Q: What is a cardiac catheterization, or angiogram?

A: This test is usually performed in patients with chest pain, shortness of breath, positive stress test, or people with suspected heart valve abnormalities. The procedure involves placement of a catheter in the groin or wrist and injection of contrast dye into the coronary arteries and heart itself. The physician can visualize blockages in the arteries or abnormalities of the heart muscle or valves on specialized X-ray equipment. The procedure usually takes around 15-30 minutes.

Q: My heart failure doctor has prescribed a water pill. Does that mean I should drink more so I do not become dehydrated?

A: If you have heart failure and are taking a water pill (diuretic) you should not drink any extra fluids. The purpose of a water pill is to get rid of excess fluid in the body, if you increase you intake of fluids you will be preventing the pill from doing its job.

Q: My ejection fraction is 25% and my friends' is 15%. Why do I feel worse than she does? Isn't my heart working 10% better?

A: The ejection fraction number 10%, 20%, etc., does not necessarily have a correlation with how the patient feels or functions. Many other factors can affect how a patients feels/functions.

Q: What is an angioplasty, stent or coronary intervention?

A: After a diagnostic angiogram is performed, there are several possibilities. If there are no or mild blockages, medical therapy is advised and the procedure is complete. If there are numerous blockages, a blockage in unfavorable locations, or abnormal heart valves, a heart operation (bypass surgery or valve surgery) is advised. If there are blockages which are amenable to angioplasty then that procedure is usually performed immediately after the diagnostic angiogram.

Angioplasty is a procedure where a catheter with a small balloon at the tip is inserted at the site of a blockage. The balloon is properly sized and then inflated to open the blocked artery. The balloon catheter is then removed from the body.

This procedure is rarely performed by itself in 2005 due to an increased chance of a recurrence (restenosis) three to six months after the procedure. New metal devices called stents are utilized in over 90% of intervention procedures. The newest generation of stents which are permanently implanted metal coils coated with medications which inhibit restenosis are used in a majority of cases. The chance of a regrowth of the blockage after a medication coated stent is placed is under 5%. An intervention procedure usually requires at least a one night stay in the hospital.

Q:  How long will my stent last?

A: Forever, but there is still a small chance of restenosis (a new blockage forming). It is very important for you to take an active role in living a heart healthy lifestyle, as doing so will lessen your chance of restenosis. The stent (coronary) will never be removed.

Q: Will my stent set off a metal detector in the airport?

A: No, but if multiple stents have been recently put in place, the detector may be set off. After about three weeks, tissue will grow around the stent(s). This usually prevents the metal detector from going off. Don't worry if the metal detector goes off; just show your stent identification card to the airport personnel.

Q: When can I engage in more strenuous activity such as heavy lifting and sexual relations?

A: We advise avoiding these activities for a two-week period. Sexual activity is a more personal choice. Talk with your partner and resume when you both feel comfortable.

Q: When can I go back to work?

A: Usually, the day after discharge, as long as heavy lifting or other strenuous activity is avoided for at least two weeks.

Q: How long must I take Plavix?

A: Plavix should be taken between six and twelve months, unless otherwise instructed by your cardiologist. Do not stop taking Plavix without first checking with your cardiologist.

Q: Is it safe to take Plavix and aspirin together?

A: Generally speaking, it is safe to take Plavix and aspirin together. It must be understood that risk of bleeding is increased slightly, and bruising can occur more frequently.

Q: What do I do if I experience chest pain again?

A: Call 911, go to the emergency room, and/or call your cardiologist.

Q: What if my stent closes?

A: If restenosis occurs, an angioplasty and/or another stent procedure can be performed. Your physician will discuss what the best treatment would be for you.

Q: What is an echocardiogram and is radiation involved?

A: An echocardiogram is a common and painless test that uses very high frequency sound waves. The sound waves travel through the layers of the skin and muscle to produce an image of the heart that can be seen on a screen. In this sense, it is similar to radar or sonar imaging. There is no radiation involved with an echocardiogram.

Q: What does an echocardiogram show? Does it show blockage in the arteries of my heart?

A: No, it does not show blockages in the heart arteries but it can help diagnose areas of a previous heart attack. It can also diagnose many other forms of underlying heart disease. An echocardiogram can help diagnose leaky or tight heart valves, enlargement of the heart chambers, or poor heart muscle function.

Q: Are there special preparations necessary for a regular echocardiogram?

A: There are no special preparations needed for a regular echocardiogram. However, for other types of echocardiograms, you may be asked to avoid eating and drinking or stop certain medications.

Q: How long does the echocardiogram take?

A: The echocardiogram is performed and recorded by a specially trained sonographer. It may take from 30 minutes to an hour, depending on the information requested and the type of heart problem.

Q: When will my doctor get the results of the echocardiogram?

A: The sonographer or physician performing the test may explain what is seen as the test is being performed. However, it is important that precise measurements be made and that the current study is compared with prior echocardiograms you may have had. Formal written reports are sent to your referring physician within 24 hours of the date of your echocardiogram.

Q: What other types of echocardiograms are there?

A: There are three other types of echocardiograms performed by this lab:

1. Stress Echocardiogram: combines the echo exam with treadmill exercise or medications that simulate exercise. This test is used to diagnose the presence and severity of coronary artery blockages.
2. Contrast Echocardiogram: combines the echo exam with intravenous administration of a sterile contrast solution. This solution may be needed to better visualize your heart.
3. Transesophageal Echocardiogram: utilizes a special miniaturized echo transducer that is passed down the esophagus (feeding tube) to better image the heart. This test is most often used to evaluate patients with prior neurologic events (strokes or transient ischemic attacks), heart valve replacements, infections of the heart, or abnormal rhythms.