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Recent Questions:
Lifestyle
What is a normal heart rate and what should be my maximum heart rate?
What precautions or restrictions are associated with heart disease?
Should I get a cardiac evaluation before beginning an exercise program?
What exercises are appropriate for cardiovascular health?
Why is exercise good for the heart?
What steps should I take to lower my blood pressure?
Are there exercises that can improve lung capacity for someone with heart failure?
What length of time should pass before resuming exercise after a pacemaker implant?
How much of a risk factor is it to smoke after bypass surgery?
What effect does caffeine have on your heart rate?
Conditions
What is the average life span for men after a major heart attack?
How long does it take for atherosclerosis to build up in the coronary arteries?
What is tachycardia?
What is PAT?
What is right ventricular hypertrophy?
Can smoking cause enlargement of the heart?
Does mitral valve prolapse lead to arrhythmia during extreme exercise?
Why is it that the mitral valve is the valve that is most likely to be damaged, prolapsed or infected with endocarditis?
Is it normal for an atrial chamber to become enlarged due to mitral valve prolapse?
Is there a connection between acid reflux and heart palpitation resulting in atrial fibrillation?
What is hypertension?
What is meant by fluid around the heart (pericardial effusion)?
What does it mean when someone has been told that the bottom of their heart is dead?
Symptoms
What are the signs of a heart attack?
How long do you hurt after having a heart attack?
Is it normal to have emotional changes after bypass surgery?
Why do I have a lack of energy after bypass surgery?
I have been having pains all over my chest recently. Should I be concerned?
Could nausea, vomiting and diarrhea be symptoms of an impending heart attack?
Why does your left arm hurt before a heart attack?
Should I be concerned about palpitations when I'm trying to go to sleep?
Will a high fever make your heart beat faster ?
What is occurring when the heart rate changes at a certain time of day consistently?
What is the significant of a pounding, hard heart beat?
Should I be concerned about a "fluttering" feeling on the left side of my chest?
Can severe anxiety cause heart spasms?
What is the typical pulse of a person with an enlarged heart?
What causes dizziness and rapid heart beat during sleep?
Why does my chest hurt when my potassium is low?
Tests & Treatment
I am a healthy male with a family history of heart problems. Am I a candidate for a cardiac MRI?
What is a V02 difference?
What is a normal ejection fraction?
What medications are used for an enlarged heart?
Can a stent be safely placed if a patient has pericardial effusion?
What is the method used to repair heart valve leakage?
Is minimally invasive mitral valve repair offered by Providence?
What is the average lifespan of a pig valve replacement?
How long do mechanical heart valves last?
How long does atrial fibrillation last after heart surgery?
What is the average time in years that bypass veins are expected to last?
Why does nitroglycerin relieve pain that is not coming from the heart?
What is the average life expectancy after triple bypass surgery?
If you have previously had bypass surgery and your leg veins have already been used, where will they get veins if you need another surgery?
When a leg vein is removed, what happens to the blood that flowed through it?
What is the success rate for stopping & restarting the heart to control its rhythm?
What is the average length of life after having a cardiac pacemaker inserted?
What are the dangers of accidentally reaching a pacemaker's maximum programmed rate?
Are there any special precautions for a patient with a pacemaker who is going into surgery?
What is the normal level of potassium in a blood test?
What is defibrillation?
Question: What does it mean when someone has been told that the bottom of their heart is dead?
Answer: When someone refers to" the bottom of the heart being dead", they usually mean that the inferior wall of the left ventricle may have scar tissue from a prior heart attack. This is usually diagnosed by a echocardiogram , heart cath, or stress imaging study.
Dr. Jeff Gress, Interventional Cardiologist, Everett
Question: I am a woman in her 70s who had a triple bypass a year ago. Why do I have a lack of energy and have to push myself in everyday activities?
Answer: This is a great question and one that my mother asked me a few years ago after her bypass. The operation was a massive stress to the body and it is not unusual to feel fatigued for several months to maybe even a few years. It depends on the condition of the heart before the operation as well. One of the first things to do is to have your doctor look at all of your medications to see if there is a way to decrease them. The beta blockers in particular can have this effect. I am not saying that they should all be discontinued as much as that the dose being lowered sometimes helps. A good physicial exam and bloodwork to make sure of no anemia or other issues is a good thing as well. And finally depression after this life threatening event should be addressed if present. It is much more common than you think after bypass.
Dr. Jeff Gress, Interventional Cardiologist, Everett
Question: What is the success rate for stopping & restarting the heart to control its rhythm for a person in their late 70s.
Answer: The success is over 90% for restoring normal rhythm during an electrical criterion. The big issue is can the heart remain in normal rhythm after this procedure is completed. Sometimes anti-arrhythmic drugs or beta blocker drugs are needed to keep the heart in normal rhythm after the procedure. A cardiologist can discuss the benefits and risks of these medications. The risk of this procedure is less than 1% so it's even for older patients under mild anesthesia.
Dr. Jeff Gress, Interventional Cardiologist, Everett
Question: What medications are used for an enlarged heart?
Answer:The treatment depends on the cause of the enlarged heart. For example, if the cause is a heart attack then the medicine would be those that control the risk factors of atherosclerosis; if the cause is congestive heart failure then the treatment would be medicines that would control the heart failure.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is right ventricular hypertrophy?
Answer: This condition is not as common as left ventricular hypertrophy, which is seen commonly with high blood pressure. When the right ventricle gets "large" or becomes hypertrophied, it usually means that there can be either a congenital problem with the heart or that a lung disease is present. Most common forms of right ventricular hypertrophy(RVH) are due to emphysemia or other problems with the lungs . Sometimes congenital disease such as a "hole in the heart" can cause this. In any case your cardiologist can preform certain tests to figure out why it may be present and an echocardiogram will be needed.
Dr. Jeff Gress, Interventional Cardiologist, Everett
Question: I am a 47-year-old male in good shape. My cholesterol and blood pressure are within normal ranges. I exercise 3-4 times a week. My father has had heart problems his entire life and has had several procedures. Other members in his family has also heart problems and have had fatal heart attacks. My concern is that I may also develop heart disease and will drop dead from a heart attack even though I am in good shape. Am I a candidate for a cardiac MRI?
Answer: Genetics are only one of the many things that can cause heart disease. If you exercise, do not smoke, keep your blood pressure and cholesterol in the normal range, you are doing everything that you can to prevent heart disease from occurring in yourself. Anyone is a potential candidate for cardiac MR. However, I would not recommend this for someone in your situation. MR is better for identifying heart structures and previous heart attacks. It does not at this time look at the arteries form the inside to see if there are any blockages that have already formed.
A cardiac CT can do that presently. However, this will expose you to a mild to moderate dose of radiation (about 300 chest X-rays). What I do with people in your situation is put them on a treadmill stress test and follow them yearly with this test. If they have serious concerns, an angiogram can look inside of the arteries but with a 10 fold reduction of radiation exposure.
Dr. Chris Price, Cardiologist, The Everett Clinic
Question: What is the method used to repair heart valve leakage?
Answer: The most commonly repaired heart valve is the mitral valve. The repair technique generally includes making the valve opening smaller with a reinforcing ring and may also include removal of a section of the diseased valve leaflet.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Why does my chest hurt when my potassium is low?
Answer: Symptoms of low potassium (hypokalemia) include irregular heartbeat, which can range from mild to severe. Other symptoms can include muscle weakness, cramping, or flaccid paralysis (limpness); leg discomfort; extreme thirst; frequent urination; and confusion. Gastrointestinal illnesses that cause prolonged vomiting and diarrhea can cause potassium levels to become dangerously low.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What causes dizziness and rapid heart beat during sleep?
Answer: Dizziness is unusual when you're actually asleep but not uncommon when you lie down. The dizziness could be from a problem with the middle ear. It could be a problem with the brain and the nerves from or to the balance center behind the ear. If you're only dizzy when lying down and not when standing up its unlikely to be your heart. A fast heart beat or rapid heartbeat during sleep could be from anxiety, dreaming, any arrhythmia, heart disease or heart failure or sleep apnea-not necessarily in that order. The combination of the two (dizziness & rapid heart beat) is not likely to be from your heart itself but more likely to be from whatever causes the dizziness.
Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Everett Medical Center
Question: What is PAT?
Answer: “PAT” or paroxysmal atrial tachycardia is a fast heart rhythm that comes from the top of the heart and can be associated with rapid heart rate, chest pain, lightheadedness and sometimes even loss of conciousness. This heart rhythm abnormality can be more frequent with stimulants and sometimes other medications. “PAT” can occur in patients with structurally normal hearts, but an echocardiogram can be ordered by your physician to assess the structure and function of your heart.
Dr. Grace Buono, Cardiologist, The Everett Clinic
Question: What precautions or restrictions are associated with heart disease?
Answer: Precautions and restrictions for heart disease will vary by the kind of heart disease and by the particular individual. For instance, a very active individual who has a heart attack may need to restrict their activity for a while but an inactive person will need to increase their activity level. In general, a healthy lifestyle is good for all forms of heart disease. These would include no smoking or second hand smoke, a healthy diet (lots of fruits and vegetables, [9-10 helpings a day], 100% whole grains and low in saturated and trans fat, refined flour and salt), regular exercise and control of blood pressure, weight and blood lipids. Each individual should review these topics with their physician to get the proper guidance for their situation. Those with coronary heart disease will almost always require medication to obtain optimal risk reduction.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How long do you hurt after having a heart attack?
Answer: It varies in each individual. Many people can have a heart attack and not even experience any pain, some perhaps feeling fatigue or shortness of breath instead. Others may have pain off and on for years, even after the best available therapy, if parts of the heart remain without adequate blood supply. Prevention remains the best choice.
Dr. Steve Maxood, cardiologist, Western Washington Medical Group
Question: Will a high fever make your heart beat faster ?
Answer: Assuming that everything else is functioning normally, a fever will increase the heart rate.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: When a vein is taken out of the leg for use in bypass surgery, what happens to the blood that had been flowing through that vein. Is it automatically re-routed by the body through other veins?
Answer: When a leg vein is removed, the blood is automatically rerouted to other veins. This may take some time and leg swelling can occur during this time period.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Does mitral valve prolapse lead to arrhythmia during extreme exercise?
Answer: Mitral valve prolapse is associated with arrhythmias and these can be precipitated by exercise. Patient’s who have an enlarged heart, decreased heart function, history of passing out or fainting, arrhythmias, or significant leakage of the mitral valve associated with their prolapse are advised to avoid competitive sports and high intensity exercise. However, for those patients with mitral valve prolapse who do not have these findings or symptoms associated with their mitral valve prolapse, regular exercise is encouraged. I recommend that anyone with mitral valve prolapse seek the advice of their physician and have an echocardiogram performed prior to engaging in vigorous exercise.
Dr. Thomas M. Richardson, Jr., Cardiologist, Western Washington Medical Group
Question: What is a normal heart rate and what should be my maximum heart rate?
Answer: When resting, the adult heart beats at about 70 bpm (males) and 75 bpm (females), but this rate varies among people (between 60 bpm (if less termed bradycardia) and 100 bpm (if greater, termed tachycardia). Resting heart rates can be significantly lower in athletes. The infant/neonatal rate of heartbeat is around 130-150 bpm, the toddler's about 100–130 bpm, the older child's about 90–110 bpm, and the adolescent's about 80–100 bpm.
The body can increase the heart rate in response to a wide variety of conditions in order to increase the cardiac output (the amount of blood ejected by the heart per unit time). Exercise, environmental stressors, psychological stress, or disease can cause the heart rate to increase above the resting rate. Some diseases will cause the heart rate to slow.
Maximum heart rate ( MHR) is the maximum heart rate that a person should achieve during maximal physical exertion. Research indicates it is most closely linked to a person's age; a person's MHR will decline as they age. Some research indicates the speed at which it declines over time is related to fitness—the more fit a person is, the more slowly it declines as they age.
A quick way to estimate MHR is to subtract your age from 220, but MHR can vary significantly between same-aged individuals.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Why is it that the mitral valve is the valve that is most likely to be damaged, prolapsed or infected with endocarditis?
Answer: The mitral valve controls blood flow between the heart's left atrium and left ventricle. Mitral valve abnormalities most commonly are birth defects or are caused by rheumatic heart disease. Abnormalities to the valve can include mitral valve stenosis, mitral valve regurgitation and mitral valve prolapse. Rheumatic fever can cause damage to all of the heart valves, but most commonly to the mitral valve. Mitral valve stenosis is when the valve becomes narrow or tight. Mitral valve regurgitation is when the mitral valve does not close well and blood leaks back into the left atrium. Mitral valve prolapse is when one or both valve leaflets are enlarged. As a result, when the heart pumps, the mitral valve leaflets don't close as they should and blood leaks across the valve into the left atrium during systole. Any of these abnormalities make the valve more susceptible to infection.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How long does it take for atherosclerosis to build up in the coronary arteries?
Answer: The time that it takes for atherosclerotic plaques to build up in the coronary arteries varies from person to person. In general it begins during the teenage years. How rapidly it progresses depends on coronary and hereditary risk factors. The controllable risk factors include smoking, lipid abnormalities (cholesterol, LDL, HDL and triglycerides), blood pressure, weight and exercise. Diet is very important in helping to control the lipid abnormalities, blood pressure and weight. In general, the more risk factors that are not under control the faster the atherosclerotic process progresses.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: If you have cardiac bypass surgery, and you have had heart surgery before, where will they get the veins if both leg veins have already been used?
Answer: Mammary arteries in the chest and radial arteries from the arms may also be used for bypass grafts.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: How long do mechanical heart valves last?
Answer: Mechanical valves usually last a lifetime. There is probably a 2-5% lifetime risk of needing re-replacement.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: I'm a 21 year old female who had a baby a year ago. I have heart palpitations when I'm laying there trying to go to sleep and my heart is slow. Is this something I need to check into? I went to a cardiologist when I was pregnant and they found nothing!
Answer: The sensation of one's heart beating, either fast, irregularly or even skipping, is what is frequently known as palpitations. These are usually benign (not worrisome) heart beats, and may even be normal beats that are felt. It is hard to know exactly what you are feeling. Stress, or stimulants (such as caffeine or decongestants) can bring them on, or they can occur for no reason at all. These heart rhythm abnormalities can sometime be picked up with an EKG in the doctor's office, or other times require wearing a 24 hour heart rhythm monitor(holter monitor), or even a monitor that you keep for a week or more. I suggest checking this out with your family doctor. Certainly, any heart rhythm abnormality that causes dizziness or fainting or loss of conciousness; or significant other symptoms (chest pain, shortness of breath) should be evaluated immediately.
Dr. Grace Buono, Cardiologist, The Everett Clinic
Question: Can smoking cause enlargement of the heart?
Answer: Smoking can cause enlargement of the heart in several ways: by causing a heart attack which may make the left side of the heart enlarge or by damaging the lungs which may make the right side of the heart enlarge.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Is there any information on the possible connection between acid reflux and heart palpitation resulting in atrial fibrillation?
Answer: There is a connection between atrial fibrillation and swallowing as well as reflux disease. However, very little is known about the mechanism and treatment. The best approach would be to have your doctor consider treating the reflux and see what happens to the atrial fibrillation. The esophagus lies in back of and nearly on the left atrium. As the esophagus moves during normal peristalsis its relationship to the atrium changes. Both structures have lots of nerves that interconnect in the brain and spinal cord.
Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Everett Medical Center
Question: Is it normal for an atrial chamber to become enlarged over the years due to mild mitral valve prolapse? Is the chamber accommodating the defective valve to compensate?
Answer: It is normal for the atrial chambers to enlarge over the years without mitral valve prolapse.
Dr. Chris Price, Cardiologist, The Everett Clinic
Question: Is minimally invasive mitral valve repair offered by Providence?
Answer: "Minimally invasive" means different things to different people. Mitral valve repair can be done through a variety of incisions using a variety of cannulation techniques. These include partial sternotomy, and mitral repair through a small right thoracotomy incision. Both of these incisions have their merits and drawbacks, both when compared to each other and when compared to the more conventional median sternotomy incision. All of these techniques have been used by our surgeons. The choice of incision is important and should be discussed fully with the consulting surgeon at the time of consultation.
Dr. Timothy Byrnes, Cardiac Surgeon, Everett Cardiac Surgical Associates
Question: What is the average life expectancy after triple bypass surgery?
Answer: Survival after coronary surgery is influenced by a number of factors such as heart muscle function, diabetes, age at time of surgery, kidney function, other medical conditions. For patients with three vessel disease, the survival after surgery is generally superior to multivessel stenting or medical therapy in most patients. A recent study from the Netherlands published in the Annals of Thoracic Surgery noted survival rates after surgery of 97%, 93% and 87% at 3, 5 and 8 years respectively, all of which were statistically significantly better than survival after stenting. Consultation with the patient's doctors should be able to help choose the best therapy for an individual. Following bypass surgery, the patient can improve long term results by controlling diabetes, obesity, high blood pressure andcholesterol. Smoking should be discontinued.
Dr. Timothy Byrnes, Cardiac Surgeon, Everett Cardiac Surgical Associates
Question: What is occurring when the heart rate changes at a certain time of day consistently? For example at night, it seems that I get a 1 - 2 second interval of very rapid beats that start and stop immediately. Can the heart have this type of arrhythmia? It always happens in bed at night.
Answer: The symptoms you describe are suggestive of premature atrial or ventricular ectopic beats, or "extra beats" that are generated by a small area in either the top or bottom chamber of the heart. These arrhythmias are generally benign if there is no structural defect with the heart. A resting electrocardiogram and echocardiogram are often helpful in making a decision whether anything needs to be done at all.
Dr. Sanjeev Garhwal, Cardiologist, Western Washington Medical Group
Question: Should I get a cardiac evaluation from a licensed professional before beginning an exercise program?
Answer: If you've been sedentary for a long time, are overweight, have a high risk of coronary heart disease or some other chronic health problem, see your doctor for a medical evaluation before beginning a physical activity program.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the average lifespan of a pig valve replacement?
Answer: Durability of porcine prosthetic valves depends on a number of factors. The younger the patient at time of implantation, the shorter the lifespan of the valve. This is thought to be due to the more active calcium metabolism in the younger patients. Porcine valves are rarely implanted in young patients unless there is a specific contraindation to anticoagulation with coumadin, for example, if a young woman wishes to get pregnant, or if the patient is unable to take coumadin regularly and reliably due to alcohol or drug problems. The longevity of the valve also depends on the valve replaced. Porcine valves tend to last longer in the aortic position than in the mitral. The underlying issue for valve replacement is to determine the likelihood of having repeat surgery to replace a malfunctioning prosthetic valve. The younger you are at time of implantation, the more likely you are to "outlive" your valve. This has to be weighed against the risks of longterm anticoagulation for a mechanical valve. These risks are approximately one per cent per year of major bleeding complications or clotting problems. Many surgeons and their patients would prefer to consider the prospect of repeat surgery in fifteen to twenty years in exchange for freedom from the risks and complications of lifelong anticoagulation.
Dr. Timothy Byrnes, Cardiac Surgeon, Everett Cardiac Surgical Associates
Question: Why does nitroglycerin relieve pain that is not coming from the heart?
Answer: Nirtoglycerin relaxes smooth muscle. That is how we think it works in the heart and that is why it relieves pain from esophageal spasm and possibly other pain originating from smooth muscle spasm or tightness.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: How much of a risk factor is it to smoke after quadruple bypass surgery? What are the odds of your heart failing again?
Answer: Smoking is one of the major risk factors for coronary heart disease. Each risk factor that is not addressed increases the probability that the disease will progress more rapidly. Progression will involve new lesions in the arteries and grafts increasing the risk of new events including angina, heart attack, percutaneous coronary intervention, repeat bypass or death.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I understand that about 40% of patient have atrial fibrillation after bypass surgery. How long does this usually last and what treatment is advised?
Answer: Atrial fibrillation occurs in 15% to 30% of patients following heart surgery. It is rarely life-threatening and resolves within 30 days.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: I have borderline high blood pressure. What steps should I take to lower my blood pressure?
Answer: The American Heart Association recommends the following to help lower your blood pressure.
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Lose weight if you’re overweight.
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Eat a healthy diet low in saturated fat, cholesterol and salt.
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Be more physically active.
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Limit alcohol to no more than one drink per day for women or two drinks a day for men.
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Take medicine the way your doctor tells you.
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Know what your blood pressure should be and work to keep it at that level.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Are there any precautions or special needs for a patient with a pacemaker who is going into surgery?
Answer: This is a very commonly asked question and one that can best be answered by your physician. Here is a link to a Web site from one manufacturer of pacemakers with some general guidelines.
Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Everett Medical Center
Question: Can a stent be safely placed if a patient has pericardial effusion?
Answer: It depends on the circumstances (i.e. the size of the effusion, hemodynamic condition of the patient, the level of urgency or the need to place the stent). There are no direct contraindications to placing a stent in a patient with pericardial effusion.
Dr. Vinaya Chepuri, Cardiologist, Western Washington Medical Group
Question: What is a normal ejection fraction? Is an ejection fraction of 60% good or bad?
Answer: Ejection fraction is a measure of how much blood the heart's left ventricle pumps out with each contraction. With each beat, a normal heart ejects about one-half to two-thirds of the blood in its left chamber. An ejection of 60% is normal.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What length of time should pass before resuming roller skating after a pacemaker implant?
Answer: After one week you can gradually increase your activities. I would wait approximately one month before resuming more strenuous activities like roller skating.
Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic
Question: What are the signs of a heart attack?
Answer: Here are signs that can mean a heart attack is happening: 1) Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. 2) Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. 3) Shortness of breath. May occur with or without chest discomfort. 4) Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: I am a 25-year-old male with severe anxiety. My body seems to be in a constant state of fright/flight. I'm obsessed with checking my pulse and can always feel my heartbeat, and it sometimes seems to skip a beat. Less frequently, I can feel a dull pain in the left side of my chest directly over the bottom of my heart. Am I having heart spasms?
Answer: I would recommend that you see your personal physician about your cardiovascular symptoms and consider counseling regarding your anxiety.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the typical pulse of a person with an enlarged heart?
Answer: There are many reasons for an enlarged heart. Whatever the reason however, the heart rate (pulse) should be within the normal range (50-100 beats per minute). Well trained athletes may have a mildly enlarged heart and they may safely have a much slower heart rate.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is a V02 difference?
Answer: VO2 is the amount of oxygen consumed by the body in one minute (usually measured as liters/minute). VO2 max is the maximum volume of oxygen that the body can consume during intense, whole body exercise while breathing air at sea level. VO2 difference would be the difference between rest and exercise or between two individuals.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What are the dangers of accidentally reaching a pacemaker's maximum programmed rate during training? Letting aside battery consumption and assuming that heart functionality would be ok at that rate plus 5-10 bpm, should I avoid it at any cost, or just be careful?
Answer: Some patients with slow heart rates need a rate-responsive pacemaker to increase their heart rate with physical exertion. Assuming that the pacemaker is programmed correctly, there should not be any danger if you reach the maximum programmed rate with training. I recommend that you discuss this in more detail with your cardiologist.
Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic
Question: What is the average life span for men after a major heart attack?
Answer: There are many factors that affect the life span of someone after a "major" heart attack. Some of these factors are: blood pressure, residual function of the heart muscle (ejection fraction), blood supply to the heart, heart rhythm, heart rate, hemoglobin, kidney function, lung function, serum lipids (LDL, HDL, triglycerides), weight, fasting blood glucose, diet and activity level. Your own physician is the best one to put all of these factors together for you.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the average length of life after having a cardiac pacemaker inserted?
Answer: Early recognition and treatment of the underlying heart disease has allowed patients to live much longer with a pacemaker than previously. The pacemaker is now only part of a larger more complex and comprehensive treatment of heart disease. Programming of the device is now software-based rather than hardware-based, making it possible to change "what kind of pacemaker it is" based on the physiologic needs of the patient. In addition, patients at high risk for sudden death are now treated with devices that are combination pacemakers, implantable arrhythmia management devices and defibrillators. See Pacemaker Improvements - A Historical Perspective.
Dr. Jeffrey Rose, Director, Clinical Electrophysiology, Heart Institute at Providence Everett Medical Center
Question: I recently had bypass surgery. After returning to work, I have had several panic attacks. My blood pressure meds have been doubled and I get emotional at times. I have a very stressful job but I never had a problem with emotions before. Are these symptoms normal?
Answer: Emotional changes are common after bypass surgery but usually resolve after 2-3 months. See your primary care physician if these symptoms persist longer.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: I recently had triple coronary bypass involving both saphenous and mammary artery grafts. What is the average time in years that bypass veins are expected to last? I also take medication for high blood pressure.
Answer: The average patency rates for saphenous vein grafts is 50% at 10 years. The 10 year patency rate of the mammary artery graft is 97%. Saphenous vein grafts are more prone to atherosclerosis; the reason is unknown. Overall, about 15% of patients will require a second operation in their lifetime. Adequate control of high blood pressure is important to slow the progression of coronary disease.
Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates
Question: Could nausea, vomiting and diarrhea be symptoms of an impending heart attack?
Answer: Nausea can be the only symptom or one of several symptoms of a heart attack. Vomiting and diarrhea would not be very common.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What effect does caffeine have on your heart rate?
Answer: Caffeine is a mild stimulant in most people. Therefore, you would expect to see a mild increase in heart rate in some people and it would tend to be dose dependant.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is meant by fluid around the heart?
Answer: Fluid around the heart is within the pericardial sac and is called pericardial effusion. Under normal conditions, minimal fluid (just enough for "lubrication") is present. If, however, the pericardial sac fills with additional fluid, a condition known as Pericardial Effusion occurs. Small amounts of additional fluid usually do not cause any symptoms. Larger amounts may cause symptoms such as shortness of breath, cough, lightheadedness or fainting.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is the normal level of potassium in a blood test?
Answer: The reference range (normal test result values) for potassium in an adult is 3.5 to 5.0 mmol/L.
Dr. William J. Monteforte, Laboratory Medical Director, Providence Everett Medical Center
Question: What is defibrillation?
Answer: Defibrillation indicates the change of a heart chamber's rhythm from fibrillation to another rhythm, usually sinus. This usually refers to the use of a cardiac defibrillator to give a precordial direct current shock.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: My dad has just been diagnosed with heart failure, and has trouble breathing. Are there any exercises he can do to improve his lung capacity?
Answer: It is likely that his shortness of breath is not due to poor lung capacity per se but rather to the fact that heart failure often results in fluid build-up in the lungs, which makes it difficult to exchange oxygen/carbon dioxide in the lungs, resulting in the symptom of shortness of breath. So, the goal is to reduce the fluid buildup through the proper combination of medicines, and sodium and fluid restriction. A simple program of exercise such as short walks, 5-20min several times per day and light dumbbell exercises for arm strength may help overall fitness, but this should not be done until the heart failure and its symptoms are well controlled. See Exercise and Congestive Heart Failure
Greg Lawson, Program Specialist, Heart Life Services, Providence Everett Medical Center
Question: Why does your left arm hurt before a heart attack?
Answer: This a question that often difficult to understand. For example, when you hit your finger with a hammer, you know exactly where it hurts and why. When it comes to the heart "hurting," it has a very different nervous innervation (nerve supply) that cannot distinguish exactly where it hurts. It doesn't need to be as precise as your finger and shares the same innervation as the left arm and chest wall. Therefore, during a heart attack, or a bout of angina, your arm can hurt as well as other structures such as the jaw or even a tooth. It's different for everybody, and not all arm pain is from the heart.
Dr. Jeffrey P. Gress, Cardiologist, Providence Physican Group
Question: What exercises are appropriate for cardiovascular health?
Answer: The best exercises for cardiovascular health are "aerobic" exercises. Aerobic means "with oxygen." These are exercises that use the large muscles of the body for a sustained period of time. Brisk walking, biking, swimming top the list. The ideal exercise program for cardiovascular health should include aerobic exercise for 30 to 60 minutes on most days of the week. If you are a beginner to exercise, you may not be able to start out with 30 minutes. Try for 10-15 minutes once or twice per day, then gradually (10% per week) add more time to work up to 30 minutes. Intensity (speed) should be such that you can do the activity for 10-15 minutes without getting so breathless that you have to stop. It's better to slow down and be able to finish your time goal, rather than go so fast that you have to stop before your time goal. As your cardiovascular fitness improves, you will be able to go faster and still meet your time goal.
Examples of exercises that are NOT aerobic are: golf, bowling, and any activity that is so vigorous that YOU could not sustain it for more than 10 minutes. Activities like golf and bowling are great recreation, but the physical activity required for those sports is not sustained; there is too much rest between the activity bouts.
Gregory J. Lawson, MS, FAACVPR, Supervisor and Clinical Exercise Physiologist, Providence Everett Medical Center
Question: When a heart beat changes from its normal beat to a pounding, hard beat, does it have a particular significance?
Answer: The significance of a "pounding, hard beat" depends on many factors and coexisting medical conditions. For instance, an occasional feeling of "skipped" or "strong heart beat" in an otherwise healthy person with a normal heart may be a normal occurrence. However, the same may not be true for another person with heart disease. The frequency, duration and speed of the pounding heart rate, as well as the symptoms these beats generate, are also important factors in determining if anything needs to done about evaluating or treating them.
Dr. Sanjeev Garhwal, Clinical Electrophysiologist, Western Washington Medical Group
Question: For the past week, I've been having a fluttering feeling on the left side of my chest, above my stomach just below my breast. It happens several times during the day. Could this be something I need to have checked out?
Answer: You may have an abnormal heart rhythm. I recommend that you see your primary care physician. An electrocardiogram and a holter monitor (a device that records the heart rhythm for 24 hours) may be necessary to determine the cause of your "fluttering".
Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic
Question: I have been having pains all over my chest recently. For the past two days it has felt like I am being pinched on the left side of my chest, where my heart is. Also, after the pain started I began to feel a little bit dizzy. I don't think it is a heart attack, because I would have died by now, so what do you think it is? Also how long does it take for a heart attack to take place, and what does it feel like?
Answer: Typical chest pain from the heart (angina) is an uncomfortable pressure, fullness, squeezing or pain in the center of the chest. The discomfort also may be felt in the neck, jaw, shoulder, back or arm. Many types of chest discomfort aren't related to angina. Acid reflux (heartburn) and lung infection or inflammation are examples. Angina often occurs when the heart needs more blood. For example, running to catch a bus could trigger an attack of angina while walking might not. Angina may happen during exercise, strong emotions or extreme temperatures. Some people, such as those with a coronary artery spasm, may have angina when they're resting. The discomfort that occurs with a heart attack usually will last longer than 20-30 minutes and is often more severe. Other less common symptoms of heart attack are stomach or abdominal pain, nausea or dizziness, shortness of breath, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness. Also, up to one third of heart attack victims do not report any pain or discomfort at all. If you think you are having a heart attack you should call 911.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: Why is exercise good for the heart?
Answer: Regular exercise training, such as brisk walking, biking, swimming (aerobic activities that are continuous in nature) improves stamina, improves tolerance to routine activities, and usually results in less fatigue for activities which are not routine. This happens partly because of adaptations by the heart. These adaptations include an improved heart rate (pulse) response to exercise and a decreased resting heart rate. Another adaptation is an increased stroke volume during exercise and at rest. Stroke volume is the amount of blood that is pumped by the heart per minute and this improves with exercise training.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is hypertension?
Answer: Hypertension is the term used to indicate that the resting blood pressure is higher than "normal". Normal varies with age and also in association with other diseases. In the past, 140/90 has been considered the upper limit of normal. Recent data suggests that 135/85 is a more desirable cutoff.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
Question: What is tachycardia? What causes it and is it serious?
Answer: The normal heart rate is between 60 and 100 beats per minute. Tachycardia is defined as a heart rate greater than 100 beats per minute. There are many causes of tachycardia, some serious and some not serious at all. In general the faster the heart, the more serious it is. Tachycardias are also classified by where the abnormal beats originate. Some originate in the sinus node and are not serious, and some originate in the ventricles and can be life threatening. Treatment, if indicated, may include medication, ablation or occasionally an implantable device such as a defibrillator.
Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Everett Medical Center
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