Conditions

Below are some of the common conditions we treat with some basic information about them. We consult on all issues related to the heart and vascular system including all arterial and venous disease.

Coronary Artery Disease (CAD)
-Also known as atherosclerotic heart disease or ischemic heart disease.
It is a disease where the arteries that supply blood flow to the heart become narrowed and “clogged” from the buildup of cholesterol plaque. This can cause symptoms of chest pain or pressure with physical activity (angina). In more serious cases, a plaque can “rupture” causing a sudden blockage of blood flow which can lead to a heart attack. Risk factors for this disease include diabetes, hypertension, smoking, high cholesterol, older age, and a family history.
Diagnosing CAD is usually done with non-invasive procedures such as a stress test, a nuclear perfusion study, a stress echocardiogram, or a more invasive procedure such as a cardiac catheterization.

Myocardial Infarction (heart attack)
A sudden blockage of an artery that supplies blood flow to the heart. This can cause pain in the chest and down the left arm, sweating, sometimes with nausea, palpitations and light-headedness. In certain types of heart attacks, an emergency life-saving procedure such as a coronary angioplasty is required.

Aortic Stenosis
Most commonly a disease of the elderly. The aortic valve is what the pumping chamber of the heart (left ventricle) has to pump blood through to exit the heart and flow throughout the body. In some people, the valve can build up calcium deposits over time, and become stiff and narrowed, which prevents adequate blood flow to the brain and the rest of the body. Symptoms may include shortness of breath with activity, chest pressure with activity, or fainting spells. It is usually diagnosed by the presence of a heart murmur, and confirmed by performing an echocardiogram (a sonogram of the heart). Treatment usually involves replacing the valve with open heart surgery. Newer techniques are also available for higher risk people that involves replacing the valve through catheters and tubes introduced into the groin arteries or the chest wall known as a Transcatheter Aortic Valve Replacement (TAVR).

Mitral Valve Disease
The mitral valve is what separates one of the top chambers of the heart (the left atrium), with the main pumping chamber of the heart (left ventricle). In various situations, this valve can become leaky. This causes difficulty in breathing and a build up of fluid in the body. It is commonly diagnosed by the presence of a heart murmur, and confirmed by an echocardiogram (a sonogram of the heart). When the leakiness becomes very severe, it may require an open heart operation to fix the valve, or replace it with a prosthetic valve.

Congestive Heart Failure
This refers to symptoms of shortness of breath and leg swelling which happens when fluid gets backed up into the lungs and the body because of poor heart function. There are many causes of this.

1. “Systolic Heart Failure”. A reduction in the pumping function of the heart (Ejection Fraction) causes the heart to become weak and not able to adequately pump blood forward to the body. This causes fluid to accumulate in the lungs causing difficulties in breathing, and fluid to accumulate in the body causing weight gain and leg swelling. This weakened heart can be caused by heart attacks or other types of Cardiomyopathies (*link to that section?)..

2. “Diastolic Heart Failure”. Sometimes the heart pumps well, but it becomes stiff and there is a problem with the heart’s ability to relax and fill with blood. This again causes backing up of blood, and fluid accumulates into the lungs, causing difficulties in breathing. Patients with this type of heart failure generally have a long history of high blood pressure.

3. Valvular Heart Failure. Patients with abnormalities in one of the valves in the heart can develop heart failure. Valves can become hard and stiff, or very leaky. In both scenarios the blood does not flow through the heart in the way it should, and this causes blood and fluid to get backed up again into the lungs and the body.

Treatment of heart failure includes many things. Specific medications are given that can improve the heart’s function and efficiency (beta blockers and ACE inhibitors). Diuretics such as lasix help remove excess fluid from the body. Reduction in salt intake and blood pressure control are paramount in controlling heart failure. Patients with coronary artery disease may benefit from stenting or heart bypass surgery procedures. In advanced cases, patients require implantation of an implantable cardioverter defibrillator (ICD) to protect their heart’s from stopping.

Cardiomyopathy
This refers to an abnormality of the heart’s function. In general it means the heart function is depressed. This is measured by the “Ejection Fraction”. The normal range is 55-65%. Patients with Cardiomyopathy have a depressed ejection fraction, and often have symptoms of Congestive Heart Failure. The causes of cardiomyopathy are many. Most commonly it is due to somebody with prior heart attacks or significant blockages due to coronary artery disease. In these cases, one can sometimes improve the heart function by fixing the blockages with stents or a bypass surgery. Patients without blockages are labeled as “non-ischemic cardiomyopathy”. This can be from a viral infection, hypertension, or other unknown causes. Most of these patients are treated with an aggressive medical regimen in hopes of some improvement in heart function. Patient’s whose heart function does not improve often require implantation of an implantable-cardioverter-defbirillator (ICD), which protects the weak hearts from dangerous arrhythmias.

Atrial Fibrillation
The most common heart arrhythmia (or abnormal heart rhythm) that is seen. This is a condition where the top chamber of the heart (the atrium), has a diseased electrical system, and causes the heart to be very irregularly and fast. It also predisposes some people to develop blood clots in the heart that can sometimes lead to a stroke. This usually occurs in elderly patients with a history of high blood pressure, but can be seen in younger people as well. Symptoms include everything from no symptoms at all, to palpitations, to more severe symptoms such as passing out and stroke. Treatment is directed at controlling the heart rate with medications, and in most people giving blood thinners to prevent strokes. The blood thinners used are usually coumadin or similar medications that can have risks of bleeding as well. Sometimes trying to restore a normal heart rhythm is necessary when someone has significant symptoms. This can be done through medications, or delivering an electric shock to the heart to try to “reset” the rhythm back to normal. If all these techniques fail and one continues to have symptoms, a procedure called an “atrial fibrillation ablation” can be performed by an electrophysiologist to try and eliminate the arrhythmia, potentially for good.

Cardiac Arrhythmias
The heart is composed of a complex system of electrical pathways and impulses to control it’s rhythm and contraction. Occasionally there can be problems with the normal impulses that cause abnormal heart rhythms. These can be both slow and rapid. When heart rhythms become extremely slow due to diseases of the heart’s electrical conduction system, it may require implantation of a pacemaker to prevent slow heart rates. Other heart arrhythmias can occur that cause the heart to go very fast. Most commonly this is atrial fibrillation, discussed above. Other fast heart rhythms can occur due to a type of short circuit that can occur in the heart. These can be very symptomatic, and some of them are life threatening depending on the type of arrhythmia. These fast heart rhythms can be treated with various medications, or sometimes can be cured by an ablation procedure that can “burn” the abnormal circuit with catheters. Other fast heart rhythms, especially those occurring in patients with heart attacks and cardiomyopathies, can be life threatening. These often require implanting an ICD to protect the patient from sudden death that can occur as a result of these arrhythmias.

Congenital Heart Defects
Some people are born with abnormalities of the heart structure. Serious and more complex ones are often picked up during childhood, and repaired as needed. Patients who have had surgeries during childhood to repair heart defects should be followed closely by a cardiologist during their lives to ensure no problems occur.

Occasionally people can be born with holes in the heart that can be asymptomatic for many years. These are usually atrial septal defects (ASD), or ventricular septal defects (VSD). These can sometimes be picked up by a cardiologist listening to your heart, or by an electrocardiogram, but often go unnoticed. The diagnosis is usually made with an echocardiogram (a heart sonogram). When these holes are picked up in adulthood, sometimes nothing needs to be done if they are small. Larger holes are often repaired. This can be either through surgery, or through a minimally invasive approach using catheters in the groin that can plug the hole up with a small device.

Peripheral Arterial Disease (PAD)
Also known as Peripheral vascular disease (PVD). This is a condition where the arteries that supply blood flow to the body develop cholesterol plaque buildup and blockages. This can involve arteries supplying any part of the body, most commonly the legs and sometimes the arms. Patients generally have symptoms of leg pains and cramping when they walk, which is usually relieved with resting. In more advanced disease, people can experience pain even at rest, and can occasionally develop non-healing ulcers. Diagnosis of this is made by performing vascular ultrasound (link) to detect blockages in the arteries. Treatment includes everything from medication and exercise, to performing angioplasty and stenting procedures (link) to open up the blockages and restore blood flow to the affected area.

In addition, arteries supplying vital organs of the body can also be affected including the Carotid arteries that supply the brain, the Renal arteries that supply the kidneys, and the mesenteric arteries that supply the intestines.

Carotid Artery Disease
The carotid arteries supply blood to the brain. When there is excessive plaque buildup in these arteries, blockages can form which can sometimes lead to a stroke. Our goal is to detect these blockages before they become severe enough to cause a stroke that can be devastating to a patient and family. The diagnosis is usually made by physical exam and vascular ultrasound to detect the presence of plaque. These tests are followed closely, and if the blockage reaches a critical level, a procedure to fix it is usually performed before someone suffers a stroke. This is usually by a surgery (Carotid Endarterectomy) or a stenting procedure (Carotid Artery Stenting).

Varicose Veins
As people age, the superficial veins of the legs can sometimes become dysfunctional. When this happens, it can lead to a variety of problems including leg swelling and varicose veins. These are often managed with compression stockings and elevation therapy. However in extreme cases, people can develop large varicosities, significant pain and swelling, and formation of ulcers. When this happens and compression therapy is not adequate, a procedure called a vein ablation (link) can be performed to get rid of the vein, and along with it the problem. It is a simple procedure performed in the office.

Leg Swelling
Leg swelling is a common problem and can be caused by a variety of things. This includes more benign problems such as refluxing superficial veins of the leg and varicose veins, to more serious problems such as a blood clot in the leg, to heart failure or kidney failure. A doctor’s visit and physical exam is necessary to determine the cause of the swelling, and oftentimes referral to a cardiovascular specialist is needed when no cause is found. Often tests including ultrasounds of the heart and the legs and blood tests are required to determine the cause and the appropriate treatment.

Hypertension
Hypertension is a common problem in Americans. Often referred to as the “silent killer”, as it remains asymptomatic for many years until the the body finally develops problems as a result which can include heart attacks, strokes, kidney failure, and more. Medical therapy is the mainstay of treatment and blood pressures should be followed closely. Sometimes when the blood pressure is not controlled despite medications, other causes need to be looked for, such as problems with the renal arteries supplying the kidneys, or abnormal hormone levels in the blood. If you have never had your blood pressure checked, make an appointment with your doctor today.

Hyperlipidemia
Hyperlipidemia, also referred to as “high cholesterol” or “dyslipidemia” is a common problem in Americans. It is the most important modifiable risk factor for coronary artery disease and stroke. People with a family history of high cholesterol are more likely to develop high cholesterol themselves. Diagnosis is simple as a blood test. There are different types of cholesterol, that include the LDL (bad cholesterol), HDL (good cholesterol), and triglycerides (fatty cholesterol). Diet and exercise are the mainstay of initial therapy and prevention for high cholesterol, and in many cases, a medication is required to help keep the cholesterol low. These medications have also been shown to prevent heart attacks and strokes in people with high cholesterol. Different people will have different cholesterol “goals”, and targets for the specific types of cholesterol vary. Ask your doctor about your cholesterol profile, and what your targets are, and whether medication is indicated for you.