What does diabetes have to do with heart disease?
People with diabetes are more likely to get heart disease. When you have diabetes, your blood sugar level is often much higher than it should be. Too much sugar in the blood can cause damage to many parts of the body, including blood vessels. Some lifestyle habits may also raise the risk of heart disease. Here are some things you can do to lower your risk:

1. Keep your blood sugar level under control.
   Keeping your blood sugar level under control will lower your risk of heart disease. Many people with diabetes check their blood sugar level every day to make sure that their medicines and diet and exercise are working to keep blood sugar in a normal range.
   
   By exercising often and eating a healthy diet, many people with type 2 diabetes (the kind of diabetes you're not born with) can keep their blood sugar level nearly normal. Some people have to take medicines to control their blood sugar level.
    
2. Lose weight--and keep it off.
   Diabetes, being overweight and heart disease often go together. Losing weight helps a lot of health problems. For example, if you have been told that your blood pressure is too high, losing weight can bring it down. If your blood sugar level has been hard to control, losing weight can help.
   
   Weight loss is important if you have a lot of extra weight around your waist and tummy. People who have "spare-tire" or fat around their waist are more at risk for heart disease than people who have extra weight around the hips or thighs.
   
   You don't have to lose a huge amount to lower your risk for heart disease. Losing even 10 pounds can help.
    
3. Lower your cholesterol level.
   Cholesterol is in many fats and oils, but it is not a fat. It is a part of many important body substances (like hormones) and body structures (including the brain and nerves). But, too much cholesterol in your blood can clog your arteries.
   
   You've probably heard about "good" and "bad" cholesterol. Bad cholesterol or LDL cholesterol, which stands for low-density lipoprotein, can clog your arteries and lead to heart disease. Good cholesterol or HDL cholesterol, which stands for high-density lipoprotein, carries unneeded cholesterol away from body tissues, so it lowers your risk of heart disease.
   
   If your doctor says your cholesterol level is too high, what can you do about it? It helps to lose weight and eat a healthy diet. Your diet should limit the amount of fatty and cholesterol-rich foods you eat.
   
   There are many cookbooks available that contain low-fat, heart-healthy recipes and meal suggestions. If you need help figuring out how to change your diet, your doctor might refer you to a dietitian. A dietitian has special training in planning healthy diets.
   
   If diet alone doesn't lower your cholesterol , medicines can help do that. You and your doctor can talk about these medicines. The medicine that is best for you depends on your special needs and medical condition.
    
4. Increase your physical activity.
   Along with diet, exercise is very important for people with diabetes. Diet and exercise work together to help your body work properly. If you have changed your diet to lose weight, exercising can help you lose weight faster.
   
   You and your doctor can plan exercises that will work for you and be safe. You don't need a gym or expensive equipment to get good exercise. Brisk walking is great exercise. Climbing stairs instead of taking an elevator is another good thing to do.
   
   Like eating a healthy diet, exercise will also help keep your blood sugar level normal and can lower your risk of heart disease.
    
5. Control your blood pressure.
   People with diabetes often have high blood pressure too. High blood pressure is a big risk factor for stroke. It also increases your risk for heart disease and kidney disease.
   
   The same lifestyle changes that control blood sugar levels and lower your risk of heart disease may also keep your blood pressure at safe levels. Weight loss and exercise are important. The more weight you lose, the more you lower your blood pressure. It is also important not to drink very much alcohol.
   
   If your blood pressure doesn't come down enough with diet and exercise, your doctor might have you take medicines that will help.
    
6. If you smoke, stop smoking.
   Smoking is bad for everyone but it's even worse for people with diabetes because it damages the blood vessels. If you have diabetes and you also smoke, you double your risk of getting heart disease. Worse still, if you keep smoking while you try to reduce other risks (like losing extra weight), you won't be able to exercise as much and you probably won't lose the weight you need to.

Remember: Diabetes and heart disease are related. Diabetes, being overweight and having high blood pressure are related. Diet and exercise are good ways to control your blood sugar level, lower your blood pressure and cut your risk of getting heart disease. When diet and exercise don't help enough, medicines can help control blood sugar levels, lower cholesterol levels and control blood pressure. You can do a lot to help by your own efforts.

Are women at risk?
Women are at risk for heart disease and heart attacks, just like men. In fact, heart disease is the leading cause of death among women over 65. American women are 4 to 6 times more likely to die of heart disease than of breast cancer and it kills more women over 65 than all cancers combined. Women develop heart problems later in life than men -- typically 7 or 8 years later. However, by about age 65, a woman's risk is almost the same as a man's.

What do I need to know about heart disease and heart attacks?
Women are less likely to survive heart attacks than men. It may be that women don't seek or receive treatment as soon as men. Or it may be because women's smaller hearts and blood vessels are more easily damaged. Doctors are working on finding answers to these questions. There's no question, however, that it makes sense to prevent heart problems before they start.

What can I do to protect myself?
For both men and women, the biggest factors that contribute to heart disease are smoking, high blood pressure, high cholesterol, family history and age. Take a moment to look at your lifestyle, family history and your general health. With this information, you and your family doctor can assess your risk and make a plan to avoid potential problems. Although you can't do much about your family history or your age, you can make lifestyle changes to avoid many of the other risk factors (see below).

• Dont smoke. Smoking is a major risk factor for heart disease in women. More than half of the heart attacks in women under 50 are related to smoking. If you stop smoking, you can lower your risk of heart attack by one third within 2 years. Women who smoke and use birth control pills increase their risk even more. There are a variety of products to help you quit smoking. You may want to try using nicotine skin patches or nicotine gum: these types of medicines are available over the counter. There are also prescription medicines available that can help you stop smoking. Talk to your doctor about the best way for you to quit smoking. Breathing smoke from someone else's cigarettes is also bad for your heart and lungs. If you live with someone who smokes, encourage him or her to quit.
   
• Control your blood pressure. Treating high blood pressure can lower your risk of heart attack and stroke. Losing weight, exercising regularly and eating a healthy diet are all ways to help control high blood pressure. Reducing how much salt you consume can also help. If these steps don't lower your blood pressure, your doctor may recommend medicine for you to take.
   
• Control your cholesterol level. If you don't know your level, ask your doctor to check it. Diet is a key part of lowering high cholesterol levels. However, some people may need to take medicine in addition to diet and exercise.
   
• Maintain a healthy weight. Extra weight puts strain on your heart and arteries. Exercise and a low-fat diet can help you lose weight. Being overweight means you have a higher risk for many other health problems, especially diabetes, high blood pressure and heart disease. If you're overweight, talk to your doctor about a safe way to shed the pounds.
   
• Exercise regularly. Remember, your heart is a muscle. It needs regular exercise to stay in shape. Aerobic exercise, such as brisk walking, swimming, jogging or biking, gives your heart the best workout. You can also use fitness equipment like exercise bicycles, treadmills and ski machines when exercising indoors. Finding an exercise partner may make it easier and safer for you to exercise often. You should exercise at least 30 to 60 minutes, 4 to 6 times a week. Talk to your doctor before starting an exercise program.
   
• Eat a low-fat diet. Keep fat calories to 30% or less of the total calories you take in during a day and avoid saturated fat (the fat in meats and coconut oil). Information is available to help you make healthy choices. For example, food labels list nutrition information, including fat calories, many cookbooks have heart-healthy recipes and some restaurants serve low-fat dishes.
   
• Take care of diabetes. If you have diabetes, regular exercise, weight control, a low-fat diet and regular doctor visits are important. If you need to take medicine for diabetes, be sure to take it exactly as your doctor tells you to.
• Be aware of chest pain. Chest pain is not always caused by heart disease. Be sure to contact your doctor if you suffer from pain in your chest, shoulder, neck or jaw. Also notify your doctor if you experience shortness of breath or nausea that comes on quickly.
   
• Know your family history. Having a father or brother with heart disease before age 55, or a mother or sister with heart disease before age 65 are factors that contribute to heart disease. Inform your doctor about your family history.
   

Will medicine lower my risk of heart disease and heart attacks?
Cholesterol-lowering medicines lower the risk of heart attacks in men. However, there is not enough evidence to show that these medicines work as well in women who have never had a heart attack. If you have already had a heart attack, cholesterol-lowering medicines can lower your risk of another attack.

Taking an aspirin every day may lower your risk of problems if you have coronary artery disease, a heart attack or angina. Aspirin makes your blood thinner, so it is less likely to make a blood clot. However, aspirin can cause gastrointestinal bleeding and other problems. Talk to your doctor about your risk factors for heart disease and whether you should consider taking aspirin.

Angina is chest pain caused by a sudden decrease in the blood supply to the heart. Medicines called statins, beta blockers and ACE inhibitors may also help if you have heart problems. Ask your doctor if any of these medicines are right for you.

Can estrogen replacement therapy reduce my risk for heart disease?
No. Estrogen replacement therapy, also called hormone replacement therapy, can help minimize the symptoms of menopause (such as hot flashes) and to reduce the risk of osteoporosis (weakening of the bones). It was once thought that HRT could also help protect against heart disease. New studies have shown that when it comes to heart health, HRT actually does more harm than good. If youre taking HRT to help prevent heart disease, talk to your doctor about whether you should stop.

Why is physical activity a big deal?
Physical activity builds muscles, so even if you don't lose pounds, you will look and feel better when you are more active. Being active also reduces your risk of chronic diseases like heart disease and diabetes, even if you are overweight.

Im thinking about becoming more physically active.
Whats the best kind of activity?
First, ask your family doctor if there is any kind of physical activity that you should not do.

Aerobic exercises, such as swimming, walking or jogging, raise your heart rate and help burn calories. The longer you exercise, the more fat your body will burn. Walking can be very helpful even if you don't walk fast.

Light weight training also has many health benefits. It helps add muscle mass to your body. Muscle burns calories faster than fat does.

How can I change my eating habits?
Change them one at a time. Healthy habits include:

• Eat breakfast.
• Eat your biggest meal of the day at lunchtime.
• Begin meals with a low-fat salad, soup, broth or a glass of water.
• Eat more vegetables and whole grains at each meal.
• Drink fewer sugar-sweetened beverages (such as regular soda and fruit juice).
• If you drink more than one regular soda per day, replace one of them with a diet soda, water or skim milk.
• Limit your alcohol intake.
• Know what 1 portion looks like -- and stick to it.
• Eat slowly so your body has time to know when you are full.
• Be more active in your daily life.
• Replace some of the sugar in your diet with non-caloric sweeteners
• Get support from family and friends. Support is very important for long-term success in adopting healthy habits.

Whats so bad about foods that are high in fat and added sugar?
Foods that are high in fat and added sugar have lots of calories. Foods high in calories from fat and/or added sugar include:

• Pastries, doughnuts, cakes, cookies, sweet rolls, pies
• Most crackers and chips
• Cheeses
• Cooking oils, margarine, butter, lard, shortening
• Cream, ice cream
• Fried foods, hot dogs and luncheon meats
• Regular soda and fruit-flavored juices

Why is skipping meals not helpful?
Though skipping meals may work for a while, it backfires in the long run. When you skip a meal, you are likely to get too hungry, and then you may eat too much at once.

What can I do when my friends or family members pressure me to eat?
Sometimes a direct explanation and a request for support are enough to get people to understand that you're trying to improve your health habits. If that doesn't work, telling them it's your "doctor's orders" may do the trick. If not, you may have to avoid those people until you feel comfortable enough with your new habits to handle the pressure.

How does what I eat affect my heart?
The food you eat can affect the way blood flows through your heart and arteries. A diet high in fat and cholesterol can gradually cause a buildup (called "plaque") in your arteries. That buildup slows down the blood flow and blocks small arteries. If the blockage happens in an artery that carries blood to the heart muscle, a heart attack can occur. If the blockage happens in an artery that carries blood to the brain, a stroke can occur. The right diet helps keep your arteries clear and reduces the risk of heart problems and stroke.

Tips for a heart-healthy diet:

• Eat less fat (especially butter, coconut and palm oil, saturated or hydrogenated vegetable fats such as Crisco, animal fats in meats and fats in dairy products).
• Use nonstick vegetable oil cooking sprays instead of oils.
• Buy lean cuts of meat, and eat fish, skinless chicken and turkey instead of beef.
• Try low-fat snacks that have been baked instead of fried, such as pretzels.
• Choose low-fat dairy products, such as skim milk, and low-fat cheese, yogurt and margarine.
• Try to limit how many sweets you eat.
• Eat no more than 4 egg yolks a week (use egg whites or egg substitutes).
• Bake, broil, steam or grill foods instead of frying them.
• Eat fewer "fast foods" (burgers, fried foods), which are high in fat. Instead, eat more fruits, vegetables and carbohydrates (rice, pasta, breads, grains).
• Drink low-calorie beverages, such as unsweetened tea or diet soda pop.

Why is exercise good for my heart?
Exercise makes your heart stronger, helping it pump more blood with each heartbeat. The blood then delivers more oxygen to your body, which helps it function more efficiently. Exercise can also lower blood pressure, reduce your risk of heart disease and reduce levels of LDL ("bad" cholesterol), which clogs the arteries and can cause a heart attack. At the same time, exercise can raise levels of HDL ("good" cholesterol), which helps protect against heart disease.

Combined with a healthy diet, exercise can speed up weight loss. Exercise is also the best way to maintain weight loss. Regular exercise also helps you burn calories faster, even when you're sitting still.

What's the best type of exercise for my heart?
Aerobic exercise causes you to breathe more deeply and makes your heart work harder to pump blood. Aerobic exercise also raises your heart rate (which also burns calories). Examples of aerobic exercise include walking, jogging, running, swimming and bicycling.

How much exercise do I need?
In general, if you haven't been exercising, try to work up to 30 minutes, 4 to 6 times a week. Your doctor may make a different recommendation based on your health. If you can't carry on a conversation while you exercise, you may be overdoing it. It is best to alternate exercise days with rest days to prevent injuries.

How will I fit exercise into my busy schedule?
There are lots of ways to raise your heart rate during your regular day. Take the stairs instead of the elevator. Walk during a coffee break or lunch. Walk to work, or park at the end of the parking lot so you have to walk farther. Walk more briskly. Do housework at a quicker pace and more often (for example, vacuuming every day). Rake leaves, push the lawn mower or do other yard work.

Why does it seem so hard to stop smoking?
Smoking causes changes in your body and in the way you act. The changes in your body are caused by an addiction to nicotine. The changes in the way you act developed over time as you bought cigarettes, lit them and smoked them. These changes have become your smoking habit.

Immediate reasons to stop

• Bad breath and stained teeth
• Bad smell in clothes and hair and on skin
• Lower athletic ability
• Cough and sore throat
• Faster heartbeat and raised blood pressure
• Risk of passive smoking to people around you
• Cost of smoking

Long-term reasons to stop

• Toxic chemicals in cigarette smoke
• Risk of lung cancer and many other types of cancer
• Risk of heart disease
• Serious breathing problems
• Wrinkles
• Risk of stomach ulcers and acid reflux
• Risk of gum disease/li>
• Risk of damage to babies of pregnant women who smoke
• Setting a bad example for your children

How should I get ready to stop smoking?
Set a stop date 2 to 4 weeks from now so you'll have time to get ready. Write down your personal reasons for stopping. Be specific. Keep your list with you so you can look at it when you feel the urge to smoke.

To help you understand your smoking habit, keep a diary of when and why you smoke. Using information from this diary, you and your doctor can make a plan to deal with the things that make you want to smoke.

Just before your stop date, get rid of all of your cigarettes, matches, lighters and ashtrays.

How can I get support and encouragement?
Tell your family and friends what kind of help you need. Their support will make it easier for you to stop smoking. Also, ask your family doctor to help you develop a plan for stopping smoking. He or she can give you information on telephone hotlines or self-help materials that can be very helpful. Your doctor can also recommend a stop-smoking program. These programs are often held at local hospitals or health centers.

Give yourself rewards for stopping smoking. For example, with the money you save by not smoking, buy yourself something special.

What about stress and my urges to smoke?
You may have a habit of using cigarettes to relax during stressful times. Luckily, there are good ways to manage stress without smoking. Relax by taking a hot bath, going for a walk, or breathing slowly and deeply. Think of changes in your daily routine that will help you resist the urge to smoke. For example, if you used to smoke when you drank coffee, drink hot tea instead.

What will happen when I stop smoking?
How you feel when you stop depends on how much you smoked, how addicted your body is to nicotine and how well you get ready to stop smoking. You may crave a cigarette or feel hungrier than usual. You may feel edgy and have trouble concentrating. You also may cough more at first and you may have headaches.

These things happen because your body is used to nicotine. They are called nicotine withdrawal symptoms. The symptoms are strongest during the first few days after you stop smoking, but most go away within a few weeks.

What about nicotine replacement or medicine to help me stop smoking?
Nicotine replacement products are ways to take in nicotine without smoking. These products come in several forms: gum, patch, nasal spray, inhaler and lozenge. You can buy the nicotine gum, patch and lozenge without a prescription from your doctor. Nicotine replacement works by lessening your bodys craving for nicotine and reducing withdrawal symptoms. This lets you focus on the changes you need to make in your habits and environment. Once you feel more confident as a nonsmoker, dealing with your nicotine addiction is easier.

A prescription medicine called bupropion SR (brand names: Zyban, Wellbutrin SR) helps some people stop smoking. It is taken as a pill. Bupropion SR does not contain nicotine, but it helps you resist your urges to smoke.

Talk to your doctor about which of these products is likely to give you the best chance of success. For any of these products to work, you must carefully follow the directions on the package. It's very important that you don't smoke while using nicotine replacement products.

Will I gain weight when I stop smoking?
Most people gain a few pounds after they stop smoking. Remember that any weight gain is a minor health risk compared to the risks of smoking. Dieting while you're trying to stop smoking will cause unnecessary stress. Instead, limit your weight gain by having healthy, low-fat snacks on hand and exercising on a regular basis.

What if I smoke again?
Don't feel like a failure. Think about why you smoked and what you can do to keep from smoking again. Set a new stop date. Many ex-smokers did not succeed at first, but they kept trying.

The first few days after stopping will probably be the hardest. Just remember that even one puff on a cigarette can cause a relapse, so don't risk it.

Angina pectoris is the term used to describe the disorder associated with chest pain or chest discomfort. It is due to an imbalance of oxygen supply and demand to the heart muscle and is often the first sign of coronary disease. The need for oxygen may increase, as it does with exercise, excitement, eating a heavy meal or exposure to cold. The amount of oxygen available in the bloodstream can be reduced due to the narrowed vessels supplying the heart muscle with blood and oxygen.

Angina can occur suddenly or gradually and usually lasts for a short time (5 to 15 minutes). The discomfort usually occurs in the mid-chest area and can radiate to the back, neck, arms, jaws, shoulders and upper abdominal area. The discomfort is frequently described as vague "aches," "sensations," or "feelings." It has also been described as "pressure," "burning," "squeezing," heaviness," "smothering," "tightness" and "indigestion." Other symptoms associated with angina are shortness of breath, sweating, nausea, belching and apprehension.

Management of this disorder is directed toward correcting the imbalance of oxygen supply and demand. If you are engaging in some activity, you should stop the activity and rest, which may relieve the discomfort. Drugs can be used to increase blood flow and oxygen to the heart muscle.

Nitroglycerin tablets are commonly used for anginal discomfort. After you sit or lie down, place the tablet under your tongue for immediate absorption and relief. If there is no relief after five minutes, a second nitro tablet is placed under the tongue. If you get no relief after another five-minute interval, place a third tablet under your tongue. If you still get no relief with this sequence of three nitroglycerin tablets, call 911 immediately and go to the nearest Emergency Room. Nitroglycerin tablets can cause you to experience a headache and a "flushed" feeling. You should carry the nitroglycerin with you at all times. It should be kept in the original dark bottle and should be replaced when it has expired. Other medications known to treat angina are: calcium channel blockers, beta blockers and long-lasting nitrates. When predictable angina becomes unpredictable in its course, it is called unstable angina. This disorder requires more aggressive therapy. You should notify your primary care physician or our office if your symptoms occur more frequently or the pattern changes.

More than 60 million Americans have high blood pressure (hypertension), which requires regular monitoring either by medical personnel in the office or at home by the patient or family member.

Home blood pressure measurement offers several benefits. It allows patients to take an active role in their health care, it reduces health care costs, and it can reduce the incidence of "white coat hypertension" (a phenomenon where blood pressure measurements tend to be higher in doctors' offices than at home).

There are two general types of blood pressure monitoring devices sold for home use: mechanical (manual) and electronic. Each system has advantages and disadvantages. Mechanical models, when used properly, are more accurate and less expensive than electronic models. However, patients who have poor eyesight, hearing or eye-hand coordination have difficulty using them. Electronic models offer the advantage of simplicity of operation, but they are more susceptible to error and more expensive.

To ensure the most accurate readings, follow these simple guidelines:

• Larger arms require larger cuffs, while smaller arms should have smaller ones. If the cuff is too small, the blood pressure reading may be elevated.
  If it's too large, the reading may be low.
• Find a quiet place and relax before taking your reading.
• Tensing muscles can elevate your blood pressure.
• Avoid cigarettes, caffeine or exercise for at least one hour prior to taking your blood pressure.

Recommendations: Devices

Mechanical:

• Marshall 104
• Omron HEM-18

Electronic:

• Sunbeam 7650
• Sunbeam 7621
• Omron HEM-704C

Schedule Home blood pressure monitoring should be done at a regular time in the morning and afternoon. For example, try 9 a.m. and 5 p.m.

Reporting
Please ask us to help you check your blood pressure device to make sure you and the machine are working properly. We will be glad to evaluate your readings.  We will be glad to give you block sheets with which to organize your readings.  Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

Congestive heart failure (CHF): Describes a condition in which the heart is unable to pump blood efficiently

Dyspnea: Medical term for shortness of breath

Edema: Medical term for swelling

Ejection fraction (EF): Amount of blood pumped out of the heart with each heart beat. Normal is 55% to 65%. Tests to measure EF include:

A. Echocardiogram: Sound waves are used to assess the chambers of the heart and the function of the heart valves.

B. Resting first pass (RFP):Assesses the pumping efficiency (EF) of the hearts main chambers. Patient is injected with a low-level radioisotope, then pictures are taken with a special camera.

IV inotropic therapy: Continuous IV fusion of a medication designed to strengthen the hearts pumping efficiency. This treatment is reserved for patients whose CHF does not respond to maximal medical therapy. Benefits typically last days to a few months. Currently only available in the hospital, which requires at least a two-day stay.

Left ventricle (LV): One of the bottom chambers and the main pumping chamber of the heart. When health care providers refer to the EF, they are referring to the pumping efficiency of the left ventricle.

Medications commonly used to treat CHF:

ACE (angiotensin converting enzyme) inhibitors: Used to dilate the peripheral arteries so that heart does not have to work as hard to pump blood out.

Lanoxin (digoxin): A digitalis preparation, which strengthens the heart beat.

Diuretics: Commonly referred to as "water pills" used to prevent water retention.

Nitrates: Used to dilate arteries and increase oxygen supply to the muscles, tissues and organs.

A Health Care Problem for the 90s and Beyond
Congestive heart failure (CHF) is a growing cardiovascular problem in the United States today. According to the American Heart Association, three to four million Americans currently suffer from CHF, and another 400,000 patients are diagnosed annually. The AHA also predicts that the number of cases will increase, due to the fact that many patients, who survive acute myocardial infarctions because of today's advanced technology, will go on to develop CHF.

With a mortality rate of approximately 50% at five years after diagnosis, CHF is an important cause of death in our country. Approximately 200,000 Americans will die of CHF this year. In addition, among hospitalized patients over 65, CHF is the leading hospital admission diagnosis. In 1988 alone, it accounted for 643,000 admissions to the hospital in the United States. An estimated 35% of chronic CHF patients are admitted to the hospital one or more times a year.

These factors make CHF an important health care issue, from the standpoint of disease and death, as well as the cost of caring for these patients in the hospital. Many patients are on multiple medications and often require parenteral inotropic agents in addition to extensive invasive procedures, both for diagnostic and therapeutic purposes.

In years gone by and even today, some physicians have regarded CHF as a dead-end diagnosis, since the underlying cause is irreversible in most cases. Despite recent clinical trials involving the use of two novel vasodilators, standard therapy with relatively old drugs has so far been shown to be the most effective treatment for CHF. However, effectiveness depends on the early and proper use of these drugs, which include digitalis,ACE inhibitors, and beta-blockers.

In the evaluation of patients with CHF, careful attention should be paid toward the possibility of myocardial ischemia (heart muscle blood deficiency) as a cause of the disease or a cause of worsening symptoms.

Aggressive medical and even surgical management is another key tool in the treatment of some patients with this life-threatening illness. It has been shown that patients with multi-vessel coronary artery disease, who have impaired left ventricular systolic function, benefit more in terms of improved survival with surgical rather than medical therapy. Therefore, in the appropriate patient, surgical myocardial revascularization should be considered for the relief of angina and CHF symptoms and to improve survival.

Cardiac transplantation is another accepted form of therapy for appropriately screened patients with end-stage heart failure who have less than six months or a year to live. Statistics show that patients who have successful cardiac transplantation go on to resume productive lives. However, patients must be carefully selected for this procedure since it is very costly, and there is a shortage of donor organs.

How should the CHF patient be approached?
First, effective treatment is based on a complete cardiovascular history and physical examination. Identification of the cause for the patient's heart failure, particularly if it is a reversible one, often can be made at this time.

Secondly, appropriate laboratory and diagnostic studies should be performed promptly to define the cause and severity of the disease.

Finally, as a result of the above, cause-specific treatment can be directed toward this problem.

In most cases, consultation with a cardiologist should be obtained, particularly for those patients with unexplained heart failure, new onset of CHF, or difficult to manage patients, either because of intolerance to standard therapy or because of apparent ineffectiveness of standard therapy.

In those patients who have been resistant to treatment by standard therapy, attention should be given to the possibility of diastolic dysfunction as a cause for heart failure, because treatment strategies can be radically different. Since cardiac arrhythmias, especially malignant ventricular tachyarrhythmias, are an important cause of death in this group, they should be appropriately screened for these life-threatening arrhythmias.

A cardiologist can be of particular help in choosing the appropriate screening study and in recommending more extensive testing, such as electrophysiologic study. Frequent office follow-up for these patients is key toward assessing changes in functional status, for careful adjustment of medications, and to keep close watch on serum electrolytes, particularly as they relate to the exacerbation of cardiac arrhythmias.

All of these things should be done with the main goal of avoiding the emotional and financial strains of hospitalization. A close working relationship between the patient's primary care physician and cardiologist is essential toward accomplishing this goal.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

A heart attack or "myocardial infarction" results from a blockage of blood flow through one of the hearts arteries. Without blood supply, the heart muscle dies. Although a myocardial infarction is a sudden event, it is due to arteriosclerosis that develops very slowly over time.

Arteriosclerosis is the formation of fatty plaque along the inside of the artery wall. This plaque can build up and completely block the artery, thus causing a heart attack. Once the plaque forms on the inside of the artery wall, there is a tendency for blood clots to form. These too can cause blockage of blood flow, resulting in a heart attack. A further cause of heart attacks are arterial spasms, a quick and abrupt stoppage of blood flow.

Symptoms Of A Heart Attack
Symptoms of a heart attack vary from person to person. Heart attack pain may range from an intense crushing pain to mild chest tightness. Although it is not very common, some people experience indigestion or no chest pain at all.

According to the American Heart Association, the warning signs of a heart attack include:

• Uncomfortable pressure, fullness, or a squeezing pain in the center of your chest for more than two minutes.
• Pain radiating to your shoulders, neck, arms, jaw or upper back.
• Severe pain, dizziness, fainting, sweating, nausea or shortness of breath.

It is very common to ignore these symptoms or blame them on indigestion. However, if you experience these, call 911 or have someone drive you to the nearest hospital emergency room immediately.

Heart Attack Risk Factors
Several risk factors predispose you toward having a heart attack. Some you can control and others you cannot. Cigarette smoking is a major risk factor which you can change. Nicotine raises blood pressure and causes arteries to narrow.

You cannot change diabetes and high blood pressure.You can control your blood pressure and practice good diabetic control by taking medication, reducing your weight and lowering your salt intake. You can also modify high cholesterol levels with medication and / or diet.

One factor which cannot be changed is family background. You cannot choose your parents. However, you can exercise and maintain your ideal body weight to help minimize your risks.

How Do You Know If You've Had A Myocardial Infarction?
If you're admitted to the hospital. Blood work will be obtained to help determine whether you've had a heart attack. An EKG will also be done to obtain data to support the diagnosis.

What's Next?
If you have a heart attack, a portion of your heart muscle has been injured. The recovery process takes about four to six weeks. Your doctor will advise you about the level of activity that is appropriate for your situation during this process and after your recovery.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

Statins

• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Lovastatin (Mevacor)
• Simvastatin (Zocor)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Action
This type of drug acts primarily in the liver by blocking the liver's ability to manufacture cholesterol. The liver responds by increasing the number of LDL receptors, which pull the LDL cholesterol from the blood. The end result is a decrease in LDL in the blood.

Side Effects
Side effects appear to be minimal, and the drugs are well tolerated. However, possible side effects are: muscle inflammation/pain (myositis), stomach discomfort, rash and elevations in liver enzymes. Blood test for liver function abnormalities should be obtained every six months after starting therapy and with every dosage change, and then as needed.

Note: If you are taking Cyclosporin (used after transplants), Pravastatin is the only drug shown to be safe to use in this setting.

Other Drugs to Lower Lipids

• Nicotinic Acid (Niaspan, Niacin)
• Fibric Acid (Lopid, Tricor, Antara)
• Bile Acid Sequestrants (Questran, Welchol)
• Cholesterol Absorption Inhibitor (Zetia)

Cardiac Catheterization is an x-ray procedure that invloves a catheter being introduced through a vessel in the groin or the arm. Numbing medicine is used to prepare the site so that minimal discomfort should occur during the procedure. The catheter is then advanced toward the heart to the base of the aorta where the coronary arteries originate. When the tip of the catheter reaches the opening of these arteries, a contrast agent is then injected which illuminates the vessels under x-ray examination. Your doctor can see if there are any obstructions in the three main arteries of the heart.

Also, during the procdedure, your doctor will place a catheter in the left ventricle or the main pumping chamber in the heart, to take some pressure measurements as well as inject more contrast to see how well the heart is functioning. During this part of the examination you will have a brief warm sensation that will pass in about a minute. The entire procedure should take about 30 minutes.

Please Remember!!

• Drink plenty of fluids over the next 24 hours after the procedure. (The purpose is to flush the contrast out, and to keep it from settling into the kidneys).
• Do not bend over, strain or lift heavy objects until the next day. If you feel you are about to cough, apply pressure to the site and cough as lightly as possible.
• If bleeding occurs from the entry site, apply direct pressure, contact your doctor, and summon for help at home in the mean time.
• Remove the dressing from the entry site the following day.
• Some bruising may be seen the following day which is not unusual and may take a couple of days to resolve.
• There may be a knot or lump under the entry site which will subside in two or three weeks. If there is any enlargement or swelling to the entry site, call your doctor.

Post-Operative Recovery
The normal recovery period following defibrillator implantation is six to eight weeks, varying with each patient. During that time, avoid strenuous activities such as lifting heavy objects, vigorous push-pull movements (vacuuming) and above the shoulder activities (swimming, tennis, golf). (See Pacemaker Care Fact Sheet.) You should notify your surgeon if you develop a fever, redness or drainage around any of your surgical wounds. Gradually return to daily activity and rest when you're tired.

Responding To Shock Therapy
If you feel the symptoms that tell you your arrhythmia has begun, stay calm and move to where you can sit or lie down comfortably. If you do not feel well after the shock, or if more than three shocks occur, call your cardiologist or 911. If you feel fine after the shock, you do not need to seek medical attention. Instead, call your cardiologist at your earliest convenience.

Things To Avoid

• Tight belts and restrictive clothing around the defibrillator
• Driving (until cleared by your cardiologist)
• Sources of strong electric or magnetic fields, such as:
• airport security wands
• stereo speakers
• industrial equipment
• arc welders
• large generators
• power plants
• MRI
• electrocautery
• diathermy procedures
• touching the spark plug or distributor on a running car or lawn mower
• touching the antenna of an operating CB or HAM radio

Things To Remember
Carry your identification card and wear a medical alert necklace or bracelet at all times. Notify healthcare providers of your defibrillator. Contact your cardiologist before you have any surgery or treatments. Schedule and keep all appointments for follow-up visits. Call the Florida Heart Group Arrhythmia Clinic for problems or questions: 407-894-4474 or 1-800-284-3278, ext. 465.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

What Is An EPS?
Electrophysiology Study, also called EPS, is an examination of your heart's electrical system. This is similar to your car. There is an ignition switch to signal the car to start, a series of wires to transmit the signal and a motor to receive the signal for the car to start. Your heart's electrical system has the sinoatrial (SA) node to signal it to contract at a certain rate, the conduction system to transmit the signal throughout the heart and the heart to contract and pump blood to all parts of the body.

Your heart's electrical system can develop problems with the signal to contract, the ability to transmit the signal or a combination of both. These problems are called arrhythmias. Some of the arrhythmias cause your heart to beat too slowly, and others cause your heart to beat too fast.

How Is An EPS Performed?
The electrophysiology study is performed in the EPS lab by a specially trained cardiologist who is experienced with your heart's electrical system. She/ He will pass the specifically designed catheters through a vein in the thigh or neck into the right side of your heart, and sometimes through an artery to the left side of your heart. The catheters will be positioned in the heart to study and record normal heart electrical activity and then the arrhythmias. Your cardiologist will stimulate the heart in different patterns to change the transmissions of signals.

This type of heart stimulation is a way to reproduce your arrhythmia and try to correlate it with symptoms you might be experiencing. It allows your cardiologist to study the arrhythmia, evaluate its cause and decide how to treat it.

In the EPS lab, your arrhythmia is created under very controlled circumstances, and you will be monitored very closely during the entire procedure. You will receive immediate treatment for any dangerous arrhythmias created during the test.

What Is The Recovery Time?
After the EPS procedure, you will be taken back to your room for four to six hours of bed rest and recovery. The length of your hospital stay will be determined by the type and severity of your arrhythmia, along with the treatment required to stop or control the arrhythmia and prevent its recurrence.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

Preparing For Heart Surgery
Here are the answers to a few of the most common questions you may have if your doctor has told you that you need heart surgery. Please feel free to ask us if you have additional questions.

What Is A Coronary Artery Bypass Or Open Heart Surgery?
Both are terms used to describe a type of surgery to either bypass blocked arteries or replace heart valves.

Will Anyone Talk To Me Or My Family
About What To Expect Before And After Surgery?
Yes. We believe a well-prepared patient and family help ease the recovery phase. Florida Heart Group nurses and cardiovascular surgery nurses will talk with you one-on-one to explain what to expect before and after surgery. The hospital also has educational TV channels for in-room teaching. Prior to your discharge, our nurses will arrange for you and your family to attend a cardiac rehabilitation class. Then the nurse will go over the information with you again and answer any questions prior to your leaving the hospital.

How Long Will I Be In The Hospital?
Although each person progresses at a different level, most patients stay in the hospital an average of 7 to 10 days.

How Uncomfortable Will I Be After Surgery?
Pain tolerance varies from person to person. The nurses in the critical care unit will provide pain medication to make you comfortable. Remember, changing positions, deep breathing and walking are very important to your healing and recovery.

When May I Return To Work?
Most people are able to resume minimal activities, including job-related activities, within 4 to 6 weeks, depending on the type of work.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

You will be observed in the hospital on a heart monitor for 24 to 48 hours after your pacemaker is inserted. Your cardiologist will discharge you as soon as he is certain that your pacemaker is properly adjusted. You will be given an appointment to be seen in the Florida Heart Group Arrhythmia Clinic in one week. You should follow-up with your regular physician as appointed. Pacemaker checks will be conducted every three months, either in the office or with the telephone transmitter.

DON'T

 

• Don't lift your arm above your shoulder on the side where the pacemaker is for four weeks.
• Don't lift anything over five pounds with your arm on the side where the pacemaker is for four weeks.
• Don't do any vigorous pushing or pulling (vacuuming) with your arm on the side where the pacemaker is for four weeks.
• Don't do any above the shoulder activities (swimming, tennis, golf) for six weeks.

DO

• Do follow wound-care instructions provided to you.
• Do notify the arrhythmia clinic if you develop a fever, redness or drainage around your pacemaker wound.
• Do carry your pacemaker identification card at all times.
• Do call if you have any questions or problems.
  Phone: 407 / 894-4474 (ext. 465)
  1-800-284-3278 (ext. 465)

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

What Is A Pacemaker?
A pacemaker is a small battery-operated device used to regulate your heart's rhythm. When your heart's electrical system does not signal it to contract often enough, or if the signal is not transmitted to the entire heart, you may need a pacemaker to do this work for you.

Your cardiologist will evaluate you and select the type of pacemaker for your needs. Some pacemakers use a single lead to the lower chamber of the heart (ventricle). This is referred to as single-chamber pacing. Other pacemakers use two leads, one in the upper chamber of the heart (atrium) and one in the ventricle. This is called dual-chamber pacing. If necessary, your cardiologist will select a type of pacemaker that changes its own rate with your activity. This is called rate-responsive pacing.

How Is A Pacemaker Implanted?
Implantation of a pacemaker takes about one hour and under most circumstances, is done with local anesthesia. Your cardiologist will make a small incision in the skin, close to your shoulder, under your collar bone (clavicle). He will then pass the lead wire into the right side of your heart. The lead wire will be tested for proper position. A small pocket will be made under the skin in your upper chest for the pacemaker, and the lead will be connected to the pacemaker pulse generator. The incision will be closed, and you will be taken back to your room for rest and recovery. Immediately after surgery, your cardiologist will go to the surgical waiting room to speak with your family. Please be sure they wait there.

What Are The Risks?
Your potential risks in having a pacemaker inserted include, but are not limited to: pain at the incision site, infection, pneumothorax (air in the lung), perforation of heart muscle, lead dislodgment or failure, bleeding and/or swelling in the pacemaker pocket, and erosion of the pacemaker generator through skin over time.

What Is The Recovery Time?
Allow about four weeks for your pacemaker to settle firmly in place. During this time, avoid lifting anything over five pounds, raising your arms above your shoulder, or doing any vigorous pushing or pulling with your arm on the side where your pacemaker is located.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

PTCA is a non-surgical procedure used to restore blood flow to narrowed arteries in the heart caused by arteriosclerosis (coronary artery disease). A balloon catheter is inserted into the narrowed artery and, once in position, is inflated for a short period of time to compress plaque against the artery wall. The balloon is then deflated and removed. PTCA is a treatment for arteriosclerosis it is not a cure. And it will not make an old heart attack scar go away.

Its important to remember that arteriosclerosis is a progressive process and in many cases will continue to cause narrowing of the arteries. Inherited tendencies and life-style habits contribute to the development of the atherosclerotic process.

After PTCA
Following the procedure, you will be taken to a recovery area where you will be closely attended:

• Your cardiac status will be watched on an electrocardiogram (EKG) monitor.
• Your catheterization site (groin or arm) will be watched for signs of bleeding, and your pulse will be checked frequently.
• You will be encouraged to drink fluids to flush the dye from your system (or you may have an IV to infuse fluids).

When the sheath is removed, manual pressure will be applied for at least 30 minutes (or until all signs of bleeding stop).

You will remain on bed rest for three to eight hours after the sheath is removed and bleeding stops. A nurse will then help you get out of bed and walk. You will probably be in the hospital a day or two before you are discharged by your physician.

When You Go Home
You cannot drive yourself home from the hospital. Since you will not be able to drive for 24 hours following your PTCA, please be sure to arrange in advance for someone to drive you home from the hospital.

You should take it easy for about a week after your PTCA. However, in some cases, your physician may allow you to return to work in one to two days. If the PTCA was performed because a heart attack was occurring, your activities will be limited for about four to six weeks.

Please remember:

• Avoid heavy lifting, straining or vigorous leg activities until the PTCA site is healed (about 24 hours) because it may cause bleeding. If bleeding does occur, apply continuous pressure and call your physician at once.
• You may remove the bulky dressing 24 hours after your heart PTCA, leaving a small bandage underneath to cover the puncture site. Please apply a new bandage with betadine ointment for two days, then leave open to air. Remember to keep the site clean and dry.
• Because of the bending involved, please take showers instead of tub baths for 24 to 48 hours after your catheterization.

Some discomfort, discoloration and even a small knot are normal at the puncture site. However, redness, drainage and/or fever, which may be signs of an infection, should be reported to your physician immediately.

Recovery From PTCA
During your recovering from PTCA, please remember:

• Take all medications as directed.
• Eat a low-fat, low-cholesterol diet.
• Do not smoke.
• Walk daily.
• Refrain from sex until the PTCA site is healed.

If you have any chest pain, take a nitroglycerine tablet and call your physician. If three nitroglycerine tablets do not relieve your pain, call 911 or have someone take you to the hospital immediately.

Keep all follow-up appointments with your physician and call to report any changes in your condition.

Most patients have no problems after a successful PTCA. Some, however, may experience restenosis, in which the narrowing in the coronary artery returns. This most often occurs within the first three to six months after PTCA. Restenosis can usually be treated successfully with a second PTCA.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

Frequently Asked Questions
Here are answers to some of the most often asked questions after a vascular procedure.

When Does The Dressing Come Off?
You may remove the pressure dressing the next day. It is usually easiest to remove it in the shower with soapy warm water, which helps take off the adhesive. Apply a small adhesive bandage over the puncture wound for the first two days, then leave the area open to air (change the bandage daily).

Will I have Any Bruising Or Permanent Scars?
Some bruising and even a small hard knot may occur. This will go away in time. Unless otherwise instructed, you may take acetaminophen if the area is painful. Notify your physician if you have any numbness or excessive pain in the affected extremity.

Will This Procedure Cure My Problem?
Peripheral vascular disease is caused by plaque buildup in the arteries (arteriosclerosis). Currently, there is no cure for this disease. However, your procedure should help alleviate pain and provide oxygen to the tissues.

Should I Restrict My Activities?
You may resume your normal activities unless otherwise instructed by your physician. You may drive the day after the procedure. However, you cannot drive yourself home, so please arrange in advance to have someone drive you to and from the hospital. Daily walking is crucial to your well-being. You should walk until you feel pain, stop and then resume walking. This helps stimulate the growth of smaller arteries called collaterals.

What About My Diet?
Diet is very important in the control of vascular disease. Although there is no cure for arteriosclerosis, current research shows that a diet that is very low in fats (no fried foods, very little meat and dairy products and lots of fresh fruits, vegetables, cereals and breads) can help slow the progression of blockage and in some cases, even reverse it.

Cardiovascular diagnostic and interventional procedures may cause unexpected problems, but serious and life-threatening problems are unusual. Your Florida Heart Group physician will discuss the potential risks and benefits in detail so you can both decide which treatment is best for you.

Stress Echocardiography, or stress echo, is an exercise test that helps your doctor see how well your heart pumps when made to beat harder. Harmless sound waves bounce off your heart. The sound waves show the structure and movement of your heart before and immediately after exercise. By comparing the images taken before and after the exercise, your doctor can see any changes in the way your heart muscle works when under the stress of exercise.

How Stress Echo Works
During a stress echo, a transducer (a small device that produces sound waves) is placed on your chest both before and immediately after you exercise. The sound waves bounce off your heart and are changed into images on a video screen. The doctor compares the two images to detect any changes in the way your heart responds when you exert yourself.

During your Stess Echo
After you arrive, you'll be asked to undress from the waist up. Women are give a hospital gown to wear. A technician places a painless transducer at various places on the left side of your chest. Then pictures of your heart at rest are recorded on videotape. Your blood pressure is also monitored, and electrodes are attached to your chest to record an EKG.

Next, you are asked to walk on a treadmill until your heart is beating rapidly. If you have a medical condition that prevents you from exercising, your heart may be increased with medication instead of exercise. This is normally done in a hospital setting.

Finally, a technician records a second set of video images of your heart immediately after you finish exercising. The doctor can then display the two sets of images side by side to compare the way your heart funtions at rest and after exercise.

Treadmill Cardiolite Stress Test and
Cardiolite Stress Test with IV Adenosine
A Nuclear Medicine Stress Test is a diagnostic exam used to determine if your heart muscle is getting an adequate blood supply. It involves the injection of Cardiolite, a small amount of radioactive material, which is cleared from your body by natural processes. The amount of radiation you are exposed to is comparable to that from an x-ray.

This exam usually consists of two parts - Rest and Stress

• Cardiolite is administered by injection while you are at rest, and a camera takes pictures of your heart.
• Cardiolite is administered to you one other time by an injection during exercise (stress portion), and additional pictures are taken of your heart.

The pictures are generally taken one to three hours after the cardiolite is administered. Routinely,  your test will be performed in two days with the resting portion on day 1 and the stress portion on day 2.

Prior to the stress exam, you will be asked to sign a consent form. If you have any questions about the procedure, do not hesitate to ask the person supervising the test.

What Should I Do Before the Test?

• You will be asked not to eat three hours prior to the STRESS portion of the test. This will prevent the possibility of nausea, which may accompany exercising after eating.
• It is crucial that you DO NOT have any form of caffeine 24 hours prior to the STRESS portion of the test. This includes decaffienated products.
• Unless your physician specifically instructs you to hold a medication, all medications can be taken normally with water.
• For the exercise portion of the test, please wear a comfortable two piece outfit and good walking shoes.
• Please bring a list of the medications you are currently taking.

What Will Happen During the Resting Test?
For the resting portion of the exam, Cardiolite will be injected into a vein in your arm and the resting images will be taken one to three hours later. During this time, it is necessary for you to eat something with fat content and drink something carbonated, preferably Sprite or 7-UP. The reason we ask you to do this is beacause it helps process the isotope and we are able to obtain better images.

For the imaging portion of the exam, you will be asked to lie flat on your back on an imaging table. The camera takes 32 pictures at various angles and takes approximately 20 minutes. The camera is NOT a tunnel and you will be able to see out at all times. It is important for you to remain very still and breathe normal while images are being taken.

What Will Happen During The Stress Test?
Several small pads (electrodes) will be placed on your chest. These pads will be connected to an electrocardiograph (ECG) monitor so that your heart rhythm can be watched closely throughout the exercise portion of the test. An IV line will be placed in your arm. This line will be used to inject Cardiolite into your bloodstream during exercise. The IV line will be removed as soon as the exercise portion is completed.

Treadmill Stress Test - You will exercise by walking on a treadmill. As you exercise longer and harder, your heart rate and blood pressure will rise. This is a normal response to exercise and it will be monitored along with your ECG. Throughout the stress exam, you will be encouraged to continually exercise. It is your responsibility to immediately tell the person supervising the test of any unusual symptoms, such as chest discomfort, shortness of breath, or lightheadedness. To increase the effectiveness of the test, it is important to exercise as long as you can.

Cardiolite will be injected through the IV line approximately one minute before the end of the exercise and will be immediately carried to the heart by the blood. Approximately, one to three hourse after this injection, you will be asked to return for a second set of images used to visualized the Cardiolite in your heart at stress. During this time, it may be necessary for you to eat something with fat content and carbonation.

Adenosine Stress Test - For those who are unable to exercise on a treadmill, we provide them with an Adenosine infusion which is injected with the cardiolite. The IV is then removed as soon as the stress portion is completed. If you are physically able, you will be asked to walk slow and flat on a treadmill for four minutes while the adenosine infuses. By doing this it decreases some of the potential side effects of the medicine. If you are physically unable to walk, you will be asked to do some leg and arm exercises instead of doing the treadmill.

As the adenosine is given, you may feel flushed, chest pressure/pain, shortness of breath, nausea, headache or some other discomfort. These are perfectly normal side effects, but it is important that you inform the person supervising the test. Usually, these side effects disappear within a minute after the infusion is over.

After the Test
Following completion of the exam, you may resume your normal activities, but follow any special instructions you may be given. The test is sent to your doctor for review, and results are usually available within a few days. It is recommended that you make an appointment with your physician to review the results. If you have any further questions concerning this procedure, please call our office.

What is TEE?
TEE is a specialized ultrasound test which allows your cardiologist to obtain high-resolution pictures of your heart and its valves. It is used to enhance the information which is obtained from a regular echocardiogram or as a test by itself. It is particularly helpful in evaluating patients who have artificial heart valves.

TEE invloves swallowing a small tube after you have recieved some local anesthesia to numb the back of the throat. An IV line will be started to allow medication to be given to relax and ensure your comfort.

Prior to the Procedure

• The night before your procedure, eat normally.
• From midnight to the day of the procedure DO NOT eat, drink or take any medications.
• If you are diabetic, please let the staff know. DO NOT take your insulin or oral diabetic pill the day of the procedure. Please bring your diabetic medication or insulin with you.
• Please bring all medications with dosages and schedule with you.
• Do not wear any cologne, perfume, or nail polish.
• If you wear dentures, you will be asked to remove them. (They will be stored and returned to you after the procedure.)