Preventive Cardiology

The Preventive Cardiology program is an integral part of Cardiovascular Medicine to help prevent cardiovascular diseases.This includes research and educational programs, each of which is focused on reducing death and disability from heart and vascular disease.

The Preventive Cardiology program usually encompasses the following services: preventive cardiology clinics, which include lipid, hypertension, nutrition and risk reduction clinics; inpatient and outpatient cardiac rehabilitation; pulmonary rehabilitation, risk factor and vascular screening programs, exercise stress testing, exercise prescription and counseling, smoking cessation, stress management and several other clinical, research and educational programs.

Hypertension

Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia.

One of the most dangerous aspects of hypertension is that you may not know that you have it. In fact, nearly one-third of people who have high blood pressure don’t know it. The only way to know if your blood pressure is high is through regular checkups. This is especially important if you have a close relative who has high blood pressure.

Hypercholesterolemia/ Hyperlipidemia

Hypercholesterolemia is the most common inherited type of hyperlipidemia (high fat or lipid levels in blood). It predisposes to premature arteriosclerosis including coronary artery disease with heart attacks at an unusually young age. About half of men and a third of women suffer a heart attack by age 60.

Persons with familial hypercholesterolemia can reduce their risk by adhering to a very low cholesterol diet under a doctor’s supervision, and may also need to take medications that reduce their cholesterol level. Familial hypercholesterolemia is recognizable in childhood. Children and other relatives at risk for familial hypercholesterolemia can be screened (checked) for the condition.

Coronary Artery Disease

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), refers to a group of diseases which includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It is within the group of cardiovascular diseases of which it is the most common type. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack.

Coronary artery disease (CAD) causes impaired blood flow in the arteries that supply blood to the heart. Also called coronary heart disease (CHD), CAD is the most common form of heart disease and affects approximately 16.5 million Americans over the age of 20.

It’s also the leading cause of death for both men and women in the United States. It’s estimated that every 40 seconds, someone in the United States has a heart attack.

A heart attack can come from uncontrolled CAD.

Cardiac Arrhythmia

Cardiac arrhythmia (also known as arrhythmia, dysrhythmia, or irregular heartbeat) is a group of conditions in which the heartbeat is irregular, too fast, or too slow. A heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia and a heart rate that is too slow – below 60 beats per minute – is called bradycardia. Many types of arrhythmia have no symptoms. When symptoms are present these may include palpitations or feeling a pause between heartbeats. In more serious cases there may be lightheadedness, passing out, shortness of breath, or chest pain. While most types of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in cardiac arrest.

There are four main types of arrhythmia: extra beats, supraventricular tachycardias, ventricular arrhythmias, and bradyarrhythmias. Extra beats include premature atrial contractions, premature ventricular contractions, and premature junctional contractions. Supraventricular tachycardias include atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia. Ventricular arrhythmias include ventricular fibrillation and ventricular tachycardia. Arrhythmias are due to problems with the electrical conduction system of the heart. Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. A number of tests can help with diagnosis including an electrocardiogram (ECG) and Holter monitor.

Syncope

Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It’s also called fainting or “passing out”. It most often occurs when blood pressure is too low (hypotension) and the heart doesn’t pump enough oxygen to the brain. It can be benign or a symptom of an underlying medical condition.

Syncope is a symptom that can be due to several causes, ranging from benign to life-threatening conditions. Many non life-threatening factors, such as overheating, dehydration, heavy sweating, exhaustion or the pooling of blood in the legs due to sudden changes in body position, can trigger syncope. It’s important to determine the cause of syncope and any underlying conditions. However, several serious heart conditions, such as bradycardia, tachycardia or blood flow obstruction, can also cause syncope.

Congestive Heart Failure

Inability of the heart to keep up with the demands on it, with failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs, such as the brain, liver, and kidneys. Abbreviated CHF. CHF may be due to failure of the right or left ventricle, or both. The symptoms can include shortness of breath (dyspnea), asthma due to the heart (cardiac asthma), pooling of blood (stasis) in the general body (systemic) circulation or in the liver’s (portal) circulation, swelling (edema), blueness or duskiness (cyanosis), and enlargement (hypertrophy) of the heart. The many causes of CHF include coronary artery disease leading to heart attacks and heart muscle (myocardium) weakness; primary heart muscle weakness from viral infections or toxins, such as prolonged alcohol exposure; heart valve disease causing heart muscle weakness due to too much leaking of blood or causing heart muscle stiffness from a blocked valve; hyperthyroidism; and high blood pressure.

Adult Congenital Heart Disease

Congenital heart disease (congenital heart defect) is one or more abnormalities in your heart’s structure that you’re born with. This most common of birth defects can alter the way blood flows through your heart. Defects range from simple, which might cause no problems, to complex, which can cause life-threatening complications.

Advances in diagnosis and treatment mean most babies who once died of congenital heart disease survive well into adulthood. However, signs and symptoms of the condition can occur in adults later in life, even those who had treatment as a child.

If you have congenital heart disease you might need care throughout your life. Check with your doctor to determine how often you should be seen as an adult.

Valvular Heart Disease

Valvular heart disease is any disease process involving one or more of the four valves of the heart (the aortic and bicuspid valves on the left side of heart and the pulmonary and tricuspid valves on the right side of heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Anatomically, the valves are part of the dense connective tissue of the heart known as the cardiac skeleton and are responsible for the regulation of blood flow through the heart and great vessels. Valve failure or dysfunction can result in diminished heart functionality, though the particular consequences are dependent on the type and severity of valvular disease. Treatment of damaged valves may involve medication alone, but often involves surgical valve repair (valvuloplasty) or replacement (insertion of an artificial heart valve).

Mitral Valve Prolapse

Mitral valve prolapse (MVP) occurs when one of your heart’s valves doesn’t work properly. The flaps of the valve are “floppy” and don’t close tightly. Most people who have the condition are born with it. It also tends to run in families.

Most of the time, MVP doesn’t cause any problems. Rarely, blood can leak the wrong way through the floppy valve.

MVP puts you at risk for infective endocarditis, a kind of heart infection. To prevent it, doctors used to prescribe antibiotics before dental work or certain surgeries. Now, only people at high risk of endocarditis need the antibiotics.

In Hospital Procedures

Cardiac Catheterization

Cardiac catheterization is a procedure used to diagnose and treat cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.

Using this catheter, doctors can then do diagnostic tests as part of a cardiac catheterization. Some heart disease treatments, such as coronary angioplasty, also are done using cardiac catheterization.

Usually, you’ll be awake during cardiac catheterization, but given medications to help you relax. Recovery time for a cardiac catheterization is quick, and there’s a low risk of complications.

Tilt Table Test

The tilt-table test is a simple, inexpensive, and informative test that can help identify the causes of fainting. As its name implies, the tilt table test involves placing a patient on a table with a foot-support, then tilting the table upward. The tilt-table may start off in a horizontal position and be tilted by degrees to a completely vertical position. The patient’s blood pressure, pulse, and symptoms are monitored throughout the test.

The tilt-table test is designed to detect one of the most common causes of fainting or lightheadedness, a phenomenon known as postural hypotension (orthostatic hypotension). Tilt-table testing may be done when heart disease is not suspected of being responsible for an attack of fainting (syncope) or near-syncope.

Transesophageal Echo TEE

A transesophageal echocardiogram (TEE) uses echocardiography to assess the structure and function of the heart. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves. When the transducer is placed at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or “echo” off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer displays the echoes as http://njpremierheart.com/wp-content/themes/nj-premier-heart/images of the heart walls and valves.

A traditional echocardiogram is done by putting the transducer on the surface of the chest. This is called a transthoracic echocardiogram. A transesophageal echocardiogram is done by inserting a probe with a transducer down the esophagus. This provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. The TEE probe is much closer to the heart since the esophagus and heart are right next to each other.

Loop Recorder

A loop recorder is a type of heart-monitoring device that records your heart rhythm continuously for up to three years. It records the electrical signals of your heart and allows remote monitoring by way of a small device inserted just beneath the skin of the chest.

A loop recorder can help answer questions about your heart that other heart-monitoring devices don’t provide. It allows for long-term heart rhythm monitoring. It can capture information that a standard electrocardiogram (ECG or EKG) or Holter monitor misses because some heart rhythm abnormalities occur infrequently.