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Patient Education

To help you better understand the cardiovascular system, what is involved in certain diagnostic tests we use, and what some of the terminology means, we have included some information below. Please feel free to ask our staff any questions you might have regarding your diagnostic testing, treatment, or any other aspects of your care.

What is Cardiac Catheterization?

Cardiac Catheterization is a procedure that involves the insertion of a catheter into the body. The catheter is inserted into a vein or artery and directed toward the heart.

[Other terms used to describe cardiac catheterization include: coronary angiography, angiogram, and cardiac (or heart) cath.]

The Heart as a Pump

The heart is a muscular, hollow organ that constantly pumps blood throughout the body. It is made up of strong muscle tissue, called heart muscle.

The heart has four compartments or chambers. There are two chambers on the “left side” and two chambers on the “right side.” The upper chamber on each side, called an atrium, receives and collects blood. The lower chamber on each side, called a ventricle, pumps blood.

The left ventricle is the heart’s main pumping chamber. It pumps blood to all parts of the body, except the lungs. The right ventricle pumps blood only to the lungs.

There are four valves, which control the flow of blood within the heart. They function like one-way doors, allowing blood to move in only one direction and preventing it from backing up into the chamber from which it came.

The oxygen-poor (“used”) blood that returns from the body collects in the right side of the heart. It is then pumped into the lungs, where it picks up fresh oxygen. The oxygen-rich blood coming from the lungs flows into the left side of the heart. It is then pumped into arteries.

The four heart chambers work together to contract and pump blood. As it circulates, blood delivers oxygen and nutrients throughout the body.

The Coronary Arteries

The coronary arteries are the vessels that carry oxygen-rich blood to the heart muscle.

As blood leaves the left ventricle, it is forced into the body’s main artery, the aorta. At the very beginning of the aorta, near the top of the heart, emerge the two coronary arteries. They are referred to as the “left” and “right” coronary arteries.

The first segment of the left coronary artery is called the left main artery. It is about as wide as a drinking straw, and less than an inch long.

The left main artery then branches into two slightly narrower arteries: the left anterior descending, which travels down the front side of the heart; and the left circumflex, which circles around the left side and then to the back of the heart.

The right coronary artery comes from the aorta, circles around the right side, and then to the back of the heart.

The two left coronary arteries (left anterior descending and left circumflex) supply blood to the front, left-side, and back of the heart. The right coronary artery supplies blood to the bottom, right side, and back of the heart.

Coronary Heart Disease

The inside walls of arteries are normally smooth and flexible, allowing blood to flow through them easily. Over the years, the inside of an artery’s wall may become plugged with fatty deposits.

As these fatty deposits, known as plaques, continue to build up, they narrow the arteries and can reduce the flow of blood. These plaques may sufficiently reduce the flow of blood in the coronary arteries to cause angina (pain or discomfort in the chest, arm, or neck) or a heart attack.

During catheterization, x-ray dye is injected into the coronary arteries and pictures are taken. In patients with coronary disease, the pictures show the actual blockages and their severity.

Defective Heart Valves

Valve disease is present when one or more of the heart valves do not work properly. A heart valve may be “narrowed” or “leaky.”

Most valve defects are mild and have little effect on the pumping function of the heart. Some defects, however, tend to worsen with time and may cause weakening of the heart.

In some cases, catheterization may be needed to confirm the diagnosis and to accurately measure the severity of a valve’s narrowing or leakage.

Before Your Catheterization

  • Get specific instructions about the food you can have. Generally, you will be asked not to eat or drink anything for 6 to 8 hours before the procedure. [You may have sips of water to swallow your medications.]
  • Make arrangements for someone to drive you home after the procedure – you probably won’t be permitted to drive. Family members and friends can wait in an assigned area.
  • Pack a small bag in case your doctor decides to keep you overnight in the hospital. You may want to include a robe, slippers, pajamas or nightgown, and toiletries.
  • Bring a list of all the medications you are currently taking. It is important for the doctor to know the exact names and dosages of any medications that you take.
  • Be sure to mention to the doctor or nurse if you have had an allergic reaction to x-ray dye (contrast), Iodine, or seafood, or if you have a history of bleeding problems.
  • For your comfort, empty your bladder as completely as possible before the procedure starts. [A bedpan or urinal will be available during the procedure].

During Catheterization

Cardiac catheterization is performed in a specially equipped x-ray room, called a cardiac catheterization laboratory or simply “cath lab.”

You will be transported to the cath lab on a movable bed, and then transferred to an x-ray table. The table has a large camera above it and television screen close by. The equipment in the cath lab also includes heart monitors and various instruments and devices.

The cath lab team generally includes a cardiologist, an assistant, a nurse, and one or two technicians.

After being positioned on the x-ray table, you’ll be connected to a variety of monitors, and covered with sterile sheets. The staff will be wearing sterile gowns, gloves, and masks.

During the Procedure

The area where the catheter will be inserted, usually the groin, is cleansed thoroughly. A local anesthetic is injected into the skin with a tiny needle to numb the area. This may cause a stinging sensation.

A small incision is made in the skin, and a needle is used to puncture the blood vessel (vein or artery) into which the catheter will be inserted.

After the catheter has been inserted into the blood vessel, it is slowly advanced toward the heart. The doctor and staff can follow its progress on the television screen.

Measuring the pressures inside the heart allows doctors to assess the heart’s pumping function and estimate the severity of valve defects. The pressure waves are displayed on monitor screens and can be recorded on special tracing paper.

During a coronary angiogram, specially shaped catheters are inserted, one after the other. They are directed toward the openings of the coronary arteries. Dye is injected through the catheter into each coronary artery, and an x-ray camera takes pictures. These pictures help detect areas of narrowing (“blockages”) and assess their severity.

During a left ventriculogram, a special catheter is directed into the left ventricle (the hearts main pumping chamber). Dye is injected under pressure into the ventricle. A series of pictures is obtained, giving a detailed view of the left ventricle during its pumping action.

Tilting the camera allows multiple shots to be taken at multiple angles. This allows a more detailed study of the coronary arteries and heart chambers.

What You Can Expect

You will be awake during the procedure, and you may be asked to take a deep breath and hold it. You may also be asked to cough forcefully several times. Cardiac catheterization generally is not painful, although you may feel some discomfort during the insertion of the catheter(s) in the groin. You will not feel the catheters moving through the blood vessels and into the heart.

During the injection of dye into the ventricle, you may feel a warm sensation or “hot flash” over your body, lasting for 10 to 20 seconds.

A complete catheterization study usually takes from one to two hours. If at any time during the study you feel pain or discomfort, let the staff know.

Most of the complications associated with catheterization are minor and of no long-term consequence. These include nausea and vomiting, allergic skin rash (hives), and heartbeat irregularity.

Some patients may develop bleeding at the insertion site. Blood collects under the skin, resulting in a local swelling and/ or a bruise.

Rarely, catheterization may be associated with more serious complications. These include damage to blood vessels, formation of blood clots, infection, abnormal heart rhythms, a heart attack, or a stroke. Deaths are very rare.

Potential Benefits

Catheterization provides important information about the heart’s pumping function and the condition of the coronary arteries and heart valves.

This kind of information often cannot be obtained by any other means. It allows an accurate diagnosis and enables your doctor to begin treatment before irreversible damage to the heart occurs.

After Your Catheterization

After the procedure is completed and the catheters are removed, the doctor (or nurse) will apply firm pressure over the groin for about 10 to 20 minutes. This is done to prevent bleeding.

You’ll be transported to the recovery area or to your room. The nurse will apply a pressure dressing over the insertion site. Sometimes a weight (usually a small sandbag) is applied at the site.

You’ll need to lie flat in bed for 4 to 6 hours, to allow a small seal to form over the puncture in the artery. During that time, do not bend or lift the leg where the catheters were inserted. To relieve stiffness, you may move your foot or wiggle your toes.

The nurse will check your pulse and blood pressure frequently, and will also keep checking the site where the catheters were inserted. If you feel sudden pain at the site or if you notice a warm, sticky sensation of fluid, notify the nurse immediately.

You will be able to eat shortly after the procedure is over. You’ll be encouraged to drink plenty of liquids, to flush the x-ray dye out of the body.

At Home, After the Procedure

  • Have a family member or friend drive you home from the hospital.
  • Limit your activity during the first 24 hours after returning home. You may move about, but do not strain or lift heavy objects.
  • Leave the dressing on your groin (or arm) until the day after the procedure. The nurse will tell you how to take it off and when it’s okay to take a shower.
  • A bruise or small lumps under the skin at the insertion site are common. They generally disappear within 3 to 4 weeks.
  • Call your doctor if the insertion site begins to bleed, the bruising or swelling increases or the leg (or arm) in which the catheters were inserted feels cold or numb.
  • Call your doctor or nurse if the insertion site becomes painful or warm to the touch or if you develop a fever over 100 degrees F.
  • Ask your doctor when you can return to your normal activities, and whether there are any specific restrictions.
  • Be sure to check with your doctor or nurse about medications – which ones to continue, and which ones to stop.

Coronary Angioplasty

Coronary angioplasty is a non-surgical technique used to open narrowed arteries. A special catheter with a balloon at its tip is passed into the narrowed artery. The balloon is inflated, compressing the fatty deposits against the artery walls. This allows better flow of blood to the heart muscle.

Changes in Your Lifestyle

No matter which treatment your doctor recommends, it is important that you make some changes in your lifestyle. This will help eliminate certain factors (such as high blood cholesterol and smoking) that can lead to the continuing build-up of fatty deposits in your arteries.

  • Enjoy a diet low in fat and cholesterol.
  • Lose extra weight, and keep it off.
  • Exercise regularly (consult your doctor before starting an exercise program).
  • Keep your blood pressure under control.
  • Reduce excess tension and stress.
  • If you smoke—quit!

What is a cardiac PET exam?

A cardiac Position Emission Tomography (PET) exam is used by doctors to evaluate the health of your heart. People who receive this exam may have symptoms and/or risk factors for heart disease. The results of this exam will help your doctor determine if you should have follow-up treatment. If you are already being treated for a heart-related condition, the results of this exam can also be used to help your doctor manage your treatment.

What is heart disease?

Heart disease can be described as a narrowing of the vessels that supply blood to your heart. This narrowing can be caused by a build-up of plaque (fatty deposits). When this happens blood cannot flow through the vessels normally. Consequently, your heart may not get the oxygen and nutrients it needs.

How is the procedure performed?

  • Trained medical personnel will be with you throughout the exam.
  • You will be asked questions about your medical history.
  • An IV line will be placed in your arm to allow administration of medication during the exam.
  • Small pads called electrodes will be placed on your chest so that the medical team can monitor your heart throughout the study.
  • You will be asked to lie on a scanning table made especially for the PET camera.
  • A small amount of a radiopharmaceutical will be given through your IV line that will allow the PET camera to take pictures of your heart.
  • The amount of radiation exposure you receive is considered safe by the National Council on Radiation Protection.
  • A PET camera will take pictures of your heart in two phases: a resting phase and a stress phase. The order in which these phases occur will be determined by your doctor.
  • These phases are then compared to allow for the assessment of blood flow through your heart and/or to look for prior damage to the heart muscle.

How should I prepare for the procedure?

You should ask your doctor and follow his/her advice about directions regarding your preparation for the exam.

Here are a few general guidelines:

  • You may be asked not to eat or drink anything for a period of 6 hours before your test.
  • You may be asked not to have any caffeine/nicotine products for at least 12-24 hours before your exam.
  • You may be asked not to take certain medications before the exam. It is very important that you check with your doctor BEFORE discontinuing any medications.
  • You may be asked if you have any allergies.
  • Wear comfortable clothing.
  • Bring a list of all your medications with you to the exam.

What can I expect from the stress portion of the procedure?

  • The stress phase of the exam is usually performed with a pharmaceutical that makes you heart feel like it is exercising.
  • This pharmaceutical is given through the IV line while an electrocardiogram (ECG) is performed to monitor your heart.
  • It is important to let the healthcare professional know if you are having any symptoms during the test to allow them to better assess when to stop the test.
  • You may experience chest pain, palpitations, headache or a flushing feeling during the test. You may also feel short of breath.
  • Remember, tell the healthcare professional if you experience any of these symptoms.

Is there important safety information I should know about a cardiac PET exam?

Only a doctor can decide if a cardiac PET exam is right for you. Special precautions may be take for patients with the following conditions:

  • Congestive heart failure
  • Diabetes
  • Asthma or lung disease
  • Female patients who are pregnant, nursing or think they may be pregnant
  • Patients who have recently suffered from a heart attack or stroke
  • Patients allergic to caffeine, theophylline, aminophylline or dipyridamole

If it important that you discuss the medications you are taking with the medical personnel performing your exam.

Always inform you healthcare provider about any symptoms you may be experiencing before, during and after the exam.

Your Test Results

Our Office nurse will contact you with your test results by phone; Or your Cardiologist will discuss the test results with you during a future office visit.

The test results help the doctor make an accurate diagnosis and develop a treatment plan that’s best for you.

What is a Cardiolite Scan?

A Cardiolite scan is a test that uses a radioactive substance, known as a tracer, to produce images of the heart muscle. When combined with an exercise test, the Cardiolite scan helps determine if areas of the heart are not receiving enough blood.

The exercise Cardiolite scan is especially useful in diagnosing coronary heart disease, the presence of blockages in the coronary arteries (the vessels that supply oxygen-rich blood to the heart muscle).

[Other terms used to describe the Cardiolite scan include: sestamibi scan, myocardial perfusion scan, and cardiac nuclear imaging.]

Other tracers, such as thallium, may be used for this type of scan. In some cases, doctors use two tracers during one test (dual-isotope imaging).

What Does it Show?

During the test, a small amount of Cardiolite tracer is injected into a vein in you arm while you walk on a treadmill or pedal a stationary bicycle.

The tracer travels in the bloodstream, is carried through the coronary arteries, and is picked up by the heart muscle cells.

Areas of the heart muscle that have an adequate blood supply pick up the tracer right away and more completely. Areas that do not have an adequate blood supply pick up the tracer very slowly or not at all.

The tracer gives off a small amount of radiation that is detected with a scanning camera. A computer processes the information and produces images of the radioactivity distributed in the heart.

If an area of the heart receives less blood than the rest of the heart (because of a blocked or narrowed artery), it will pick up less radioactivity and will show up as a lighter area, called a “defect.”

Additional Cardiolite is injected, while you are at rest, and anther set of images is taken. This allows doctors to compare how much blood flows through the heart muscle during stress and at rest.

Either the exercise or rest portion of the test may be done first. The entire test can be completed in either one day or two separate days.

Preparing for the Test

  • Do not eat or drink for 4 hours prior to the test. This will help prevent the possibility of nausea, which may accompany vigorous exercise after eating. Sips of water are okay.
  • If you are currently taking any heart medication, check with your doctor. He or she may ask you to stop certain medications a day or two before the test. This can help get more accurate test results.
  • Wear loose and comfortable clothing that is suitable for exercise. Men usually don’t wear a shirt during the test; women generally wear a lightweight blouse or hospital gown. Also wear comfortable walking shoesor sneakers.
  • Before the test, you’ll be given a brief explanation of the test and you’ll be asked to sign a consent form. Feel free to ask any questions about the procedure.
  • Several electrodes (small sticky patches) will be placed on your chest to obtain an electrocardiogram (ECG or EKG), a recording of your heart’s electrical activity.
  • An intravenous (IV) line will be inserted into a vein in your arm, to allow injection of the tracer during exercise.

What Happens During the Test

The Cardiolite scan is usually performed at a hospital, clinic or test center. Either the exercise portion or rest portion of the test may be done first. The doctor or technician will inform you whether the test can be completed in one day or two separate days.

Exercise Portion

You will either walk on a treadmill or pedal a stationary bicycle. The treadmill moves slowly at first, then the speed and incline increase gradually. If you pedal a stationary bicycle, it feels easy to pedal at first, then it gradually gets harder.

Be sure to report any symptoms, such as chest pain or discomfort, dizziness or severe shortness of breath. Try to exercise for as long as you are able to, because it increases the accuracy of the test.

When you reach the point where you feel you can’t exercise for much longer, let the doctor know. The technician will then inject the tracer into the intravenous line. You will be asked to continue exercising for another minute or so after the injection.

Next, you will lie flat on a special table under a large scanning camera. During imaging, the camera takes pictures of your heart at various angles. Remain still while the pictures are being taken. This part of the test may take up 20 minutes.

Rest Portion

The tracer will be injected one other time and another set of pictures will be taken, while you are at rest. These images are compared to images obtained during the exercise portion of the test.

How Long Does it Take?

Allow 3 to 4 hours for the entire test, which includes preparation, the exercise portion, and imaging. Keep in mind that you may have to come back for more pictures later in the day or the next day.

Dual-Isotope Imaging

In dual-isotope imaging, two tracers are used. A rest study with thallium is done first, and a stress study with Cardiolite follows soon after. The entire test can be completed in 2 to 3 hours (there is no need to come back).

Is the Test Safe?

The radiation exposure during a Cardiolite scan is small, and the doses used are safe. However, if you are pregnant, suspect you may be or are a nursing mother, be sure to let your doctor know.

The exercise test is also safe. A small amount of risk does exist, however, because it stresses the heart. Possible rare complications include abnormal heart rhythms and a heart attack. Experienced personnel are available to handle any emergency.

Your Test Results

Our office nurse will contact you with your test results by phone. Or, your doctor will discuss the test results with you during a future office visit.

What is an Echocardiogram?

An echocardiogram (also called “echo”) is a test that uses ultrasound waved to examine the heart. It is a safe and painless procedure that helps doctors diagnose a variety of heart problems.

How does it Work?

During the test, a small microphone-like device, called a transducer, is held against the chest. The transducer sends ultrasound waves that bounce off the various parts of the heart.

A computer uses the information coming from the transducer to construct an image of the heart. The image is displayed on a television screen, and it can be recorded on videotape or printed on paper.

The echocardiogram study usually combines three different techniques. The simplest technique, called M-mode echo, produces an image that looks more like a tracing than an actual heart. The M-mode echo is especially usefully for measuring the exact size of the heart chambers.

A more advanced technique, the two-dimensional (2-D) echo, shows the actual shape and motion of the different heart structures. In a way, these images represent “slices” of the heart in motion.

A third technique, the Doppler echo, allows doctors to assess the flow of blood flow the blood through the heart. The signals that represent blood flow are displayed as a series of black-and-white tracings or as color images on the television screen.

If you are having a Doppler echo, you may hear a whooshing or pulsating sound. This is not the actual sound of your heart, but an amplified and computerized audio signal.

Why is the Echo Done?

The echo test gives doctors useful information about the heart, such as:

  • Size of the heart. The echo is used for measuring the size of the heart chamber and thickness of the heart muscle.
  • Pumping strength. The test shows whether the heart is pumping at full strength or if weakened. It can also help determine whether the various parts of the heart pump equally.
  • Valve problems. The echo shows the shape and motion of the heart valves. It can help determine if a valve is narrowed or leaking and show how server the problem is.

Other uses. The test may also be used to detect the presence of fluid around the heart, blood clots or masses inside the heart, and abnormal holes between heart chambers. Sometimes, the echo is combined with an exercise test, to see how well the heart pumps when made to work harder.

Before Your Echo

No special preparations are necessary. You may eat and go about your normal activates unless you are told otherwise. Make sure you wear a two-piece outfit. The echo may be done at a hospital, test center or doctor’s office.

What Happens During the Test?

You may be asked to undress from the waist up and put on a short hospital gown. Electrodes (small sticky patches) are placed on your chest and shoulders to monitor your heartbeat.

You then lie on a hospital bed or exam table. To improve the quality of the pictures, a colorless gel is applied to the area where the transducer will be placed. This may feel cool and bit moist, but the gel will be wiped off at the end of the test.

A technician moves the transducer over the chest, to obtain different views of your heart. He or she may ask you to change positions. You may also be asked to exhale or hold your breath for a few seconds (air in your lungs can affect the echo images).

The images are recorded on videotape or printed on paper, so the doctor can review them later.

How Long Does it Take?

An echo exam usually takes from 20 to 45 minutes, depending on the number of views and whether the Doppler echo is also used. Be sure to allow extra time to check in. when the rest is over, you may eat and return to your normal activities.

Is the Echo Safe?

The echo test is very safe. There are no known risks from the ultrasound waves. It is also painless, even though you may feel a slight discomfort when the transducer held firmly against the chest.

What Are the Benefits?

A major benefit of the echo test is that it gives information about the heart’s structures and blood flow without anything entering the body.

The major limitation is that it is often difficult to obtain good quality images in patients who have broad chests, are obese or are suffering from chronic lung disease (such as emphysema).

Your Test Results

Our office nurse will contact you with your test results by phone. Or, your doctor will discuss the test results with you during a future office visit.

The information gained from the echo test helps your doctor make an accurate diagnosis and develop a treatment plan that’s best for you.

When you have angina, your body is telling you that your heart is not receiving enough oxygen.

A treatment, in harmony with your heart, can improve circulation to your heart muscle. EECP treatment appears to stimulate the opening of new, natural pathways around narrowed or blocked arteries.

After EECP Treatment you may find that:

  • You can walk farther, carry heavier packages, and be more active without having angina
  • You have fewer attacks of angina
  • Your episodes of angina are less intense
  • You can return to work, go out to dinner, garden, travel or enjoy golf, tennis or bowling once again
  • You no longer have to restrict your social life, volunteer activities or exercise because you are worried that they will cause angina.

Understanding Angina

If you are one of more than seven million people in the United States with angina, you may be all too familiar with angina.

Angina signals that a part of your heart muscle is not receiving an adequate supply of blood supply because of its heavy workload, and receives this nourishment through the coronary arteries. When these vessels are narrowed or blocked, restricting blood flow, they fail to supply adequate oxygen.

Detours Around Blocked Arteries

The body has a response to pain and problems caused by narrowed arteries. The body often can increase the amount of blood flowing to the muscle by opening up tiny branches of nearby vessels. This network of tiny blood vessels- known as “collateral circulation” – makes it possible for blood to detour around blocked or narrowed arteries.

The development of collateral circulation is particularly important in the heart muscle where it may be life-saving. However, the development of collateral circulation is a gradual process and not everyone has the same natural ability to develop these networks at a rate that will relieve angina.

Learning about EECP Treatment

Enhanced External Counterpulsation may stimulate the opening or formation of, small branches of blood vessels (collaterals) to create a natural bypass around narrowed or blocked arteries.

The term “Enhanced External Counterpulsation” describes what will happen during treatment.

“Enhanced” refers to the equipment that has evolved over decades or research and development to become the state-of-the-art treatment delivery system now used in EECP treatment centers.

“External” means treatment happens outside of your body and doesn’t require surgery.

Before we can understand the term “Counterpulsation,” we have to understand the cardiac cycle, the period from the beginning of one heartbeat to the beginning of the next. The cardiac cycle includes diastole when the heart relaxes and fills with blood and systole when the heart contracts and pumps blood out to the body

The EECP system compresses your lower limbs to increase blood flow toward your heart. Each wave of pressure is electronically timed to your heartbeat so that the increased blood flow is delivered to your heart at the precise moment it is relaxing. When the heart pumps again, the pressure is released instantaneously. This lowers resistance in the blood vessels of your legs so the blood may be pumped more easily from the heart. Decreasing the amount of work required of your heart muscle.

During counterpulsation, the EECP system pumps when your heart is resting and releases pressure when your heart is working.

Determining if you May be a Candidate for Treatment

Your doctor will evaluate you to determine if you may be eligible to receive EECP treatment. You may be a candidate for EECP treatment if:

  • You have angina
  • Nitroglycerin does not provide adequate relief from your angina
  • You have been told that you are not a candidate for bypass surgery or angioplasty
  • You underwent bypass surgery or angioplasty in the past, and angina has returned
  • You want to explore all treatment options

Some people may not be candidates for EECP treatment because of their medical conditions. Only a physician can make a decision regarding whether or not you are a candidate for EECP treatment.

Once you are eligible to receive EECP treatment, it is important that you understand the treatment schedule. Patients typically attend one-hour treatment sessions once a day, five days a week for seven weeks. Many people receive treatment, without interruption to their employment, by scheduling their session before or after work.

To make sure the treatment goes smoothly, please follow your Pre-Treatment Instructions. You may wish to bring a book, a magazine or portable CD or tape player with earphones. You also may wish to invite a family member or friend to accompany you.

At the EECP center, your therapist will explain each step as you go through treatment. You may be given a pair of stretch pants to wear at each treatment session.

Although treatment usually takes one hour, you should plan to spend approximately 1-1/2 hours at the treatment center.

Receiving EECP Treatment

Once you have changed your clothes, a therapist will weigh you, and take your blood pressure. You will lay on a padded table in a padded table in a treatment room. Three electrodes will be applied to your chest to take a constant ECG reading during treatment. A finger sensor, called a plethysmograph, will be placed over your finger like a thimble. This sensor records tracings that represent blood pressure.

The therapist will wrap a set of inflatable cuffs around your calves, thighs, and buttocks. You are likely to feel a sensation of a strong “hug” moving upwards from your calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation.

Synchronized with your Heartbeat

Inflation and deflation are electronically synchronized with your heartbeat using the ECG signal. By monitoring your ECG reading and your plethysmograph (blood pressure) tracing, your EECP therapist can time counterpulsation accurately.

Raising the Threshold for Angina

Clinical studies indicate that EECP treatment may create a “natural bypass” around narrowed or blocked portions of arteries. These channels or collaterals may eventually become permanent pathways for blood to reach heart muscle that was previously deprived of adequate nourishment.

A controlled, randomized, blinded study showed a significant increase in the length of time that participants who had received in the length of time that participants who had received active treatment were able to exercise experienced fewer attacks of angina.

Medical Research

Studies conducted at numerous university medical centers and published in peer-reviewed medical journals have demonstrated benefits including:

  • Elimination or decrease in exercise-included signs of lack of oxygen to the heart muscle (ischemia)
  • Increased exercise tolerance
  • Elimination or decrease in episodes of chest pain
  • Decrease in need for anti-anginal medication

Many Patients ask these Questions

What are the clinical benefits of treatment?
For many patients, EECP treatment can reduce the frequency and intensity of chest pain or eliminate it altogether, decrease the need for medication, and greatly improve the ability to participate in activities of everyday life. After receiving EECP treatment, patients often are able to enjoy moderate exercise for the first time since they developed angina.

How will I feel after treatment?
You may feel a little tired after your first treatment session, but you are unlikely to experience any unpleasant after effects. You may be given an Angina Diary in which you can record any episodes of angina and your use of nitroglycerin. This record may be helpful in tracking your progress.

How soon can I expect to feel an improvement in my condition?
Because each individual’s condition is unique, there is no special time when you can expect to feel improvement. Experience has shown that some patients tend to report some improvement about halfway through their course of treatment.

Are there any drawbacks to the procedure?
The length of treatment may be a consideration for some people. A course of EECP treatment typically takes seven weeks to complete. During that time, patients must visit an outpatient clinic and receive treatment for one hour per day. Some patients may require more than one course of therapy to achieve an optimal level of relief.

What are the risks of EECP treatment?
Some patients have experienced minor skin irritation due to the pressure of the cuffs. You should consult with your physician regarding any risk and complications factors.

What are the advantages of EECP treatment over other treatment for angina?
Unlike procedure such as bypass surgery and balloon angioplasty, EECP treatment is administered on an outpatient basis and does not involve any period of post-treatment recuperation.

Are there other treatment options to consider?
There are several other treatment options including bypass surgery, balloon angioplasty, and drug treatments. Discuss options with a physician to determine which course of treatment is not suitable for you.

Pre-Treatment Instructions

Specific instructions will be explained by your EECP therapist.

Please ask your EECP therapist any questions that you may have.

  • Arrive 10-15 minutes before your scheduled appointment.
  • Take all medications as instructed.
  • Don’t eat (except medication) or drink within 1-1/2 hours before treatment.
  • Chose clothing that’s easy to change.
    • Stretch pants, usually provided by the center, should be worn to reduce the possibility of skin irritation.
    • Men and women should wear form-fitting underwear.
    • Wear a loose, comfortable top with an open neck.
    • Wear short socks.
  • You may bring music (CD player or tape player with earphones) or something to read.
  • A friend or relative may stay with you during your treatment.

What is an Exercise ECG Test?

An exercise ECG test allows doctors to learn how well your heart functions when it is made to work harder. This test can help detect heart problems that may not be apparent at rest.

The exercise ECG test is done while you walk on a treadmill or pedal a stationary bicycle. During the test, an electrocardiogram (ECG or EKG) records the electrical activity of your heart.

[Other terms used to describe the exercises ECG test include: cardiac stress test, exercise tolerance test, and treadmill test.]

What does it Show?

Even if your heart functions well at rest, the blood supply to the heart may not be sufficient to meet its needs when its workload is increased. The exercise ECG test is used to see how well your heart functions during exertion. Throughout the test, several types of information are being recorded:

  • How long were you able to exercise? Generally, people with a healthy heart and in good physical condition are able to exercise longer.
  • Did you have significant symptoms? Its normal to fees tired sand short of breath during strenuous exercise. However, if you develop chest pain or discomfort, of become extremely short of breath, this may indicate a heart problem.
  • What happened to your heart rate and blood pressure? Both the heart rate and blood pressure normally rise during exercise. An abnormal heart (too fast, too slow) or fall in blood pressure during exercise may indicate heart diseases.
  • What did the ECG show? Certain patterns in the ECG tracing may indicate that the heart muscle is not getting enough oxygen-rich blood. Sometimes, the ECG during exercise shows abnormal heart rhythms.

Doctors may order an exercise test to:> diagnose the cause of chest pain;>determine the level of heart function in people with heart disease;>evaluate the efficacy of treatments such as medications or heart procedures;>look for abnormal heart rhythms that may develop during exercise; and> determine the level of exercise that is right for you.

Preparing for the Test

  • Do not eat or drink for 1.5 hours prior to the test. This will help prevent the possibility of nausea, which may accompany vigorous exercise after eating. [If you have diabetes and take medication for it, get special instructions].
  • Avoid any strenuous physical activity on the day of the test. If you are a smoker, don’t smoke for at least 3 hours before the test.
  • If you are currently taking any heart medications, check with you doctor. He of she may ask you to stop certain medications a day or two before the test. This can help get more accurate test results.
  • Wear loose and comfortable clothing that is suitable for exercise. Men usually don’t wear a shirt during the test; women generally wear a loose-fitting blouse or hospital gown. Also, wear comfortable walking shoes or sneakers.
  • Before the test, you’ll be given a brief explanation of the test and you’ll be asked to sign a consent form. Feel free to ask any questions about the procedure.
  • Several electrodes (small sticky patches) will be placed on your chest to obtain an ECG. Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place.

What Happens During the Test?

The exercise ECG test is generally performed at a hospital, test center or doctor’s office.

A technician (or a nurse) will place several electrodes on your chest, to allow recording of the ECG during the test. The electrodes are connected by wires to an ECG machine. A cuff will be applied to your arm to monitor blood pressure.

You will be shown how to step onto the treadmill and how to use the support railings to maintain your balance. The treadmill starts slowly, then the speed and incline are increased gradually. [If you pedal at first, then it gradually gets harder.]

Your blood pressure will be checked every few minutes, and your ECG will be carefully watched for abnormal changes.

Be sure to report any symptoms, such as chest pain or discomfort, dizziness or severe shortness of breath. Try to exercise for as long as you are able to, because it increases the accuracy of the test.

The test usually continues until you reach a “target” Heart rate based on your age. The test may end when you experience significant symptoms or become too tired. Other times, the test may be stopped when the ECG shoes abnormal patterns or when sufficient information has been obtained.

After the exercise portion of the test is over you’ll be helped to a chair or a bed. your blood pressure and ECG will be monitored for another 5 to 10 minutes while you recover. The technician will remove the electrodes and cleanse the electrode sites.

The exercise portion of the test usually lasts for 5 to 15 minutes. However, you should allow about an hour for the entire test, which includes preparation, the exercise and portion, and the recovery period.

Is the Exercise Test Safe?

The exercise test is generally safe. A small amount of risk does exist, however, because it stresses the heart. Possible rare complications include abnormal heart rhythms and a heart attack. Experienced personnel are available to handle any emergency.

Your Test Results

Our office nurse will contact you with your test results by phone. Or, your doctor will discuss the test results with you during a future office visit.

The information gained from the exercise test helps your doctor make an accurate diagnosis and develop a treatment plan that’s best for you.

Eating fewer high fat, high cholesterol foods and watching calories are important steps to a healthier diet and a healthier heart.

Guideline for a Healthy Diet

With your doctor; determine number of calories you need each day to achieve or maintain a healthy body weight.

  • Eat fewer high-fat foods
  • Lower cholesterol intake to less than 300 mg per day
  • Keep fat intake to 30% of your total daily calories
  • Choose foods high in starch and fiber
  • Replace some saturated fat with unsaturated fat (limit saturated fat to 8% to 10% of total daily calories)
  • If you drink alcohol, do so in moderation

To Choose Low-Fat Products, Ask Yourself

  1. Is fat a major ingredient? Read food labels. To avoid too much fat or cholesterol, go easy on products that list any ingredient high in saturated fat or cholesterol first (egg, oils, lard, cheese).
  2. Is there more than one type of fat in the product? When you see several high-fat ingredients on ingredients on a label, the product could have too much fat.
  3. Is the serving size appropriate? When you are figuring out the fat content in a food, make sure you use a serving size that is close to what you would really eat-which could be more than the label says.

Eating Out

Be just as careful when dining out, as you are when you make your own meals!

  • Salad – Use vegetable oil and vinegar dressings
  • Bread – Use margarine instead of butter if desired
  • Chicken – Eat broiled or grilled chicken; remove skin before eating
  • Steak – Ask the chef to trim off excess fat before cooking
  • Hamburger – Avoid cheese or mayonnaise toppings, add tomato or lettuce instead
  • Fish – select broiled or poached fillets
  • Pasta – Use marinara, clam or tomato sauce without meat or sausage (avoid cream sauce).
  • Pizza – Choose vegetable toppings instead of cheese or meat toppings
  • Baked potato – Avoid toppings such as butter or sour cream
  • Vegetables – Eat plenty of these, but without heavy sauces
  • Dessert – Sherbet and fresh fruit are excellent choices
  • Coffee, Tea – Use skim milk or nondairy, nonfat creamer

A Fresh Approach to Nutrition for Patients with High Blood Pressure

Nutritional Program Goals

Lose Weight
Being significantly overweight can be hazardous to your health. Too much weight can lead to high blood pressure, which is a major risk factor for heart disease. Often just losing weight will help reduce blood pressure.

Reduce Dietary Fat 
Cutting fat out of your diet is an easy way to reduce calories. High-fat foods are also the primary sources of cholesterol. A high level of cholesterol in the blood is another major risk factor for heart disease.

Reduce Salt Intake
Most Americans take in far more salt than they need. Salt cause the body to retain fluid and make the kidneys work harder. This may raise blood pressure in some people. Just cutting down on salt lowers blood pressure for may people.

Increase Fiber
Foods high in fiber are usually low in calories. Fiber may also help lower the amount of cholesterol in the blood. And since high-fiber foods a digested more slowly, they satisfy hunger longer.

Balance Your Diet 
The key to healthy eating is to provide choices from all the major types of food. This means a balance of fruits and vegetables, breads and pastas, meat, fish, and poultry, as well as dairy products. It also means becoming aware of the amount of fat or salt contained in different foods of each group.

What is a Tilt Table Test?

If you have had recurrent syncope (fainting spells), the tilt table test can help determine how your body responds to changes in position. During the test, you lie on a table that can be moved to a nearly upright position while your symptoms, heart rate, and blood pressure are continuously monitored.

What Causes Syncope?

Syncope is a sudden brief loss of consciousness or fainting spell. Syncope results when the brain does not receive sufficient blood flow and oxygen.

The most common type of syncope, the ”common faint,” is termed vasovagal syncope. It is caused by a malfunction of the nerves that control the action of the heart and blood vessels. This malfunction causes the heart and blood vessels. This malfunction causes the heart to slow down and the blood pressure to drop. As a result, the person loses consciousness.

Syncope may also be caused by heart disease, such as from an arrhythmia (abnormal heart rhythm) or a severely narrowed heart valve.

What Does the Tilt Table Test Show?

The tilt table test is designed to induce (bring on) syncope under controlled conditions. It is especially useful for diagnosing vasovagal syncope.

The upright position during the tilt table test causes blood to pool (collect) in the lower part of the body, especially the legs.

As a result of the tilt, less blood returns to the heart, less blood is available for the heart to pump, and the blood pressure tends to drop.

Normally, the nerves that control the function of the heart and blood vessels are able to maintain the blood pressure by increasing the heart rate and by tightening the blood vessels.

In people susceptible to vasovagal syncope, these nerves do not work properly. As a result, the heart rate slows down, the blood pressure drops, and the person loses consciousness. Once the person lies flat, normal flow is restored, and he or she regains consciousness.

Preparing for the Test

  • Get specific instructions about the food you can have. Generally, you will be instructed not to eat or drink anything for 6 to 8 hours prior to the test. This will help prevent nausea, which may accompany the test.
  • Make arrangements for someone to drive you home after the study-you probably won’t be permitted to drive. Family members and friends can wait in an assigned area.
  • Be sure to check with your doctor several days before your tilt table test.You may be asked to stop taking certain medications for 2 or 3 days before the study. This can help the doctor get more accurate test results.
  • Bring a list of all the medications you are currently taking. It is important for the doctor to know their exact names and dosages.
  • Before the test, you’ll be given an explanation of the test and be asked to sign a consent form. Feel free to ask questions.
  • An intravenous (IV) line will be inserted into a vein in your arm, to allow the injection of fluids and medications.
  • Several electrodes (small sticky patches) will be placed on your chest to obtain an electrocardiogram (ECG or EKG), a recording of your heart’s electrical activity.

What Happens During the Test?

During the test, you will be instructed to lie down on a special table, called a tilt table. The intravenous line is inserted in one arm, and a blood pressure cuff (or a similar device) is placed on the other arm. The ECG electrodes on your chest allow the doctor to monitor your heart rhythm. Safety straps are applied across your chest and legs.

Initially, you will lie flat on the tilt table. Then, the entire table is tilted so that your head is almost upright (60 to 80 degrees). You will be continuously monitored in the tilted position for up to 45 minutes and then returned to a flat position.

At this time, if the test is normal or “negative,” you may be given an adrenaline-like medication to help induce syncope. The drug may cause you to feel your heart pound. Following the medication, you will again be tilted for up to 45 minutes.

At any time during the test, you may get symptoms that you previously experienced when you fainted or nearly fainted. If this occurs, it is very important to notify the nurse and doctor who will be in the room with you throughout the procedure.

The test is considered abnormal or “positive,” if the titling induces loss of consciousness accompanied by a low blood pressure and/or a slow heart rate.

A complete tilt table test, including preparation for the test, generally lasts from one to two hours.

After the Test

When the test is over, it may be wise to rest for a while. Have someone drive you home. Ask your doctor or nurse about taking any medications that you were told to skip before the test.

Is the Test Safe?

The tilt table test is generally safe. By design, the test may cause you to faint for a few moments. Should this happen, the table is returned quickly to a flat position and the test is stopped. Well-trained personnel are available to handle any emergency.

What are the Benefits?

Because some causes of syncope are more serious than others, it is Important to be able to determine its cause. Heart problems, such as an abnormal heart rhythm or a severely narrowed heart valve, can be life threatening. Other causes, including vasovagal syncope, are generally less worrisome.

The tilt table test helps doctors determine whether or not you are susceptible to vasovagal syncope. The information gained from this test helps your doctor make an accurate diagnosis and develop a treatment plan that’s best for you.

Your Test Results

The doctor conducting the test may be able to give you preliminary test results before you leave. Or, your own doctor will discuss the test results with you during a future office visit.

What is Body Mass Index?

Body Mass Index (BMI) is a relationship between height and weight associated with body fat and health risk. Research has identified the health risks associated with a wide range of BMIs.

A BMI of over 25 is considered overweight.

Body Mass Index Calculator

These calculations are based on averages.

BMI

Normal: 18.5 – 24.9
Overweight: 25 – 29.9
Obese: 30 and over

America’s Silent Epidemic

Heart failure is a condition that affects nearly five million American’s of all ages and is responsible for more hospitalizations than all forms of cancer combined. Over 400,000 new cases of heart failure will be diagnosed in the next year. Yet many people with heart failure are not aware they have it, because some of the most common symptoms of heart failure, such as feeling tired and short of breath, are often mistaken for normal signs of getting older. Also, people may try and avoid symptoms by making lifestyle changes such as taking the elevator instead of the stairs, sleeping with extra pillows or cutting back in their favorite sports.

Some of the most common questions and answers regarding heart failure are found in this brochure. Remember, early diagnosis and treatment are very important, so if you think you may be at risk for heart failure, visit your doctor as soon as possible. Based on taking your medical history, examining you, and you having the necessary tests, your doctor can tell if you have heart failure and how it can be managed.

What is Heart Failure? What Causes It?

Despite the way it sounds, heart failure does not mean that the heart suddenly stopped working pr that you are about to die. Rather, heart failure is a common condition that usually develops slowly as the heart muscle weakens and needs to work harder to keep blood flowing through the body. Heart failure develops following an injury to the heart such as blood pressure or an abnormality of one of the heart valves. The weakened heart must work harder to keep up with the demands of the body, which is why people with heart failure often complain of feeling tired.

What Are Some of the Symptoms of Heart Failure?

  • Shortness of breath, which can happen even during mild activity
  • Difficulty breathing when lying down
  • Weight gain with swelling in the legs and ankles from fluid retention
  • General fatigue and weakness

What Puts Me at Risk for Heart Failure?

  • High blood pressure (hypertension)
  • Heart attack (myocardial infraction)
  • Damage to the heart valves or history of a heart murmur
  • Enlargement of the heart
  • Family history of enlarged heart
  • Diabetes

How is Heart Failure Diagnosed?

Only your doctor can tell you if you have heart failure. When you visit your doctor, he/she should review your medical history and conduct a full physical examination.

Physicians often order a number of tests when exploring a possible diagnosis of heart failure. Many of them are painless and simple. The most important of these tests is an echocardiogram or “echo” for short. This test tells your doctor what your ejection fraction or “EF,” is. The ejection fraction is a measurement of how well your heart is pumping. People with a healthy heart usually have an ejection fraction of 50 percent or greater. Most people with heart failure, but not all, have an ejection fraction of 40 percent or less.

How Can I Learn to Live with Heart Failure?

If you have been diagnosed with heart failure, there are many things that you can do to help yourself. Limiting your intake of salts is very important and you should learn what prepared foods have large amounts of salt. It is important for you to weight yourself each day and contact your healthcare provider if your weight changes significantly. Exercising at levels recommended by your physician is of great importance in keeping you fit and well. Taking your medication id also beneficial. In addition, it is important for you to maintain frequent visits to your physician and notify him or her if there are any changes in your symptoms. Finally, it is essential that both you and your family understand what heart failure is, what symptoms are, what you should do if your symptoms change and how your doctors treat this disease. These questions can be answered by your doctors, health practitioners or nurses who work in your doctor’s office.

How is Heart Failure Treated?

Early diagnosis and treatment are very important, and recently there have been some major steps forward in treatment. Today, doctors can do more than ever, so many people with heart failure can live normal lives and be less at risk for being hospitalized. If you are diagnosed with heart failure, there are a number of medications that work together to improve your symptoms and help keep your heart failure from getting worse. Taking these medicines, in addition to eating right and getting regular exercise, will help improve your health.

How Can I Find Out More About Heart Failure?

You should ask your healthcare provider for information about heart failure. He or she can point you to helpful books, support groups and other resources.

Heart Failure Society of America, Inc.
Court International, Suite 240S
2550 University Avenue West
St. Paul, MN 55114
(615) 642-1633
Web site

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