performs a programmed electrical stimulation of the heart. Depending on the heart response to this electrical stimulation, information about the electrical stability or conduction of electricity in the heart is obtained.

What is a calcium scan of the heart?

A calcium scan of the heart involves detecting the level of calcium deposits in the coronary arteries using a noninvasive specialized scan. The level of calcium in the arteries correlates with the presence of coronary artery disease. Also,the higher the calcium in the coronary arteries, the poorer the overall prognosis of a patient. If a patient has an abnormal scan, a stress test is the next step to determine whether it is necessary to proceed with an invasive test, such as an angiogram. In general, the presence of high calcium levels in the coronary arteries implies that an aggressive approach should be attempted to reduce traditional cardiac risk factors.

What is a multislice CT angiogram of the heart?

A multislice CT angiogram of the heart is a noninvasive test that visualizes the coronary arteries without pursuing an invasive cardiac angiogram (as described above). During this test, contrast dye is injected into 1 of the veins of the arm and a CT scan is obtained on the heart while a patient is holding his or her breath. Current multislice CT angiograms can take pictures so rapidly that a breath hold of 5 to 6 seconds is all that is required to complete the pictures. The multislice CT angiogram is not widely available yet, but given its high accuracy rate, it is anticipated that it will gradually replace or complement a cardiac angiogram in the near future. The main disadvantage of this test is the need for continued use of contrast dye to be able to visualize the vessels of the heart; therefore, this procedure is not necessarily safer on the kidneys, particularly in patients with diabetes and patients with known kidney disease.

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