Ask the Expert

 Q: I was just told that I am at high risk of developing heart disease. What should I do?

A: Dr. Colman Ryan: There are some risk factors that you can’t change, like having a family history of heart disease or being postmenopausal. The good news is that with careful lifestyle changes, you can stop or reverse the narrowing of your arteries. For example, you can stop smoking, improve your diet, exercise and reduce the stress in your life. Treatment of high cholesterol with drugs called statin and treatment of high blood pressure can markedly reduce the risk of heart attack and stroke.

Q: I am scheduled for a diagnostic cardiac catheterization procedure. What should I expect?

A: Dr. Colman Ryan: A diagnostic cardiac catheterization can help identify heart conditions. During the procedure, a narrow tube, called a catheter, is guided through blood vessels in your arm or leg until it reaches the coronary arteries. A special dye is injected into the coronary arteries to view any blockages. Injection of a larger volume of contrast (“dye”) can sometimes lead to a transient flushing feeling. Often, patients receive treatment at the same time the diagnostic procedure is being performed.

Q: My doctor says the chest pain I have is called angina. Can you tell me more?

A: Dr. Colman Ryan:
Angina is chest pain that occurs when your heart muscle doesn’t get as much blood as it needs. It is usually because one or more of your heart’s arteries is narrowed or blocked. Sometimes it is described as an uncomfortable pressure, fullness or squeezing pain in the center of the chest. Sometimes the discomfort is in the neck, jaw, shoulder, back or arm. Angina often occurs during physical activity or times of emotional stress. Doctors treat angina with nitroglycerin and rest. A stress test is often ordered for evaluation. Procedures such as angioplasty with a balloon or stent or bypass surgery are sometimes needed to control angina.


Q: Are heart attack symptoms the same for women as they are for men?

A: Dr. Catherine Chimenti: Women may not complain as often of classic “chest pain” as men often do. Instead they might note a sense of a strange pressure, or squeezing or tight feeling in upper chest, under the breast, or between the shoulder blades. Sometimes it feels like a too-tight bra. Other atypical symptoms are strange weakness and fatigue unlike any other. Some women note nausea, sweating, and shortness of breath or strange jaw and neck aches. For symptoms like these, one should promptly take an aspirin, and call 911.


Q: My doctor says I have a defective heart valve. What does that mean, and what caused it?

A: Dr. Catherine Chimenti: Valve disease has many causes. Valves are susceptible to damage for reasons which can range form congenital predisposition, injury (rheumatic fever, valve infection), or simply acquired wear and tear damage with aging. Valves become narrowed, leak, or have some combination of those problems. Narrowed valves can strain the heart as it takes more heart “effort” to move blood through narrowed valves. Leaking valves pose another type of stress on the heart. Your doctor will discover with an echocardiogram (heart ultrasound exam) the particular features of the valve disease. This will be useful for both diagnosis and management.

Q: Are arrhythmias and atrial fibrillation the same?

A: Dr. Catherine Chimenti: When something goes wrong with the heart’s electrical system, the heart does not beat regularly. It may beat too slowly, too fast or erratically. This is called an arrhythmia. Atrial fibrillation is a type of arrhythmia that causes a fast and irregular heartbeat. Often, the heart quivers instead of beating effectively to move blood through the ventricles. This can increase a patient’s risk for developing stroke and eventual or worsening congestive heart failure. It is important to identify the reason for the atrial fibrillation, as recommended treatments are individual to the patient and circumstances. Some atrial fibrillation rhythms are intermittent and some are chronic. Again management is variable per individual case by a cardiologist.

Q: What is endovascular therapy?

Dr GandhiA: Dr. Raju Gandhi: Endovascular therapy describes catheter-based minimally invasive techniques used for the treatment of blood circulation disorders. These procedures are often performed tore-open chronically blocked blood vessels (arteries) to the legs. In addition, endovascular therapy can be used to repair aneurysms, which are “bubbles” that form in arteries with weakened walls. If not repaired, these aneurysms can burst and can be potentially fatal. These procedures can be done without the need for general anesthesia or incisions. Patients are often discharged the same day with minimal recovery time.

Q: What is an angioplasty?

A: Dr. Raju Gandhi:Angioplasty is a minimally invasive procedure performed under local anesthetic to open up the narrowed section in your artery. This procedure improves blood flow that helps to relieve any symptoms (usually pain) you may be experiencing.

A fine plastic tube (catheter) is inserted over a wire through a blockage in an artery and a small balloon on the catheter is then inflated which in turn relieves the blockage in the blood vessel.

Q: What is PAD?

A: Dr. Raju Gandhi: Peripheral artery disease (PAD) is a condition in which blood flow to the limbs is reduced due to narrowing of the arteries. While in many cases, PAD can be treated successfully with lifestyle changes (quitting smoking, eating healthier, exercising, etc.), in some cases, more intensive treatment options are necessary.

Treatment options for peripheral artery disease include:

  • Stenting
  • Balloon angioplasty
  • Bypass surgery
  • Atherectomy

Q: What are the signs of Stroke?

A: Dr. Raju Gandhi: The most common symptoms of stroke can be remembered by the acronym FAST:

  • F = Face: Is one side of the face drooping down?
  • A = Arm: Can the person raise both arms, or is one arm weak?
  • S = Speech: Is speech slurred or confusing?
  • T = Time: Time is critical!! Call 9-1-1 immediately!

All of the major symptoms of stroke can appear suddenly without warning and they are often not painful but still need to be taken seriously. If you think someone is experiencing any of these symptoms, or you are experiencing them call 9-1-1 immediately.

Q: What is a Hemorrhagic Stroke?

A: Dr. Raju Gandhi: A hemorrhagic stroke occurs when a blood vessel that carries oxygen and nutrients to the brain bursts and spills blood into the brain. When this happens, a portion of the brain becomes deprived of oxygen and will stop functioning. Hemorrhagic stroke accounts for about 20% of strokes. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body can occur.Dr Gandhi

Q: What is a Transient Ischemic Attack?

A: Dr. Raju Gandhi: Transient Ischemic Attacks (TIAs) are often called mini-strokes. The symptoms are the same as for a major stroke but only last for a short duration.

TIAs generally don’t cause severe brain damage, but they are a warning sign of a future stroke and should be taken seriously. Even if symptoms disappear quickly, it is important to seek medical care immediately to prevent a future major stroke.

Q: What are varicose veins?

A: Dr. Raju Gandhi: Varicose veins are caused by poorly functioning vein valves, which allow stagnation and pooling of blood and dilatation of veins. Risk factors for the development of varicose veins include family history, prolonged periods of standing, pregnancy and female gender. A physical and ultrasound examination is important for the diagnosis of reflux in veins.

Symptoms: Varicose veins may appear swollen, inflamed and discolored, and in some cases, can be quite painful. Some patients report a sensation of fullness or heaviness in the area in which the veins appear, as well as swelling or discoloration of the skin.

Q: What are the various treatments for varicose veins?

A: Dr. Raju Gandhi:

  • Laser treatment
  • Sclerotherapy
  • Radiofrequency venous closure procedure
  • Graduated compression stockings