Cardiology Physicians & Surgeons - Morristown, New Jersey - Morristown Cardiology Associates, P.A.

Is My Chest Pain Due To A Heart Problem?

Heart pain which is due to reduced oxygen supply to the heart muscle is called angina pectoris, and typically involves a pressure-like sensation in the middle or slightly left of the middle of the chest, sometimes causing associated pain in the arm, jaw or neck. Sometimes associated with this is shortness of breath, sweating, dizziness or nausea. Usually this occurs initially with exercise and last minutes at a time. Angina pectoris is caused by a blockage in one or more of the arteries (coronary arteries) which feed the heart muscle. These blockages are usually due to cholesterol plaquing, scar tissue with possible calcified (bone-like) components, and some element of new or old clotted blood.

In addition, heart pains can be due to other heart problems, such as increased heart pressures, inflammation of the lining of the heart, fluid build-up in the lungs, tearing of blood vessels and other causes. Disorders of the esophagus, stomach, ribs, lining of the lungs and pinched nerves in the neck may mimic heart pain. It is the responsibility of your cardiologist to determine the cause of the pain, heart-related or not, then make decisions as to the proper means of treatment.

What Is A Stress Test?

For a patient who is stable at rest and not having angina pectoris, the blood supply to his heart muscle may be adequate. With increased need for oxygen and blood, such as with exercise, this once adequate supply can become inadequate and, as result, the heart muscle suffers from lack of oxygen, and angina pectoris occurs.

An excercise treadmill test is a controlled method of assessing your heart's response to exercise. With graduated increases in both the rate and elevation of walking on a moving treadmill, your heart has a gradually increasing oxygen need. During this stress test heart rate, your blood pressure, EKG and symptoms are all monitored to look for any indications of a blockage problem (coronary disease). This mode of testing is believable when an adequate exercise level is achieved.

What Is A THALLIUM, SESTAMIBI or MYOVIEW Stress Test?

Although treadmill testing is believable, it does have its limitations and some patients will not be properly diagnosed as either having or not having coronary artery disease. In addition, the EKG and blood pressure changes are not specific in quantitating how much muscle is suffering or exactly where in the heart the suffering is occurring. By injecting radioactive material (such as Thallium, Sestamibi or Myoview) during a stress test, and comparing these images to those taken when the patient is at rest, your doctor is better able to make the right diagnosis and be more accurate as to the location and size of the blockage problem.

Also, distinctions can be made with these techniques to differentiate living muscle from scarred/dead muscle (as in a previous heart attack). Generally these tests require 3-4 hours of your time, including 2 injections of radioactive material and 2 cycles of lying under a scanner, as well as one stress test. Another means of assessing the same information is with a stress echocardiogram, which your doctor may prefer to do. During these tests, you are exposed to a limited amount of radiation, probably similar to having had 2 chest x-rays.

What Is An Echocardiogram?

By directing harmless sound waves, at too high a frequency to be heard (so-called "ultra sound"), at your heart through the chest wall, another means of imaging the heart can be performed, and not involving any intravenous injection. This technique enables your doctor to see the sizes and contraction of all of the heart chambers, the size and function of the heart valves, and many other structural abnormalities, such as clots, tumors, fluid collections, or unusual heart structures that you may have had since birth (and never knew about). This ultra-sound technique is safe with no known risk of exposure (fetal ultra-sound involves the same machinery and testing.) If an echocardiogram is done at rest and then immediately after an exercise treadmill test, this "stress echo" can be used to look for signs of coronary artery disease and blockages.

What Is A Doppler Study?

High frequency sound waves (ultrasound) can also be used during an echocardiogram study to assess the proper or improper flow of blood across valves, and possibly between heart chambers (due to a hole in the wall). Utilizing the same techniques that are used to detect underwater objects and weather formations, this Doppler approach can provide valuable information beyond that provided by the echocardiogram itself.

What Is Meant By And What Are The Risk Factors For Heart Disease?

These risk factors include cigarette smoking, high blood pressure (hypertension), elevated cholesterol (hypercholesterolemia), diabetes mellitus, increased weight and family history. Other important risks include sedentary behavior, post-menopausal condition (for women), low HDL (high density lipoprotein), and possibly high levels of scrum homocysteine (a new concept) - although these are not officially included as official risk factors.

These risk factors represent a statistical liklihood of developing artery blockage in the heart, as well as throughout the body. Having these risk factors does not mean that you WILL have this problem, only that you have an INCREASED RISK. Likewise, NOT having these risk factors does not mean that you will NOT have this problem, only that you have a DECREASED RISK.

What Should My Blood Pressure Be?

Current guidelines suggest that blood pressure should be 130/85 as the desired levels, although 140/90 are the official cut-off points. For diabetes and patients with renal failure, the desired level is 120/80.

Measurements are typically taken with a sphygomomanometer with the patient in a supine or sitting position. Three measurements, sometimes taken over several office visits, are often used as criteria for beginning or not beginning treatment.

What Are The Treatments For High Blood Pressure (Hypertension)?

Treatment may begin with behavioral modification focusing on the risk factors for hypertension. These changes would involve weight reduction, increased exercise, salt restriction, reduction of alcohol and caffeine, stress reduction. Should behavioral modification fail or if the blood pressure is too high to wait, then drug therapy will be initiated. This involves your doctors decision to treat your blood pressure problem with a personalized approach, depending upon many factors such as your age, race and associated medical disorders. These drug therapies may require subsequent increases in the dosing of a particular drug, changing drugs, or adding one or more additional drugs. Generally this is accomplished in the outpatient setting over a series of office visits, sometimes over a period of weeks or months. Careful monitoring of excessive or side effects and blood testing is closely attended to.

What Should My Cholesterol Be?

Depending on your personal condition, particularly as to whether you do or do not have blockage disease or heart risk factors, your doctor has certain guidelines for the recommended levels of cholesterol. These guidelines do not focus on the total level of cholesterol but mainly the level of "bad cholesterol", namely the LDL level (Low Density Lipoprotein). If you only have one risk factor for heart disease, this LDL level should be 159. If you have two risk factors, the LDL level should be 129. If you have diabetes mellitus, or known coronary artery disease, or known peripheral artery disease, the LDL level should be 99. THESE GUIDELINES MAY CHANGE IN THE NEAR FUTURE TO RECOMMEND EVEN LOWER LDL LEVELS!!

Your doctor will also measure levels of HDL (High Density Lipoprotein) and Triglycerides (another fat cirulating in the blood). These are important levels to know and may factor into the final overall opinion of your cholesterol status. And they may play an important role in the treatment that your doctor decides upon for you. However, these are considered not as important as the LDL level.

Cholesterol levels should always be obtained after an overnight 12 hour fast.

What Treatments Will I Need To Control My Cholesterol?

Treatment of cholesterol always begins with behavioral modification including appropriate weight control, low fat/cholesterol diets, appropriate exercising, restrictions on excess alcohol, and potentially the changing of certain medications. With the failure of these behavioral modifications, your doctor will begin drug therapy, tailored to your particular cholesterol problems. For LDL problems, usually this involves a member of the STATIN family, as this class of drugs is well established as safe and effective, and is taken once a day. These statin agents include LIPITOR (atorvastatin), ZOCOR (simvastatin), PRAVACHOL (pravastatin) MEVACOR (lovastatin), and LESCOL (fluvastatin).

Alternative initial therapies might include QUESTRAN (cholestyramine) or COLESTIPOL (colestid) which are binding agents, in granule form; these, however, are usually the 2nd or 3rd agents. Other therapies include LOPID (gemfibrozil), TRICOR (fenofibrate), or NIASPAN (niacin), which are generally utilized for changes in HDL and Triglycerides. Combination therapies are very frequently required to achieve the desired goals of therapy. And all drug therapies are part of an overall program of continued behavioral modification.