Patient Resources

Electrical system problems of the heart may make the atria beat faster than normal. If the atria beat quickly, but still evenly, it is called atrial flutter. If the atria beat very quickly and unevenly, it is called atrial fibrillation.

When the atria beats too fast

The atria may beat quickly only once in a while (paroxysmal). Or, they may beat quickly all the time(chronic).Atrial flutter or fibrillation can be caused by such things as a heart attack, high blood pressure, or a thyroid problem. Or the cause may be unknown.

Symptoms of Atrial Fibrillation: Palpitations (a fluttering, fast heartbeat), weakness or tiredness, shortness of breath, chest pain or tightness, dizziness or lightheadedness, or fainting spells.

Electrical system problems of the heart may make the atria beat faster than normal. If the atria beat quickly, but still evenly, it is called atrial flutter. If the atria beat very quickly and unevenly, it is called atrial fibrillation.

When the atria beats too fast
The atria may beat quickly only once in a while (paroxysmal). Or, they may beat quickly all the time(chronic).Atrial flutter or fibrillation can be caused by such things as a heart attack, high blood pressure, or a thyroid problem. Or the cause may be unknown.

Symptoms of Atrial Fibrillation: Palpitations (a fluttering, fast heartbeat), weakness or tiredness, shortness of breath, chest pain or tightness, dizziness or lightheadedness, or fainting spells.

Atrial flutter

• Know that the skin where the catheter will be inserted may be shaved. You may be given medication to relax before the procedure.
• Tell your doctor what medicines you take and about any allergies you have.
• Don’t eat or drink anything after midnight, the night before the procedure.
  

You’ll likely be admitted to the hospital on the day of the procedure.

• With atrial flutter, signals travel around and around inside the atria. Circling signals tell the atria to beat
• Atrial flutter can cause symptoms similar to atrial fibrillation. It can also lead to the even faster, uneven rhythms of atrial fibrillation.

Atrial fibrillation

• With atrial fibrillation, cells in the atria send extra electrical signals. These extra signals make the atria beat very quickly and unevenly.
• The atria beat so fast and unevenly that they may quiver instead of contracting. If the atria don’t contract, they don’t move enough blood into the ventricles. This is what leads to symptoms such as dizziness and weakness.
• Blood that isn’t kept moving can pool and form clots in the atria. These clots can move into other parts of the body and cause serious problems, such as a stroke.

Symptoms of atrial fibrillation: Palpitations (a fluttering, fast heartbeat), weakness or tiredness, shortness of breath, chest pain or tightness, dizziness or lightheadedness, or fainting spells

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What are beta blockers?
Beta-adrenergic blocking agents, commonly known as beta blockers, are used in the treatment of high blood pressure (hypertension). Some beta blockers are also used to relieve angina (chest pain), correct irregular heartbeat, prevent migraine headaches, treat tremors or to help prevent additional heart attacks in heart attack patients.

How do they work?
Beta blockers decrease the heart rate and cardiac output, which in turn lowers blood pressure. Essentially, they work by blocking the action of noradrenaline at special sites (receptors) in arteries and the heart muscle. Noradrenaline is a chemical that transmits messages between nerves and muscles, or between one set of nerves and another. By blocking this action, beta blockers can cause arteries to widen and can slow the action of the heart and decrease its force of contraction. This results in a fall in blood pressure and reduced work by the heart so that it beats more regularly.

Are there side effects?
The most common side effects of beta blockers are insomnia, cold hands and feet, tiredness or depression, a slow heartbeat or symptoms of asthma. Impotence may occur.

Are beta blockers for everyone?
People should avoid using beta blockers if they have asthma, chronic bronchitis, emphysema or any other condition that affects breathing, since beta blockers can make these conditions worse by narrowing the air passages in the lungs. People with poor blood circulation, diabetes, stable heart failure, and kidney or liver problems should also use extreme caution when taking beta blockers.

How are beta blockers taken?
Beta blockers are available by prescription only. They can be taken through pills, injections, or eye drops (for glaucoma) and are often prescribed in combination with other drugs such as diuretics or calcium channel blockers.

What types of drugs are considered beta blockers?

• Acebutolol (Sectral®)
• Atenolol (Tenormin®)
• Betaxolol (Kerlone®)
• Bisoprolol/hydrochlorothiazide (Ziac®)
• Bisoprolol (Zebeta®)
• Carteolol (Cartrol®)
• Metoprolol (Lopressor®, Toprol XLTM)
• Nadolol (Corgard®)
• Propranolol (Inderal®)
• Sotalol (Betapace®)
• Timolol (Blocadren®)

Sources:
National Institute of Health
American Heart Association
Healthy Hearts.com
British United Provident Association (BUPA)

You may have had angina, dizziness, or other symptoms of heart trouble. To help diagnose your problem, your doctor may suggest having a cardiac catheterization. This common procedure is sometimes also used to treat a heart problem.

*We encourage you to check with our scheduling department for a copy of our “No-Show” fee schedule. This fee is the patient’s responsibility and is not billable to insurance.

Before the procedure

• Know that the skin where the catheter will be inserted may be shaved. You may be given medication to relax before the procedure.
• Tell your doctor what medicines you take and about any allergies you have.
• Don’t eat or drink anything after midnight, the night before the procedure.
• You’ll likely be admitted to the hospital on the day of the procedure.

During the procedure

• You will receive a local anesthetic to prevent pain at the insertion site.
• The doctor inserts an introducing sheath into a blood vessel in your groin or arm.
• Through the sheath, a long, thin tube called a catheter is placed inside the artery and guided toward your heart.
• To perform different tests or check other parts of the heart, the doctor inserts a new catheter or moves the catheter or x-ray machine.
• For some tests, a contrast dye is injected through the catheter.

When to call your doctor
Call your doctor right away if you have any of the following:

• Angina (chest pain).
• Pain, swelling, redness, bleeding, or drainage at the insertion site.
• Severe pain, coldness, or a bluish color in the leg or arm that held the catheter.
• Blood in your urine, black or tarry stools, or any other kind of bleeding.
• Fever over 101.0 F.

After the procedure

• You need to remain lying down for 2-12 hours.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check your blood pressure and the insertion site.
• You may be asked to drink fluid to help flush the contrast liquid out of your system.
• Have someone drive you home from the hospital.
• It’s normal to find a small bruise or lump at the insertion site. These common side effects should disappear within a few weeks.

Cardiac nuclear imaging is also called a “perfusion scan.” A tracer (a small amount of radioactive matter) is delivered into the bloodstream. Then a camera scans the tracer in the blood as it flows through the heart muscle. The tracer leaves your body within hours. This test can be done in a hospital or test center.

Before your test

• The entire test will take a few hours. For best results, prepare for your test as directed.
• When you schedule the test, be sure to mention all the medications you take. Ask if you should stop taking any of them the day of the test.
• Before your test, stop smoking and avoid caffeine for as long as directed.
• Don’t eat or drink for 4-6 hours before the test. Sips of water are okay.
• On the day of the test, dress for comfort. Wear a two-piece outfit, top and bottoms. Be sure to wear walking shoes.

During your test

• You may be asked to change into a hospital gown for the test. At some point, scanning pictures will be taken while you rest. This may be done before you exercise. Or, you might have to return for resting scans later that day or the next.
• You will be attached to EKG and blood pressure monitors. An IV (intravenous) line will be started in your arm.
• You will exercise on a treadmill or stationary bike for a few minutes. This increases the rate of blood flow to your heart muscle.
• Speak up when you feel that you cannot exercise for even 1 more minute. At this point, the tracer is given to you through the IV.
• If you cannot exercise, special medications can be used to increase heart rate.
• After you have received the tracer, you will be positioned on the scanning bed.
• You must lie very still for up to 30 minutes. During this time, a scanning camera will be taking pictures. The images will show where blood flows through your heart muscle.

After your test

• Before going home, ask when you may eat. Also, find out when to resume taking any medications you were told to skip before the test. If you need to return for resting scans, follow any instructions. Most people can go back to their normal routine as soon as all parts of the test are finished.

Report any symptoms
Be sure to tell the doctor if you feel any of the following during the test:

• Chest, arm, or jaw discomfort
• Severe shortness of breath
• Dizziness or lightheadedness
• Leg cramps or pain

Let the technologist know:

• What medicines you take.
• If you have diabetes, knee or hip problems, arthritis, asthma, or chronic lung disease.
• If you have had a stroke or have vascular disease of the leg.
• If you are pregnant, think you might be, or are nursing.

Cardioversion is a procedure to restore the heart’s normal rhythm. You may have the procedure in a hospital or surgery center. It’s often done on an outpatient (same day) basis. During the procedure, you’ll be given medication to keep you free from pain. Then the doctor gives you a brief electric shock. This helps your heartbeat become normal again. In most cases, you can go home the same day as the procedure.

Before Your Procedure

• Tell your doctor what over-the-counter and prescription medications, herbs, and supplements you are taking.
• Take medication as directed. Your doctor may prescribe anticoagulants (blood thinners) for a few weeks. They help prevent blood clots from forming.
• Ask your doctor about the risks and benefits of cardioversion.
• Sign your consent form.
• Don’t eat or drink anything for 8 hours before your procedure.
• Follow any other instructions you are given.
• Arrange for an adult to drive you home after the procedure.

During Your Procedure

• Small pads (electrodes) are placed on your chest to record your heartbeat at all times.
• An intravenous (IV) line is placed in your arm. This gives you medication (sedation) that keeps you free of pain. You’ll feel sleepy.
• You will be given oxygen through a soft plastic tube in your nose.
• Pads will be placed on your chest and back. A very brief electric shock is given through the pads. Remember, because of sedation you won’t feel the shock.
• Your heartbeat is watched to make sure the normal rhythm has been restored.

After Your Procedure

• You’ll be monitored until you are fully awake. Then you’ll be able to sit up, walk, and eat.
• In most cases, you’ll be able to go home after the sedation wears off. This usually takes a few hours.
• For a day, the skin on your chest may feel a little sore, like a mild sunburn.
• Don’t drive or operate heavy machinery for 24 hours after the procedure.
• The day after your procedure, try to take it easy. Take medication as directed.
• Call your doctor if you notice skipped beats, a rapid heartbeat, or chest tightness. These may be signs that an irregular heartbeat has returned.

Carotid angiography is a type of x-ray test used to view the carotid arteries (large blood vessels that supply your brain with blood). The information provided by this test helps your doctor make decisions about treatment. During the test, a thin, flexible tube called a catheter is passed into an artery leading to the carotids. Contrast fluid is then injected through the catheter. The fluid makes it easier to see the carotids on the x-rays.

Talk to your doctor about the risks and complications of angiography.

Before your procedure

• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure. If your doctor says to take your normal medications, swallow them with only small sips of water.
• Arrange for an adult family member or friend to drive you home.

During the procedure

• You’re given an IV (intravenous) line in your arm. You may also be given a sedative to help you relax.
• You’re given an injection to numb the site where the catheter is inserted. This is usually the groin area.
• A small puncture is made so the catheter can be inserted. Using x-rays, the catheter is then carefully guided into an artery.
• Contrast fluid is injected through the catheter into the artery. You may feel warmth or pressure in your legs, back, neck, or head. You lie still as x-rays are taken of the carotids. You may be asked to hold your breath during injections. When the procedure is complete, the catheter is removed.

After the procedure
You’ll be taken to a recovery area. A doctor or nurse will apply pressure to the insertion site for about 10 minutes. You’ll then need to lie flat for a few hours. Your doctor will discuss the results with you soon after the procedure.

Back at home
Once you are home:

• Don’t drive for 24 hours.
• Avoid walking, bending, lifting, and taking stairs for 24 hours.
• Avoid lifting anything over 5 pounds for 7 days.

Be sure to follow any other instructions from your doctor.

When to call your doctor
Call your doctor if you have any of the following:

• Bleeding, swelling, or notice a lump at the insertion site
• Sharp or increasing pain at the insertion site
• You become lightheaded or dizzy
• Leg pain, numbness, or a cold leg or foot
• Severe headache, visual problems, or trouble speaking

An arrhythmia (heart rhythm problem) can make your heart beat too fast. The problem is often caused by cells in your heart that aren’t working as they should. It may cause bothersome symptoms, such as an irregular heartbeat, dizziness, and shortness of breath. Your doctor has recommended catheter ablation to treat your arrhythmia. This procedure destroys the cells that are causing the problem.

Before the procedure
Before your catheter ablation, you will meet with the electrophysiologist(specially trained heart doctor) who will do the procedure. He or she will tell you how to prepare. You will likely be told to stop taking all heart rhythm medications for a few days before the procedure. Follow your doctor’s instructions. Also:

• Tell the doctor about all prescription and over-the-counter medications you take. This includes herbs, supplements, and vitamins. It also includes daily medications such as insulin or blood thinners. If you are allergic to any medications, tell the doctor.
• Have any routine tests, such as blood tests, as recommended.
• Don’t eat or drink anything 12 hours before the procedure.

How catheter ablation is done
Catheter ablation uses thin, flexible wires called electrode catheters to find and destroy (ablate) problem cells. Here’s how the procedure is done:

• The heart’s signals are mapped. To find the problem, an electrophysiology study (EPS) is done. During this study, the doctor tries to induce (start) your arrhythmia. An electrical map of the heart is then created. This shows the type of arrhythmia you have and where the problem is. Using the map as a guide, the doctor knows where to ablate.
• Problem areas are destroyed. Once the EPS shows where the problem is, an electrode catheter is moved to that area. Energy is sent through the catheter to destroy the problem cells.
• The heart’s rhythm is tested again. After ablating the problem cells, the doctor tries to reinduce (restart) your arrhythmia. If a fast rhythm can’t be induced, the ablation is a success. But if a fast rhythm does start again, further ablation may be needed.

Your experience during catheter ablation
In most cases, catheter ablation is done in an electrophysiology (EP) lab. It often takes 2-4 hours, and sometimes longer. You’ll receive medication to prevent pain. Medication will also help you relax or sleep during the procedure. If you feel uncomfortable during the procedure, tell the doctor or nurse.

• Getting started: First, skin on your groin or neck is washed. Any hair in that area may be shaved. This is where the catheters will be inserted. An IV (intravenous) line is started in your arm. Medications and fluids are provided through this IV. To help keep the insertion site sterile (germ-free), your body is draped with sheets. Only the area where the catheters will be inserted is exposed.
• Inserting the catheters: The skin where the catheters will be inserted is numbed with a local anesthetic. This is so you won’t feel pain. Then a small needle is used to make punctures in your vein or artery. Catheters are inserted through these punctures and guided to the heart with the help of x-ray monitors.
• Finishing up: When the procedure is finished, the catheters are taken out of your body. Pressure is applied to the puncture sites to help them close. No stitches are needed. You’re then taken to a recovery room to rest.

Risks and complications
The risks of catheter ablation are fairly low compared to the benefits you receive. Discuss these risks with your doctor before the procedure. Possible risks and complications include:

• Bleeding or bruising
• Blood clots
• A slow heart rhythm (requiring a permanent pacemaker)
• Perforation of the heart muscle, blood vessel, or lung (may require an emergency procedure)
• Damage to a heart valve (rare)
• Stroke or heart attack (rare)
• Death (extremely rare)

Your doctor will talk to you about your heart problem and explain how angioplasty can help. Angioplasty relieves symptoms of coronary artery disease by improving blood flow to your heart.

During the procedure

• A guide wire is inserted through the guiding catheter (a thin, flexible tube) and moved to the narrow spot in your artery. Your doctor tracks its movement on an angiogram, a special kind of x-ray.
• A balloon-tipped catheter is inserted through the guiding catheter and threaded over the guide wire. It is positioned at the narrow part of the artery.
• The balloon is inflated and deflated several times to compress the plaque against the artery wall. You may feel angina (chest pain) when the balloon is inflated. Tell your doctor if you do.
• The balloon is deflated and the catheters and guide wire are removed. The artery is now open, and blood flow to the heart muscle increases.

After the procedure

• You’ll need to remain lying down for 6 – 12 hours.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check the insertion site and your blood pressure. Before going home, you may have a chest x-ray and other tests.
• You usually remain in the hospital for several hours or overnight.

Call your doctor if:

• You have angina (chest pain).
• The insertion site has pain, swelling, redness, bleeding, or drainage.
• You have severe pain, coldness, or a bluish color in the leg or arm that held the catheter.
• You experience blood in your urine, black or tarry stools, or any other kind of bleeding.
• You have a fever over 101.0°F.

If one or more of your coronary arteries (the vessels that carry blood to your heart muscle) are blocked, blood can’t flow to the heart muscle. In this case, the heart muscle may die (heart attack). Coronary artery bypass surgery creates a path for blood to flow around a blockage and helps prevent a heart attack.

Preparing the bypass graft
First, a healthy blood vessel (graft) is taken from another part of the body. Taking this graft usually doesn’t affect blood flow in that body part. If you have more than one blockage, more than one graft may be needed. One or more of these blood vessels will be used for the graft:

• The saphenous vein, which is located in the leg.
• The radial artery, which is located in the arm.
• The internal thoracic (mammary) artery, which is located in the chest wall.

Reaching the heart
While one member of the bypass team is getting the graft, another member works to reach your heart. First, an incision is made in the chest. Then the breastbone (sternum) is pulled apart. The breastbone is held open throughout surgery. This puts pressure on the nerves of the chest. This is why you may have soreness and muscle spasms in your chest, shoulders, and back during recovery.

Attaching the Graft
A small opening is made in the coronary artery, below the blockage.

• If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end is sewn onto the aorta.
• If the internal thoracic (mammary) artery is used, one end of the graft is sewn onto this opening. The other end is already attached to a branch of the aorta.

Finishing up
Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage. If you have multiple blockages, more than one bypass may be done. Then your breastbone is rejoined with wires. These wires will stay in your chest permanently. The incision is closed, and you are taken to the intensive care unit to begin your recovery.

Using a heart-lung machine
Coronary artery bypass surgery can be done with the heart still beating (off pump) or with the heart still (on pump.) Your surgery team can tell you more about which type of procedure you will have.

• On-pump procedure: A machine does the work of your heart and lungs during surgery. Blood is circulated through a heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs start working again after the bypass is completed.
• Off-pump procedure: The heart-lung machine is not used and the heart is not stopped. This is sometimes called a “beating heart” procedure.

Risks and complications
You and your surgeon can discuss the risks and possible complications of coronary artery bypass surgery. They may include:

• Excessive bleeding
• Infection of the incision sites
• Pneumonia (lung infection)
• Fast or irregular heartbeat
• Nerve injury or muscle spasms
• Breathing problems
• Memory problems or confusion
• Heart attack, stroke, or death

A stent is a small metal coil or mesh tube that is placed in a narrowed artery to hold it open, which helps improve blood flow to your heart. The stent also helps reduce the rate of restenosis (re-narrowing) of the artery. Some stents slowly release medication over a period of time. This reduces the amount of scar tissue that forms inside the artery, helping to prevent restenosis.

During the procedure

• A stent, which comes mounted on a balloon-tipped catheter, is delivered to the blockage in your artery.
• The balloon is then inflated, causing the stent to expand.
• The expanded stent further compresses the plaque against the arterial wall, increasing the blood flow to the heart muscle.

After the procedure

• You may need to keep still, with your leg or arm straight, for 2-6 hours. How long depends partly on where the catheter was inserted and how the site was closed.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check your blood pressure and the insertion site.
• You may be asked to drink fluid to help flush the contrast liquid out of your system.
• Have someone drive you home from the hospital.
• It’s normal to find a small bruise or lump at the insertion site. This should disappear within a few weeks.

When to call Your doctor
Call your doctor right away if you have any of the following:

• Angina (a feeling of pain, pressure, aching, tingling, or burning in the chest, back, neck, throat, jaw, arms, or shoulders).
• Increasing pain, swelling, redness, bleeding, or drainage at the insertion site
• Severe pain, coldness, or a bluish color in the leg or arm that held the catheter
• Shortness of breath
• Difficulty urinating or blood in your urine
• Fever over 101 F.

What is coumadin?
Coumadin is an anticoagulant. An anticoagulant helps reduce clots from forming in the blood.

When should I take my coumadin?
Try to take your Coumadin at the same time every day. Take it exactly the way your healthcare provider tells you.

Will my dosage change?
Your dosage may change from time to time. So make sure you take the right dose on the right day, as your healthcare provider tells you.

Why do I need blood tests?
To help your healthcare provider establish the dosage of Coumadin you need. Your healthcare provider will take a small amount of your blood to find out your prothrombin time, protime, or PT for short.  

Protimes are very important. They help to show how fast your blood is clotting and whether your dosage of Coumadin should change.

What things may change my protime test results?
Several things, such as sickness, diet, other medicines (prescription and over-the-counter), or physical activities may affect your results. Tell your healthcare provider about changes in your health, medicines you are taking, or your lifestyle so your dosage of Coumadin can be adjusted if needed.

What should I avoid?

• Avoid drastic changes in you dietary habits.
• Avoid alcohol consumption.

What if I forget to take a coumadin pill?
DO NOT TAKE ANOTHER PILL TO “CATCH UP”!  If you forget to take a pill, tell your healthcare provider. Take the missed dose as soon as possible on the same day, but DO NOT take a double dose of Coumadin the next day to make up for the missed dose.

Why do I need to pay attention to my diet?
Because many foods you eat have vitamin K in them, and vitamin K helps your blood make clots. In addition, you may want to avoid herbal teas that have tonka beans, melilot (sweet clover), or sweet woodruff in them.

Why should I stay on the same general diet every day?
Because large changes in the amount of vitamin K you eat may affect the way your Coumadin works. It is important for you to keep your diet steady (consistent) so the amount of vitamin K you eat is steady.

Should I avoid foods with a lot of Vitamin K?
No. Just keep your diet steady. Some foods that are important to a healthy diet are high in vitamin K, like leafy, green vegetables and some beans and peas.

What should I do?

• Do take your Coumadin exactly as your healthcare provider tells you.
• Do keep eating habits and activities similar every day.
• Do get your blood tested when you are suppose to.
• Do tell your healthcare provider about any other medicines you are taking (prescription or over-the-counter). Also, ask your healthcare provider before you change, start, or stop taking any of your medicines.
• Do tell you healthcare provider when you get sick, get hurt, or get a cut that won’t stop bleeding.
• Do look for signs of bleeding.
• Do tell anyone giving you medical or dental care that you are taking Coumadin.
• Do refill you prescriptions according to your healthcare provider’s order.

What should I not do?

• Do not take and extra pill to catch up.
• Do not take Coumadin if you are pregnant or may become pregnant.
• Do not take any other medicines before asking your healthcare provider.

Call your Healthcare Provider right away if you have:

• A serious fall or if you hit your head
• Bleeding that does not stop from cuts or from your nose
• More bleeding then usual when you brush your teeth
• More bleeding then usual when you get your menstrual period or unexpected bleeding from the vagina
• Unusual colored urine or stool when you go to the bathroom (including dark brown urine and red or black in your stool)
• Unusual bruising (black-and-blue marks on your skin) for unknown reasons
• A fever or sickness that gets worse
• Throwing up (vomitting), coughing or throwing up blood, loose or runny stools (diarrhea) or an infection
• Pain or swelling
• Headache, dizziness, trouble breathing, chest pain, or if you feel weak or more tired than usual

Coumadin (warfarin) helps keep your blood from clotting. Be sure to take it as directed. Because it keeps your blood from clotting, you also need to protect yourself from injury. Follow These Tips

• Take Coumadin at the same time each day. If you miss a dose, take it as soon as you remember—unless it’s almost time for your next dose. If so, skip the missed dose. Do not take a double dose.
• Go for your blood (protime/INR) tests as often as directed.
• Don’t take any other medications without checking with your healthcare provider first. This includes aspirin, vitamins, and herbal and other dietary supplements.
• Tell all healthcare providers that you take Coumadin. It’s also a good idea to carry a medical ID card or wear a medical-alert bracelet.
• Use a soft toothbrush and an electric razor.
• Don’t go barefoot. And don’t trim corns or calluses yourself.

When to call your healthcare provider
Call your healthcare provider right away before you take your next dose of Coumadin if you have any of these problems:

• Bleeding that doesn’t stop in 10 minutes
• A heavier-than-normal period or bleeding between periods
• Coughing or throwing up blood
• Diarrhea or bleeding hemorrhoids
• Dark urine or black stools
• Red or black-and-blue marks on the skin that get larger
• A fever or an illness that gets worse
• Dizziness or fatigue
• Chest pain or trouble breathing
• A serious fall or a blow to the head

Keep your diet steady
Keep your diet pretty much the same each day. That’s because many foods contain vitamin K. Vitamin K helps your blood clot. So eating foods that contain vitamin K can affect the way Coumadin works. You don’t need to avoid foods that have vitamin K. But you do need to keep the amount of them you eat steady (about the same day to day). If you change your diet for any reason, such as due to illness or to lose weight, be sure to tell your doctor.

• Examples of foods high in vitamin K are asparagus, avocado, broccoli, and cabbage. Oils, such as soybean, canola, and olive oils, are also high in vitamin K.
• Other food products can affect the way Coumadin works in your body:
• Food products that may affect blood clotting include cranberries and cranberry juice, fish oil supplements, garlic, ginger, licorice, turmeric.
• Herbs used in herbal teas or supplements can also affect blood clotting. Keep the amount of herbal teas and supplements you use steady.
• Alcohol can increase the effect of Coumadin in your body.

Talk with your healthcare provider if you have concerns about these or other food products and their effects on Coumadin.

An echocardiogram (echo) is an imaging test. It helps your doctor evaluate your heart. This test:

• Is safe and painless.
• Can be done in a hospital, test center, or doctor’s office.
• Bounces harmless sound waves (ultrasound) off the heart. A transducer (device that looks like a microphone) is used.
• Helps show the size of your heart. It also helps show the health of the heart’s chambers and valves.

Before your echo

• Discuss any questions or concerns you have with your doctor.
• Mention any over-the-counter or prescription medications, herbs, or supplements you’re taking.
• Allow extra time for checking in.
• Wear a two-piece outfit for the test. You may be asked to remove clothing and jewelry from the waist up. If so, you’ll be given a short hospital gown.

During your echo

• Most echo tests take 10-20 minutes.
• Small pads (electrodes) are placed on your chest to monitor your heartbeat.
• A transducer coated with cool gel is moved firmly over your chest. This device creates the sound waves that make images of your heart.
• At times, you may be asked to exhale and hold your breath for a few seconds. Air in your lungs can affect the images.
• The transducer may also be used to do a Doppler study. This test measures the direction and speed of blood flowing through the heart. During the test, you may hear a “whooshing” sound. This is the sound of blood flowing through the heart.
• The images of your heart are stored on a computer or recorded on video. This is so your doctor can review them later.

During your echo

• Return to normal activity unless your healthcare provider tells you otherwise.
• Be sure to keep follow-up appointments.

Your test results
Your doctor will discuss your test results with you during a future office visit. The test results help the doctor plan your treatment and any other tests that are needed.

An EPS closely monitors your heart rhythm. EPS can help determine exactly what your rhythm problem is and what can be done to control it. A specially trained doctor (Electrophysiologist) performs the procedure in an EPS lab.
Before the procedure

• Tell your doctor which medications you take. Ask if you should stop taking them before the procedure.
• Have any routine tests that your doctor recommends.
• Don’t eat or drink anything after midnight, the night before the procedure.

During the procedure

• The study takes about 1-4 hours.
• After the skin is numbed with a local anesthetic, an incision is made where the catheter will be inserted.
• One or more catheters are passed through the veins and positioned in the heart.
• The catheters record electrical activity of the heart. They find where and when signals begin and how often they are sent.
• Other procedures that may be done during the study include defibrillation (electric shock to the heart to help adjust the heart rhythm) and catheter ablation (destruction of an abnormal electrical pathway or cells in the heart).

Call your doctor if:

• The insertion site has pain, increased swelling, redness, bleeding, or drainage.
• You have shortness of breath or angina (chest pain).
• You have severe pain, coldness, numbness, or a bluish color in the leg or arm that held the catheter.
• You have a fever over 100.0 F.

After the procedure

• You’ll need to remain lying down for 6-12 hours.
• If the insertion site was in your groin, you may be asked not to move your leg for several hours.
• A nurse will check the insertion site and your blood pressure.
• After the study, you usually remain in the hospital for several hours or overnight.

• Angina: symptoms that occur when the heart muscle can’t get enough oxygen-rich blood. Often appears as pressure, tightness, aching, or pain in the chest, arm, neck, or jaw.
• Angiogram: a special x-ray of a blood vessel.
• Aorta: the body’s largest artery. It carries blood from the heart to the rest of the body.
• Arrhythmia: an abnormal heartbeat.
• Arteriosclerosis: when artery walls thicken and lose elasticity. Sometimes called “hardening of the arteries.”
• Artery: a blood vessel that carries blood from the heart to the body.
• Atherosclerosis: the buildup of plaque within artery walls.
• Atria (singular: atrium): the heart’s two upper chambers. They receive blood from the lungs and body.
• Balloon angioplasty: a procedure that uses a balloon-tipped catheter to open an artery narrowed or blocked by plaque.
• Blood (serum) cholesterol: a fatty substance produced by the body and carried in the blood. Can build up within artery walls as plaque.
• Blood pressure: a measurement indicating the force of blood as it presses against artery walls while moving through vessels.
• Blood vessels: tubes that carry blood throughout the body. Arteries and veins are blood vessels.
• Bypass: a new pathway for blood flow.
• CABG (pronounced “cabbage”): another term for coronary artery bypass graft surgery.
• Cardiomyopathy: weakening of, or structural change in, the heart muscle that reduces the heart’s ability to pump.
• Catheter: a long, thin, flexible plastic tube.
• Coronary arteries: blood vessels that wrap around the heart and supply the heart muscle with oxygen-rich blood.
• Coronary artery disease: blocked or narrowed coronary arteries.
• Diastolic pressure: the pressure of blood against the inside of artery walls between heartbeats. Appears as the bottom number in a blood pressure measurement.
• Electrocardiogram: a test that records the way electrical signals move through the heart. Often called an ECG or EKG.
• Heart attack: an event that occurs when oxygen-rich blood can’t get to part of the heart muscle. Can cause permanent damage.
• Hypertension: another word for “high blood pressure.”
• Myocardial infarction: death of heart muscle tissue. Also known as a heart attack.
• Plaque: a deposit of fatty material (including cholesterol) within artery walls.
• Pulmonary artery: the large artery that carries blood from the heart to the lungs to get oxygen.
• Stenosis: the narrowing of an artery, often caused by plaque buildup.
• Stroke: a blockage or rupture in a blood vessel that cuts off blood flow to part of the brain. May cause brain damage. Also known as a brain attack or CVA (cerebrovascular accident).
• Systolic pressure: the pressure of blood against the inside of artery walls during a heartbeat (when the heart pumps). Appears as the top number in a blood pressure measurement.
• Ultrasound: a test that uses sound waves to create images of structures inside the body.
• Valves: “doorways” that open and close to let blood move and prevent backflow of blood. There are valves between the heart’s chambers.
• Vein: a blood vessel that carries blood from the body back to the heart.
• Ventricles: the heart’s two lower chambers. They pump blood to the body and lungs.

Your heart is a pumping muscle that works nonstop to keep your body supplied with oxygen-rich blood. Signals from the heart’s electrical system set the speed and pattern of the pump’s rhythm. Valves keep the blood moving in one direction, through the heart’s four chambers.
The aorta carries oxygen-rich blood to the body.
The right coronary artery supplies blood to the bottom, right side, and back of the heart muscle.
The pulmonary artery pumps blood to the lungs.
The left coronary artery supplies blood to the front, left side, and back of the heart muscle. It has three parts:

• Circumflex coronary artery
• Left main coronary artery
• Left anterior descending coronary artery

The right atrium receives blood from the body.
The tricuspid valve prevents blood from returning to the atrium.
The right ventricle pumps blood to the lungs for oxygen.
The heart’s electrical system is made up of nodes and pathways.
The left atrium receives oxygen-rich blood from the lungs.
The mitral valve prevents blood from returning to the atrium.
The left ventricle pumps oxygen-rich blood to the body.
The aortic valve prevents blood from returning to the ventricle.
The pulmonic valve prevents blood from returning to the ventricle.

The heart is a muscle. It pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart can’t pump as well as it should. Blood and fluid may back up into the lungs, and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms you feel.

When you have heart failure
Because of heart failure, not enough blood leaves the heart with each beat. There are two types of heart failure. Both affect the ventricles’ ability to pump blood. You may have one or both types.

Systolic heart failure
The heart muscle becomes weak and enlarged. It can’t pump enough blood forward when the ventricles contract. Ejection fraction is lower than normal.

Diastolic heart failure
The heart muscle becomes stiff. It doesn’t relax normally between contractions, which keeps the ventricles from filling with blood. Ejection fraction is often in the normal range.

How heart failure affects your body
When the heart doesn’t pump enough blood, hormones (body chemicals) are sent to increase the amount of work the heart does. Some hormones make the heart grow larger. Others tell the heart to pump faster. As a result, the heart may pump more blood at first, but it can’t keep up with the ongoing demands. So, the heart muscle becomes more damaged. Over time, even less blood is pumped through the heart. This leads to problems throughout the body.

What Is ejection fraction?
Ejection fraction (EF) measures how much blood the heart pumps out (ejects). This is measured to help diagnose heart failure. A healthy heart pumps at least half of the blood from the ventricles with each beat. This means a normal ejection fraction is around 50% or more.

High blood pressure is known as the “silent killer” because it often has no symptoms. Left uncontrolled, high blood pressure can lead to heart disease, heart attack, stroke, kidney disease, or blindness. Making some lifestyle changes and taking any prescribed medication should keep your blood pressure under control.

How blood pressure affects arteries
As blood moves through your body, it presses against the inside walls of arteries (blood vessels that carry blood to the body). Frequent high blood pressure can cause changes in the artery walls. The walls thicken and become rough, which leads to a buildup of plaque (a fatty material).

What you can do

• Quit smoking
• Lose weight
• Eat healthier
• Limit alcohol intake
• Exercise
• Reduce stress
• Take your medications
• Check your blood pressure regularly

High blood pressure (hypertension) is called the silent killer. This is because many people who have it don’t know it. Normal blood pressure is less than 120/80. Know your blood pressure and remember to check it regularly. Doing so can save your life. Here are some things you can do to help control your blood pressure.

Choose heart-healthy foods

• Select low-salt, low-fat foods.
• Limit canned, dried, cured, packaged, and fast foods. These can contain a lot of salt.
• Eat 8–10 servings of  fruits and vegetables every day.
• Choose lean meats, fish, or chicken.
• Eat whole-grain pasta, brown rice, and beans.
• Eat 2–3 servings of low-fat or fat-free dairy products
• Ask your doctor about the DASH eating plan. This plan helps reduce blood pressure.

Maintain a healthy weight

• Ask your healthcare provider how many calories to eat a day. Then stick to that number.
• Ask your healthcare provider what weight range is healthiest for you. If you are overweight, weight loss of only 10 lbs can help lower blood pressure.
• Limit snacks and sweets.
• Get regular exercise.

Get up and get active

• Choose activities you enjoy. Find ones you can do with friends or family.
• Park farther away from building entrances.
• Use stairs instead of the elevator.
• When you can, walk or bike instead of driving.
• Rake leaves, garden, or do household repairs.
• Be active for at least 30 minutes a day, most days of the week.

Manage stress

• Make time to relax and enjoy life. Find time to laugh.
• Visit with family and friends, and keep up with hobbies.

Limit alcohol and quit smoking

• Men: Have no more than 2 drinks per day.
• Women: Have no more than 1 drink per day.
• Talk with your healthcare provider about quitting smoking. Smoking increases your risk for heart disease and stroke. Ask about local or community programs that can help.

Medications
If lifestyle changes aren’t enough, your healthcare provider may prescribe high blood pressure medicine. Take all medications as prescribed.

Blood pressure measures the force of blood against artery walls. High Blood Pressure (Hypertension) can damage arteries and put you at risk of Peripheral Arterial Disease (PAD). PAD is a disease of arteries in the legs. If you have PAD, it’s likely that arteries in other parts of the body are diseased, too. That puts you at high risk of heart attack and other heart diseases. Read on to learn how high blood pressure can lead to PAD and affect your health.

How Can High Blood Pressure Lead to Peripheral Arterial Disease?
High blood pressure promotes plaque formation. Plaque is waxy material made up of cholesterol and other particles that can build up in artery walls. When there is too much plaque, the arteries can become narrowed and restrict blood flow. If high blood pressure isn’t controlled, this makes it more likely for you to develop PAD and other heart problems. But high blood pressure can be controlled with exercise, weight loss, dietary change and medication.

What Happens if Blood Pressure Isn’t Controlled?

• For every 20mmHg systolic or 10mmHg diastolic increase in your blood pressure, your risk of death from heart disease or stroke doubles.
• If you have diabetes, high blood pressure increases your risk of diabetes complications.

What Happens If Blood Pressure Is Controlled?
Lowering your blood pressure and keeping it low can:

• Reduce your risk of stroke by 35 to 40%.
• Reduce your risk of heart attack by 20 to25%.
• Reduce your risk of dying of heart disease by 25%.
• Reduce your risk of diabetes complications.

Holter monitoring is a painless way to record your heartbeat away from the doctor’s office. It is a small electrocardiogram (ECG) that you carry with you. Holter monitoring records your heartbeat for your doctor to review at a later time. You can receive your heart monitor in a hospital, test center, or doctor’s office.

Your holter monitor
When you receive a Holter monitor, small, painless pads (electrodes) are put on your chest. These connect to the lightweight unit, which attaches to a belt or shoulder strap. You need to keep the device on for at least 24 hours and complete a diary. While wearing the monitor, follow these tips:

• Try to sleep on your back.
• Don’t take a shower. A sponge bath is okay.
• Follow your normal routine. Don’t avoid stress, work, or exercise.
• If an electrode falls off or the unit makes noise, call to see what you should do.

When using a monitor
Stay away from electric blankets, magnets, metal detectors, and high-voltage areas such as power lines. They may affect the recording.

Holter monitor diary

• Write in the time of day for each entry you make.
• Note each change in activity, including when you take medicine.
• Note any symptoms you feel.

An ICD is a device that is placed permanently inside your body. An ICD monitors your heart rhythm (the speed and pattern of your heartbeat). If this rhythm becomes too fast or too slow, the ICD sends out electrical signals that help bring the rhythm back to normal. The ICD is put inside your body during a minor surgical procedure called implantation. In most cases, implantation takes 1 to 3 hours.

How the ICD Is put into the body
The ICD is usually implanted on the left side of your chest. Implantation does not require open heart surgery (your chest will not be opened). During implantation:

• An incision is made in the skin below the collarbone. This creates a “pocket” to hold the ICD.
• A lead (wire) is threaded through the incision into a vein in the upper chest. With the help of x -ray monitors, the lead is then guided into one of the heart’s chambers. Depending on how many leads your ICD has, this process may be repeated to guide leads into other chambers.
• The leads are attached to the heart muscle so they will stay in place.
• The generator (battery) is attached to the leads. Then the generator is placed in its pocket under the skin.
• A fast heart rhythm may be induced (started) to test the ICD.
• When everything else is done, the incision is closed with sutures, medical glue, or staples.

Other implantation sites
In some cases, the ICD can be put elsewhere in the body. This could be in the abdomen, on the right side of the chest, or on the left side under the muscle. If one of these is an option for you, your doctor will explain more.

After the procedure
You’ll stay in the hospital at least overnight. While in the hospital, your heart’s signals are monitored to see how the ICD is working. You can go home when your condition is stable. Once you get home:

• Follow your discharge instructions to care for your incision. Watch for signs of infection (see box).
• Follow any special instructions to care for the side of your body where your ICD was implanted. Your doctor may tell you not to raise that arm above the shoulder for a certain amount of time.
• You’ll likely have bruising at the incision site for about a month. This is normal and will go away as the incision heals.
• You can probably return to your normal routine soon after implantation. Ask your doctor when you can return to work.
• You may be instructed not to drive for a certain amount of time.
• See your doctor for follow-up visits as recommended.

Call your healthcare team if you have:

• Signs of an infection, such as: fever over 100F; drainage from the incision; redness, swelling, or warmth at the incision site
• Twitching chest muscles
• Pain around your ICD that gets worse, not better
• Bleeding from your incision
• Swelling in the arm on the side of the incision site
• Severe swelling of the incision site (bulging up like a golf ball)
• Chest pain or shortness of breath

A pacemaker is a small electronic device that helps your heart’s electrical system. It keeps your heart beating at the right pace. Inserting the pacemaker into your body is called implantation. You stay awake during the procedure. You may be asked some questions or be asked to take some deep breaths.

During the procedure

• A local anesthetic is given by injection to numb the area where the pacemaker will be inserted. This keeps you from feeling pain during the procedure.
• An incision is made where the generator is placed.
• The lead (transmits to and from your heart) is guided through a vein into your heart’s chambers using x-ray monitors.
• The pacemaker generator is attached to the lead or leads.
• The pacemaker’s settings are programmed to help your heart beat at a rate that’s right for you.

When to call your doctor
Call your doctor right away if you have any of the following:

• You feel any of the symptoms you had before the pacemaker was implanted (dizziness, lightheadedness, lack of energy or fainting spells).
• Your chest muscles twitch.
• You have a rapid or pounding heartbeat or shortness of breath.
• You feel pain in the area around your pacemaker.
• You have a fever over 101.0 F, or other signs of infection (redness, swelling or warmth at the incision site).

After the procedure

• You will stay in the hospital a day or two.
• Your pacemaker settings will be rechecked.
• On the incision side, don’t raise your arm above your shoulder for at least a week. This gives the lead a chance to secure inside the vein in your heart.
• Take your temperature and check your incision for signs of infection every day for a week.
• Return for a follow-up visit as directed by our staff.

Talk to your doctor about the risks and complications of angiography.

Peripheral angiography is an outpatient procedure that makes a “map” of the vessels (arteries) in your lower body and legs. This map can show where blood flow may be blocked.

Before the procedure

• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure. If your doctor says to take your normal medications, swallow them with only small sips of water.
• Arrange for a family member or friend to drive you home.

During the procedure

• You may get medication through an IV (intravenous) line to relax you. You’re given an injection to numb the insertion site. Then, a tiny skin incision is made near an artery in your groin.
• Your doctor inserts a catheter (thin tube) through the incision. He or she then threads the catheter into an artery while viewing a video monitor.
• Contrast “dye” is injected into the catheter. You may feel warmth or pressure in your legs and back. You lie still as x-rays are taken. The catheter is then removed.

Call your doctor if:

• You notice a lump or bleeding at the insertion site.
• You feel pain at the insertion site.
• You become lightheaded or dizzy.
• You have leg pain or numbness.

After the procedure
You’ll be taken to a recovery area. A doctor or nurse will apply pressure to the site for about 10 minutes. You will need to keep your leg still and straight for a few hours. Your doctor will discuss the results with you soon after the procedure.

Back at home
On the day you get home, don’t drive, don’t exercise, avoid walking and taking stairs, and avoid bending and lifting. Your doctor may give you other care instructions.

Talk to your doctor about the risks and complications of angioplasty.

Peripheral angioplasty is a procedure that helps open blockages in peripheral arteries. These vessels carry blood to your lower body and legs.

Before the procedure

• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure.
• Arrange for a family member or friend to drive you home.

During the procedure

• You may get medication through an IV (intravenous) line to relax you. After an injection numbs the site, a tiny skin incision is made near an artery in your groin.
• Your doctor inserts a catheter (thin tube) through the incision (insertion site), then threads it into an artery while viewing a video monitor.
• Contrast “dye” is injected into the catheter. X-rays are taken (angiography).
• A tiny balloon is pushed through the catheter to the blockage. Your doctor inflates and deflates the balloon a few times to compress the plaque. A stent (small metal or mesh tube) may be placed to help keep your artery open. The balloon and catheter are then removed.

After the procedure
You’ll be taken to a recovery area. Pressure is applied to the insertion site for about 15 minutes. You will need to keep your leg still and straight for a few hours. You will go home that day or spend the night in the facility. You will be instructed what to do when you go home.

Call your doctor if:

• You notice a lump or bleeding at the site where the catheter was inserted.
• You feel pain at the insertion site.
• You become lightheaded or dizzy.
• You have leg pain or numbness.

What Is EECP therapy?
Peripheral arteries deliver oxygen-rich blood to the tissues outside the heart. As you age, your arteries become stiffer and thicker. In addition, risk factors, such as smoking and high cholesterol, can damage the artery lining. This allows plaque (a buildup of fat and other materials) to form within the artery walls. The buildup of plaque narrows the space inside the artery and sometimes blocks blood flow. Peripheral Arterial Disease (PAD) occurs when blood flow through the arteries is reduced due to plaque buildup. It often happens in the legs and feet, but can also occur elsewhere in the body. If this buildup occurs in the carotid artery (a large artery in the neck), it can be a major contributor to stroke.

A healthy artery
An artery is a muscular tube. It has a smooth lining and flexible walls that allow blood to pass freely. When active, muscles need more oxygen, requiring increased blood flow. Healthy arteries can adapt to meet this need.

A damaged artery
PAD begins when the lining of an artery is damaged. This is often due to a risk factor such as smoking or diabetes. Plaque then starts to form within the artery wall. At this stage, blood flows normally, so you’re not likely to have symptoms.

A narrowed artery
If plaque continues to build up, the space inside the artery narrows. The artery walls become less able to expand. The artery still provides enough blood and oxygen to your muscles during rest. But when you’re active, the increased demand for blood can’t be met. As a result, your leg may cramp or ache when you walk.

A blocked artery
An artery can become blocked by plaque or by a blood clot lodged in a narrowed section. When this happens, oxygen can’t reach the muscle below the blockage. Then you may feel pain when lying down (rest pain). This type of pain is especially common at night when you’re lying flat. In time, the affected tissue can die. This can lead to the loss of a toe or foot.

An exercise stress test shows your heart’s response to exercise. The test records your heartbeat while you walk on a treadmill or ride a stationary bike. It can be done in a hospital, a test center, or a doctor’s office. The test is also called a stress electrocardiogram (ECG/EKG).

Before your test

• Be sure to mention the medications you take and ask if it’s okay to take them before test.
• Avoid food and drinks containing caffeine.
• Don’t eat, drink, smoke, or have any caffeine for 3 hours before test.

Getting ready

• Wear flat, comfortable walking shoes.
• Wear a shirt, blouse, or sweater that you can remove easily. You may be asked to remove your clothing from the waist up. Women may wear a gown.

During your test

• Electrodes (small pads) are placed on your upper body and a blood pressure cuff on your arm. These are used to monitor your heartbeat and blood pressure during and after the test.
• You are shown how to use the treadmill or bike.
• You are then asked to exercise for several minutes. Expect the exercise to be easy at first. It will slowly get harder.
• Exercise as long as you can, or until you are asked to stop.

Report any symptoms
During the test, be sure to tell the health care provider if you feel any of the following:

• Chest, arm, or jaw discomfort
• Severe shortness of breath
• Fatigue
• Dizziness
• Leg cramps or soreness

After the test

• You can resume your normal activity.
• The results are sent to your doctor.
• Be sure to keep your follow-up appointment.

If your blood pressure drops too low, your brain may not get enough oxygen-rich blood. Your body responds by losing consciousness briefly. You also slump or fall down. This problem is called syncope, fainting, or a blackout.

Warning signs
Syncope happens suddenly. But you may have warning signs first, including dimmed vision, lightheadedness, or a rapid heartbeat. Or you may have no warning signs at all. After syncope, you recover quickly. But you may feel tired.

Is it serious?
Syncope is a common problem with many possible causes. Often these causes are not serious. For instance, syncope can be caused by standing for too long or sitting up too fast. In some cases, you may never faint again. But if heart trouble causes syncope, this can be serious. To provide the best treatment, your doctor will want to learn why you fainted. If heart trouble is causing your syncope, treatment may even save your life.

Understanding heart rate and blood pressure changes
Your brain and body need a steady supply of oxygen-rich blood. Your heart rate and blood pressure adjust to maintain this steady supply throughout all your activities. The heart creates electrical signals that travel through it on pathways. These signals set the heart rate, and tell the heart when to pump blood. In response to your body’s needs, your brain may also trigger changes in your heart rate and blood pressure. This keeps your blood flow strong.

Tilt table testing is a simple test that helps the doctor pinpoint the cause of your fainting. It checks how changes in body position can affect your blood pressure. To do this, you are placed on a table that is tilted upward. The test tries to recreate fainting symptoms while your blood pressure and heart rate are monitored. The test can be done in a hospital or at your doctor’s office.

Before your test
Try to arrive 15 minutes early for your appointment. This will allow time to check in. For best results, prepare for the test as directed. Keep in mind:

• When you schedule the test, be sure to mention all the medications you take. Ask if you should stop taking any of them the day of the test.
• A few days ahead, arrange for a ride home after the test.
• After the midnight before the test, don’t eat or drink anything.
• On the day of the test, dress for ease and comfort. Wear a two-piece outfit, top and bottoms. You will need to undress from the waist up and put on a short hospital gown.

During your test
Tilt table testing takes about 60 minutes. The testing room is kept quiet and dimly lit. During the test:

• Small pads (electrodes) are put on your chest to monitor your heartbeat.
• A blood pressure cuff is put on your arm.
• An IV (intravenous) line may be placed in your other arm. The IV line delivers fluids.
• You’ll be asked to lie flat on the table. Your upper body and thighs will be held in place with straps.
• The table tilts until you are almost standing upright.
• You’ll remain upright for up to 60 minutes. In most cases, the test is over in 30–45 minutes.
• Occasionally, people are given certain medications and retested. These medications may make you feel shaky.

After your test
Any medications used during the test should leave your system within 15 minutes. If you were told to skip daily medications before the test, ask if you should start taking them again. You’re likely to be sent home right away. It’s a good idea to have a friend or family member drive. If you fainted during the test, you may want to rest for a few hours once you’re home.

Report any symptoms you have during the test

• Let the doctor or technician know if you notice:
• Overall weakness
• Nausea
• Dimmed vision
• Sweating or lightheadedness
• A rapid heartbeat
• Any other symptoms

Transesophageal echocardiography (TEE) is a test that allows your doctor to record images of your heart from inside your esophagus, or food pipe. These images help your doctor identify and treat problems such as infection, disease, or defects in your heart’s walls or valves. Allow 1–2 hours from your arrival to the time you can leave.

Before your test

• Mention all the medications you take and ask if it’s okay to take them before the test.
• Don’t eat or drink for 6–8 hours before the test. This includes water.
• Tell your doctor if you have ulcers, a hiatal hernia, or problems swallowing. Also, let him or her know of any allergies to any medications or sedatives.
• Arrange to have someone drive you home after the exam.

During your TEE

• When you arrive for your TEE, you will change into a hospital gown, and then be taken to the testing room.
• Your throat is sprayed with an anesthetic to numb it. You may be given a mild sedative through an IV (intravenous) line in your arm to help you relax. You may also be given oxygen. Then you’ll be asked to lie on your left side.
• The doctor gently inserts the probe into your mouth. As you swallow, the tube is slowly guided into your esophagus. The tube is lubricated to make it slide easily.
• You may feel the doctor moving the probe, but it shouldn’t hurt or interfere with your breathing. A nurse monitors your heart rate, blood pressure, and breathing. The test usually takes 20–40 minutes.

After the test

• You can eat and drink again when your throat is no longer numb.
• Be sure to keep your follow-up appointment.

What is a vascular ultrasound study?
This test examines the blood flow in the major arteries and veins in the body with the use of ultrasound (high-frequency sound waves). A vascular ultrasound study is ordered to diagnose blockages in a blood vessel that might cause a variety of symptoms or problems.

This procedure uses sound waves to obtain images and measure the blood flow. These images are analyzed to determine whether or not you have blockages in your arteries, blood clots in your veins, or if an aneurysm is present. An instrument that transmits high-frequency sound waves called a transducer is placed over an artery or vein.The transducer receives the echoes of the sound waves and transmits them as electrical impulses. The ultrasound machine converts these impulses into images that are recorded by the technologist.

The heart has a special system that creates and sends electrical signals. First, signals tell the atria (singular: atrium) to squeeze. This moves blood to the ventricles. Next, signals tell the ventricles to squeeze. This moves blood to the lungs and body.

Electrical signals
Groups of special cells in the right atrium, called nodes, send the heart’s electrical signals. The signals travel along pathways. In the ventricles, these pathways are called bundle branches.

The SA node
This sets the pace of the heartbeat. It starts each beat by releasing a signal telling the atria to squeeze.

The AV Node
This receives the signal from the atria. It is the “gateway” between the atria and the ventricles. The AV node channels the signal into the ventricles.

The bundle branches
These carry the signal through the ventricle walls. As the signal moves through the ventricles, the ventricles squeeze.