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Lifestyle
What is the normal resting heartbeat for a pregnant woman?
Will exercise help reduce my high blood pressure?
Can exercise remove the buildup of plaque in the heart?
What effect does exercise have on heart rate?
Is bowling too stressful after bypass surgery?
Why does the heart beat slower when the body is colder and faster when the body is warmer?
How high should my heart rate be when exercising without being dangerous?
Why might a very fit person have a slower resting heart rate?
How many times does your heart beat in a lifetime?
I am the ideal cardiac patient. Why might I still be getting heart blockages?
Are there any sports heart montors that I can use to calculate my peak heart rate?
When can I start exercising after acute pericarditis?
Conditions
Could tachycardia over a length of time cause a heart murmur?
What is POTS?
What are vegetations?
What is the average time between the onset of paroxsysmal atrial fibrillation and its progression to chronic or continual atrial fibrillation?
What causes calcium around the heart?
Why is it important for a person with heart leakage to take antibiotics before going to the dentist?
I have congestive heart failure. Do I have to take antibiotics before going to a dentist?
Symptoms
Should we be alarmed about a murmur in a 15-year-old boy?
What could be causing a big increase in blood pressure?
What does it mean when your heart feels like it's "flip flopping?"
Can exercise help slow down a rapid heartbeat?
I have a heart murmur and can't run for more than 30 minutes. Should I see a cardiologist?
Can hormones be the cause of rapid heartbeat and shortness of breath?
Tests & Treatment
Does vascular testing mean you are at low risk for a heart attack?
What does it mean when a tilt test comes back positive?
Can radiofrequency ablation be used to treat atrial fibrillation?
How common is it to get a blood clot after having a pacemaker inserted?
How common is it for a 25 year old male to have a pacemaker put in?
Can I have an exercise stress test if I have a pacemaker?
Why should you stop beta blockers prior to nuclear medication studies?
Is an ejection fraction under 40% always accompanied by enlargement of the heart?
What is metoprolol?
Why prescribe a beta blocker if a patient doesn't have hypertension?
How high should your blood pressure go to during a nuclear stress test?
How much fluid should I be drinking when I go home after open heart surgery?
What is the procedure called that is used to increase the blood supply to the heart?
Should I be concerned if I have traces of mitral and tricuspid regurgitation?
Can plaque be scraped out during surgery as opposed to angioplasty?
Do your surgeons perform the classic "gold standard" Maze III cut and sew technique?
Do you perform emergency angioplasty on people having a heart attack?
Will keyhole valve replacement surgery be improved in the next few years?
Is there a procedure to remove fluid from around the heart?
Question: I have a history of atrial fibrillation controlled with digoxin. What would make me a good or bad candidate for radiofrequency ablation for permanent control without the use of drugs? Whom should I contact to learn more?
Answer: Radiofrequency ablation of atrial fibrillation is a relatively new technique aimed at treating those with symptomatic atrial fibrillation. The success rate is variable, and is between 70-85% for paroxsysmal atrial fibrillation (atrial fibrillation that starts and stops spontaneously) to as low as 30-40% for chronic atrial fibrillation. This therapy comes with a 1% risk of major adverse events, which include stroke and pulmonary vein stenosis. Therefore, for anyone who is considering this procedure, it is important to know if symptoms due to atrial fibrillation are really significant. Those with no or minimal symptoms are best managed with medical therapy. I or any of the electrophysiologists in the community who are skilled in radiofrequency ablation of atrial fibrillation would be good resources for more information on this subject.
Dr. Sanjeev Garhwal, Cardiologist, Western Washington Medical Group
Question: My mom is 81 years old and her doctor just told her that she has a small leakage around her heart. He said it is nothing to be concerned about, but when she goes to the dentist (even if it is just for a cleaning) she should call and he would prescribe an antibiotic. Why would this be important?
Answer: Small leaks around a heart valve cause turbulence of the blood and increase the risk of an infection on the valve. These infections are serious and therefore worth preventing by using the antibiotics as indicated.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I have congestive heart failure. Do I have to take antibiotics before going to a dentist?
Answer: Most people with congestive heart failure do not need to take antibiotics before dental work. However, if significant valvular or congenital heart disease is present antibiotics may be required.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: My friend had quadruple bypass surgery a few years ago. He seems healthy now and does not have any symptoms. We want to go bowling, but I heard that bowling is too stressful on a person who had bypass surgery. Is that true?
Answer: After bypass surgery, the chest bones and muscles are usually well healed 3-4 months after the surgery. The surgery itself does not mean that Bowling should be too stressful. Rather, if the chest and/or arm muscles are weak because they haven't been used much since the surgery, then bowling could be too stressful. If a person wants to bowl after bypass surgery, simple and light stretching and strengthening exercises should be done for several months after the surgery; then the person can begin bowling with a lighter than normal ball, then gradually work up to a normal weighted ball.
Gregory Lawson, Supervisor, Cardiac Rehabilitation, Providence Everett Medical Center
Question: Is there a procedure to remove fluid from around the heart?
Answer: Yes, the fluid can be removed with a needle/ catheter. In rare cases an incision below the sternum is required. Not all fluid collections around the heart need to be removed.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Does vascular testing for carotid artery stenosis, peripheral artery disease and abdominal aortic aneurysm, in which the results are fine, mean you are at low risk for a heart attack, as well as being at low risk for artery disease?
Answer: A positive screening exam for carotid, aortic or peripheral arterial disease does indicate a high risk for coronary heart disease or heart attack. However, a normal screening exam does not necessarily indicate low risk. There are numerous other risk factors that also contribute to the overall risk of developing coronary heart disease.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What causes calcium around the heart and what can be done about it?
Answer: Calcium around the heart usually means calcium within the pericardium (the sac around the heart). It can be caused by any chronic infection or inflammation of the pericardium (pericarditis). Nothing needs to be done about it unless it causes symptoms (the first is usually shortness of breath). Other more subtle symptoms include swelling of the legs, liver enlargement and eventually jaundice.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How common is it for a 25 year old male to have a pacemaker put in?
Answer: The average age of the person undergoing pacemaker implantation is between 64 and 69 years +/-about 20 years. That is to say the overwhelming majority of pacemaker are placed in patients aged 45-85 years of age. Therefore it would be extremely uncommon for a 25 year old to have a pacemaker implanted.
Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Everett Medical Center
Question: I had acute pericarditis last week and am still on my anti-inflammatory medication for a while. I am am avid runner - 30 to 40 miles/week. How long should I wait before starting to run again?
Answer: Acute pericarditis is an inflammation of the pericardium (the flexible two-layered sac that envelops the heart) that begins suddenly, is often painful, and causes fluid and blood components such as fibrin, red blood cells, and white blood cells to enter into the pericardial space. It usually results from infection or other conditions that irritate the pericardium. Infection is usually due to a virus but may be caused by bacteria, parasites or fungi. Acute pericarditis due to a viral infection is usually painful but short-lived and has no lasting effects. The prognosis depends on the cause. When pericarditis is caused by a virus or when the cause is not apparent, recovery usually takes 1 to 3 weeks but may vary considerably. Increasing activity too soon may cause recurrences and can slow recovery. Consult your physician for guidance.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What would be the average time between the onset of paroxsysmal atrial fibrillation and its progression to chronic or continual atrial fibrillation?
Answer: The course of progression of paroxysmal to chronic atrial fibrillation can be quite variable. It can vary between weeks to years. The underlying risk factors for atrial fibrillation, such as hypertension, valvular heart disease, age, heart failure, among others, may modulate the time period significantly.
Dr. Sanjeev Garhwal, Cardiologist, Western Washington Medical Group
Question: I am 62 years old and have a few years to go before an operation on my aortic valve replacement. Will the keyhole operation be better perfected then? Do you have any advice on a pig's valve versus a mechanical valve?
Answer: The surgical incision to replace the aortic valve is unlikely to change in the next few years. Several years ago smaller incisions were in vogue but they were not found to improve safety or pain following surgery and in many centers have been abandoned. The choice of valve prosthesis is individualized and depends on the presence of other medical problems, lifestyle issues and medication tolerance. In general, a patient who is 62, with no other medical problems and no contraindications to coumadin therapy would be offered a mechanical valve.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Are there any "sports" heart monitors to use as a training aid that I can acquire which will give a meaningful reading?
Answer: You can go to your doctor and get an event recorder or a Holter monitor or you can make your own. What you do is buy a Polartec™ type monitor which straps around the chest and is able to detect heartbeats. However, you have to calculate the heart rate yourself. The way you do this is to intercept the radio transmission using a portable AM radio. You can tune in your heart beat on AM radio some are usually in the early part of the dial around 500 to 650 Hz. Once you've figured out how to intercept the information, go out and exercise all hooked up to your monitors and with your radio and a recording device. You can record the heartbeat tones using a cell phone and calling a voicemail. Keep the recording going as long as you can and then when you listen to the voicemail, take a stopwatch and count the tones per minute or per two minutes. In this way you can figure out what your own peak heart rate is and describe this to your doctor or play it for him or her.
Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Everett Medical Center
Question: Do you perform emergency angioplasty on people who are having a heart attack? I've recently read that this a better alternative to the more common practice of administering clot-dissolving drugs.
Answer: Providence Everett Medical Center has been performing emergency angioplasty for patients in the early phase of a heart attack for 19 years. We are among the leaders in the state for advocating and performing this life saving procedure (over 300 patients each year). Because of our success, other hospitals in surrounding counties have been referring patients here for emergent treatment of heart attack victims for a number of years.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Why might a very fit person have a slower resting heart rate than someone of average fitness?
Answer: One of the major training effects of regular aerobic exercise is that the heart is able to pump more blood with each heart beat. This is called stroke volume. Therefore, when stroke volume increases with training, the rate or heart beats per minute becomes less. For example: a sedentary person has a resting heart rate of 80 beats per minute; after 3-6 months of regular brisk walking 30-60min per day, the person notices that her heart rate is now 65 beats per minutes. The reason is that the stroke volume as improved (more blood pumped with each beat). There is an equation: Heart Rate (beats per minute) x Stroke Volume (milliliters per beat) = amount of blood pumped per minute (milliliters per minute). At rest, the need for blood to all the tissues of the body remains pretty constant. So if your resting SV is improved with exercise training, your resting HR becomes less.
Greg Lawson, Program Specialist, Heart Life Services, Providence Everett Medical Center
Question: I have read where people who have used intravenous drugs almost certainly have vegetations in, on or around their hearts. What are vegetations? Do they go away? Can they kill you?
Answer: Vegetations are clumps of bacteria that can form on heart valves. Not all IV drug users get them but many do. Yes, people can die from them, but they can be treated for vegetations with antibiotics. Most people do need to have these valves removed or replaced.
Dr. Chris Price, Cardiologist, The Everett Clinic
Question: I am a 26 year old female with various episodes of shortness of breath and rapid heartbeat these past 4-1/2 years. I've been diagnosed with sinus tachycardia, which my doctor says is a benign condition, but these symptoms continue to bother me and seem to happen either when I'm pregnant or ovulating. Could hormones play a part in this?
Answer: It does not seem unreasonable that your symptoms could be related to hormones. It would be helpful to do a menstrual calendar with your symptoms and see a gynecologist.
Dr. Brends Flake, Providence OB/GYN
Question: Why does the heart beat slower when the body is colder and faster when the body is warmer?
Answer: One reason is that the higher the temperature above normal, the more cooling that must take place to maintain a normal body temperature. The body cools itself by pumping more blood to the surface of the skin.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Do your surgeons perform the classic "gold standard" Maze III cut and sew technique in combination with some cryo/burn for chronic a-fib?
Answer: We use the cryo probe to perform the Maze procedure incorporating the atrial incisions of the right atrial transseptal approach to the left atrium.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Can the plaque that is blocking passages to the heart be 'scraped out' with an instrument during surgery as opposed to angioplasty (stent)?
Answer: Mechanically removing plaque (endartectomy) has been done with only limited success by only a very few surgeons. Angioplasty with stent has been performed quite successfully by many cardiologists.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I am 36 years old and was diagnosed with a heart murmur (non MVP) many (15+) years ago. I started running in November 2002 and have not been able to run for more than 30 minutes. I get extremely flushed and have to stop running because I can't get enough oxygen. Should I see a cardiologist?
Answer: Anyone with a heart murmur caused by an abnormal heart valve should have it evaluated and followed periodically by a cardiologist. This is especially true if symptoms of shortness of breath, lightheadedness, syncope or chest pain occur.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I recently had an echocardiogram done. Everything was normal except that there was traces of mitral and tricuspid regurgitation. Should I be concerned?
Answer: No, I would not be concerned about these results. The technology of echo has improved now to the point where most people have trace reguritation of the mitral and tricuspid valves and these would be considered normal findings.
Dr. Christopher Price, Cardiologist, The Everett Clinic
Question: A friend of mine was told that she has POTS. What is this disease?
Answer: Postural tachycardia syndrome (POTS) is a disorder characterized by a pulse rate that is too fast when the patient stands. Symptoms include rapid heartbeat, lightheadedness with prolonged standing, headache, chronic fatigue, chest pain, and other nonspecific complaints. Causes of POTS usually are not identified in individual patients. Reversible causes such as low blood volume should be ruled out.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the procedure called that is used to increase the blood supply to the heart? Blood pressure cuffs are used on the legs forcing the blood supply to the heart. The procedure is done daily for an hour for 6-8 weeks.
Answer: It is called “External Counter Pulsation."
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How many times does your heart beat in a lifetime?
Answer: Assuming an average heart rate of 70 beats per minute and average life span of 75 years, this would add up to 2,759,400,000 heartbeats. If you live to be 100 years old the number of beats would be closer to 3,679,200,000.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Could tachycardia over a length of time cause a heart murmur?
Answer: While it is unlikely, a tachycardia can cause a heart murmur. A tachycardia can result in abnormal flow of blood across heart valves temporarily, and thereby cause a transient murmur. In rare instances, an incessant tachycardia can cause heart failure, enlargement of chambers of the heart, increased "leak" across heart valves, and thus produce a murmur.
Dr. Sanjeev Garhwal, Cardiologist, Western Washington Medical Group
Question: Is an ejection fraction of 40% or less always accompanied by enlargement of the heart?
Answer: Usually but not always. It depends on what is causing the decreased ejection fraction. An enlarged heart may be caused by a thickening of the heart muscle because of increased workload. (This increased workload can be due to heart valve disease or high blood pressure, for example.) Enlarged heart may also be a dilation (expansion) of the heart due to damage that weakens the heart muscle. Examples include heart attack, congestive heart failure and dilated cardiomyopathy.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How much fluid should I be drinking when I go home after open heart surgery?
Answer: Unless otherwise directed by your surgeon, there is no fluid restriction.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: How high should your blood pressure go to during a nuclear stress test before the technician will stop the test?
Answer: The better determining factor for a treadmill procedure is the patient's heart rate. Most clinicians use 220 minus the patient's age = Maximum heart rate. Then 85% of that is the top rate we are shooting for.
Jerry Arneson , Lead Technologist, Nuclear Medicine, Providence Everett Medical Center
Question: My husband has quadruple bypass surgery in 1989. His blood pressure is never over 125/60. Why would his cardiologist prescribe a beta blocker if he doesn't fit a hypertension profile?
Answer: The beta blocker is not prescribed for its blood pressure lowering effect, but because it will reduce the risk of a future cardiovascular event by 15-20%. This beneficial effect includes a lower risk of stroke as well.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I have a form of tachycardia and sometimes I take Atenolol to slow it down. For a while I was feeling very good. My heartbeat felt "normal", but now it is speeding up again. My resting rate is 100-112. Should I exercise? I read that exercise can help, but even light exercise exhausts me.
Answer: A resting heart rate of 100-112 is of some concern and needs to be evaluated by your physician. A definite diagnosis should be established and then appropriately treated.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What does it mean when your heart feels like it is constantly flip flopping? There is no pain but it disturbs me and I am very aware of it. Is this related to stress at all?
Answer: The sensation that you describe, "flip flopping", usually represents premature heart beats arising either from the atria or the ventricles. This is very common, if not universal, and occurs at all ages. The usually causes include: use of stimulants such as caffeine, nicotine, alcohol, ephedrine or over-the-counter medications. Also, anything that causes increased adrenaline release, such as excitement, anger or fright may be responsible. In normal hearts these early heart beats are almost always benign and can be ignored. Occasionally atrial fibrillation will give a similar sensation. In atrial fibrillation the heart rhythm is totally irregular and the symptoms usually persist. In any case, if the symptoms are new or come on without any obvious reason or persist, they should be evaluated by your physician.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: We know that exercise can prevent the buildup of plaque in the heart, but can exercise also "remove" the buildup that is already there?
Answer: Exercise alone cannot prevent the buildup of plaque unless the risk is very low. It does however decrease the risk and probably the rate of plaque formation.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is metoprolol?
Answer: Metoprolol is in a class of drugs called beta-blockers. Here is more information about the drug from our medical reference library.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I am the ideal cardiac patient. Over the last three years I have lost 50 pounds, I exercise everyday jogging and running three miles in 35 minutes. I have an almost perfect cardiac healthy diet, but two months ago I had my seventh and eighth heart blockage. I have five stents and eight blockages that have been opened. I am in perfect health: my resting heart rate is 44. My cholesterol is 106. My hdl's are 51. My ldls are 57. My tri is 44. Why might I still be getting heart blockages?
Answer: The best person to answer this question is your cardiologist. He has all the information about you, not just a short paragraph. He also knows what type of stents that were placed and what the condition of the rest of your arteries are in. I would encourage you to continue to explore ways to improve your diet. More information is coming out at a rapid pace. Within weeks a book by Dr. Miles Hassell will be available and this will be the best information that I am aware of. When it is available I will post the information here.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What effect does exercise have on heart rate?
Answer: Generally speaking, a regular aerobic exercise program results in a lower resting heart rate (HR) and a lower exercise HR at any given level of work (explained below). This "training effect" occurs across the spectrum of age, but, generally speaking, as the heart muscle and blood vessels age, they have less ability to train, so the training effect is less than for younger individuals.
The classic equation for determining oxygen consumption (VO2) and showing the training effect is: Heart Rate (HR) x Stroke Volume (SV) x a-vO2 difference. VO2 = HR x SV x a-vO2
SV is expressed as the amount of blood pumped by the heart with each heart beat. The heart muscle literally gets stronger with regular aerobic exercise, so the SV improves. It accounts for about 50% of the improvement in VO2 with training.
a-vO2 difference is the amount of oxygen extracted by the working muscles in milliliters oxygen per liter of blood. With training, the muscles increase their capillary to muscle fiber ratio and the number of mitochondria per fiber, so they are able to extract more oxygen per liter of blood flowing to them. This accounts for about 50% of the improvement in VO2 with training.
Therefore, if with training, the SV and a-vO2 are increasing, the HR can decrease and still provide the amount of oxygen necessary to perform any given level of work. Example: on day 1 of my exercise program, at 4mph walking, my HR is 140 beats/min. Eight weeks later, at 4mph, my HR is 120 beats/min. Why? My SV and my a-vO2 have increased.
With aging, the heart muscle fibers and the muscle fibers in the big muscles of legs and arms become less trainable (have less ability to increase their strength and mitochondria), so an unfit older person may not be able to improve SV and a-vO2 as much as a younger person. However, if a person has remained very fit throughout their middle years, they can certainly maintain a high level of fitness relative to their older age.
Gregory Lawson, Exercise Electrophysicologist, Supervisor Cardiac Rehab, Providence Everett Medical Center
Question: When I work out using cardio-machines and doing cardio kickboxing, how high should my heart rate be without being too dangerous?
Answer: You can calculate your expected maximal heart rate quite easily. It is 220 minus your age. For example, if you are 45 years old, 220 - 45 = 175 (your maximum expected heart rate). This is as fast as a normal heart will beat with maximal exercise at age 45. Most experts believe that it is safe for people without heart disease to exercise enough to raise their heart rate to 70% of maximum. For age 45 that would be 175 times 0.70 = 122. If you are in reasonable shape, it should take a fairly strenuous workout to raise your heart rate to 122.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Why should you stop beta blockers prior to nuclear medication studies?
Answer: A stress test is more likely to detect blockages in the heart arteries when the heart is stressed to a high heart rate. Because beta blockers suppress the heart rate response during stress, they decrease the ability of the stress test to detect blockages. This is true for any type of heart stress test: treadmill, nuclear, and stress echo. At least one of the types of nuclear medication stress tests relies on increasing the heart rate.
Dr. Harold Dash, Cardiologist, The Everett Clinic
Question: Can I have an exercise stress test if I have a pacemaker? Or should I have a resting stress test?
Answer: That depends on the underlying heart rhythm and the programmed settings of the pacemaker, among other things. Generally, it is preferable to have a pharmacologic stress test in people who have pacemakers.
Dr. Sanjeev Garhwal, Cardiologist, Western Washington Medical Group
Question: If I reduced my heart rate by getting fitter, would that in turn decrease my high blood pressure (currently 150/100)?
Answer: Getting more fit usually will decrease your resting heart and decrease your blood pressure. A heart healthy diet will also help.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I have had a big increase in my blood pressure over the past year (120/84 to 158/104). I have kept my weight down and my cholesterol has stayed the same. Are there any other factors that could contribute to this increase?
Answer: There are several factors that may affect your blood pressure. The first is to make sure that the blood pressure reading is accurate and reflects your true blood pressure. The reading can be increased by recent exercise, a recent meal, especially if there was more than normal amount of salt, or by being uncomfortable or under stress. The recording should be repeated several times and over several days to be sure that the readings reflect the true blood pressure.
If the pressure is truly increased, it is wise to try to find the reason. The most common reasons are a change in diet (more salt), an increase in alcohol consumption or being under greater stress. If none of the common reasons are present, then a physician should be consulted to look for less common causes. Keep in mind, whether or not a cause of the increase in blood pressure is found, a treatment plan must be established by your physician and carried out to get the blood pressure back to a suitable level.
Uncontrolled blood pressure may cause a stroke, congestive heart failure or kidney failure and is a major risk factor for heart disease and heart attack.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the normal resting heartbeat for a pregnant woman? Mine tends to be around 100. I'm 22 weeks along?
Answer: The normal heart rate in non-pregnant women is between 60 and 100 beats per minute. During pregnancy the heart rate increases an average of 15 beats per minute. Most of this increase comes at the beginning of the 3rd trimester and remains for the remainder of the pregnancy. Therefore, to know your estimated heart rate at 22 weeks, you would need to know your resting heart rate before becoming pregnant and adding 5 to 20 beats per minute. Your doctor is the best one to advise you on any abnormality of your heart rate.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: If a murmur is heard in a 15 year old boy only when resting, should we be alarmed?
Answer: Heart murmurs are common, especially in active young people. It simply reflects the mild turbulence that occurs as the blood passes through the heart. Some heart murmurs do reflect an abnormality, and therefore it is important to have a heart murmur evaluated by a physician experienced in this area when the murmur is first noticed.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What does it mean when a tilt test comes back positive?
Answer: A tilt table test may be "positive" in several ways: A patient may pass out due to a drop in blood pressure and a low heart rate (vasovagal) or due to a low blood pressure with rising heart rate (orthostasis). The patient may also feel lightheadedness only with minor changes in blood pressure or heart rate.
Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic
Question: Three months after I had a permanent pacemaker inserted, I developed swelling in my left arm. I immediately called my doctor and was placed on Coumadin therapy. How common is this?
Answer: This is a known complication of pacemaker insertion. The vein becomes occluded because the blood flow around the pacemaker wires is slow due to the obstruction of the vein by the wires. It is not very common. It is known to occur immediately after the procedure or a few months later. Sometimes it is due to trauma to the vein during the implantation; sometimes it just happens. The treatment of choice is Coumadin. Once in a while an interventional radiologist can help dissolve the clot with a medication like streptokinase or urokinase.
Dr. Jeffrey Rose, Director, Clinical Electrophysiology, Heart Institute at Providence Everett Medical Center
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