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What are the signs of a heart attack?
Can I take Viagra?
What do I need to do to see a cardiologist for the first time?
What is a PTCA and why do I need one?
What is a Stent and why do I need one?
What is an EP study and why do I need one?
What is Atrial Fibrillation?
Why do I need to take Coumadin?
Who will follow my INR (Coumadin) levels?
What is an Ablation?
What is a heart catheterization and why do I need one?
How do I prepare for a heart catheterization?
Is it normal for there to be some bruising at the site of my heart catheterization?
How do I prepare for an echocardiogram?
How long will my echocardiogram take?
What is a contrast echocardiogram?
How do I prepare for a stress test?
How long will my stress test take?
How do I prepare for a nuclear stress test?
Is the substance tracer in nuclear stress tests the same as the dye used for catherizations? Will I be allergic to the substance tracer?
How long will my nuclear stress test take?
How long will it take for me to get my test results?
I have had a permanent pacemaker implanted. Can I use a cell phone? What about going through a metal detector?
Why does my dentist want to know if I need antibiotics before dental work?
Are the commercial blood pressure machines in stores accurate?
Can I use the little nitro pills under my tongue if I am using the nitro patch?
If I have chest pain, how many nitro pills may I take at once?
Why do I have to weigh every day with congestive heart failure?
Will my cardiologist refill all my medications?
Can I take generic brand medicines?
Can I take over the counter medication for colds/sinus?
I have an appointment with a mid-level provider – who/what is that?
Why am I seeing a mid-level provider?
What if I cant walk on a treadmill?

What are the signs of a heart attack?
Heart attacks are usually associated with chest pain that is in the center of the chest or just to the left of center. The pain is usually a dull, oppressive pain that may feel like pressure or weight on the chest. Patients may also have left arm pain, shoulder pain or jaw pain. Right arm pain has also been reported. Shortness of breath is often associated with the pain and patients may have sweating and/or nausea and vomiting. It should be noted that each person is different and any unusual symptoms that cause concern such as dizziness, feeling faint, or profound fatigue should be reported to your physician.

Can I take Viagra?
Viagra is a medication that also causes a drop in the patient’s blood pressure. It is important for patients to ask on an individual basis whether it is a medication that they can safely take with their other medications. If you are taking a nitroglycerin preparation, Viagra will not be prescribed.

What do I need to do to see a cardiologist for the first time?
Pioneer Valley Cardiology requires that patients coming in for the first time have been properly screened by their primary care physicians. Many other medical conditions can mimic heart disease/pain. Patients can save time by being properly screened.

What is a PTCA and why do I need one?
A PTCA or an angioplasty is a non-surgical procedure where a special balloon tipped catheter is inserted into the coronary artery through the groin. The procedure, which takes 1-4 hours, is used to open an area of the artery that has a narrowing due to a buildup of plaque. Once in place at the sight of the narrowing, a balloon is inflated to flatten the plaque against the artery walls to restore normal blood flow to the heart muscle.
Depending on the size and location of the blockage, a stent may also be inserted to help provide support for the artery.

What is a Stent and why do I need one?
A coronary stent is a tiny, flexible wire mesh tube. It is permanently placed at the sight of a narrowing of the artery to help keep it open. Some stents are drug-eluting (coated). These stents slowly release medication over a period of time to reduce scar tissue that forms inside the artery. This helps prevent a reoccurrence of plaque buildup.

What is an EP study and why do I need one?
An EP Study is a non-invasive procedure that provides information in treating heart rhythm disorders. The data collected provides your physician the information needed in diagnosing the source of the arrhythmia and in developing the best treatment plan for your condition.
An EPS is performed by a specialist (an Electrophysiologist) under conscious sedation in a hospital setting. A catheter is inserted in through the groin or neck into a blood vessel and navigated to the heart with the aid of a fluoroscope. Electrodes at the tip of the catheter gather data and may also be used to induce the arrhythmia that is the cause of the heart rhythm problem. The procedure can take anywhere from 1-4 hours

What is Atrial Fibrillation?
Atrial Fibrillation is an irregular and rapid heartbeat caused by a faulty electrical flow in the heart. It does not allow blood to move through the heart in a normal way which may increase the risk of blood clots and stroke. Symptoms may include shortness of breath on exertion, palpitations, and episodes of dizziness or fainting.
Appropriate treatments include medications to control the heart rate, pacemaker therapy, catheter ablation, or cardioversion which uses electric shock to restore a normal rhythm

Why do I need to take Coumadin?
Coumadin is an anticoagulant or blood thinner, which helps prevent clots from forming in the blood. It is used to help prevent and treat blood clots in the legs and lungs associated with an irregular heartbeat called Atrial Fibrillation associated with heart-valve replacement. The most common side effect of Coumadin is bleeding. Therefore, careful monitoring of the drug’s level in the bloodstream is required. Frequent blood test called INRs will assist your physician in the proper dosing of this medication.

Who will follow my INR (Coumadin) levels?
CCoumadin levels will be closely monitored by your Physician or mid-level provider. (INR = International Normalization Ratio)

What is an Ablation?
A cardiac ablation is a non-surgical procedure used to destroy the sight of abnormal electrical pathways that may be causing an irregular heartbeat. A specialist known as an Electrophysiologist inserts a catheter into a blood vessel, usually through the groin or neck. The wire is then threaded through the blood vessel into the heart. Once the location of the faulty electrical sight is pinpointed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical flow and restoring a healthy heart rhythm.

What is a heart catheterization and why do I need one?
A heart catheterization – otherwise known as cardiac catheterization, coronary angiogram or coronary arteriograms – is an invasive test done to determine whether there are any blockages in the coronary arteries or valvular heart disease. This test takes 1-2 hours. A small plastic catheter is inserted into the femoral artery and threaded up to the heart. X-ray dye is then injected into the coronary arteries and an x-ray is taken to show whether there is any narrowing or blockage of the artery. If valvular heart disease is suspected, pressure readings are taken within the heart to determine how severe the problem is. This information enables your cardiologist to appropriately treat you either with invasive therapy or with medications.

How do I prepare for a Heart Catheterization?
Patients having a heart catheterization are asked to fast from midnight the night before their test. We want you to take your usual morning medications; however, we ask that you do not take any medication for diabetes that morning. If you take Coumadin, you will need to be off this medication for five full days prior to the procedure. If you are allergic to iodine, be sure to let your physician or nurse know as the “dye” does contain iodine.
You may be asked to take additional medications to block this reaction, or medication may be given to you through the IV. Please bring a list of your current medications when you come for your catherization. Following the procedure you will be instructed about what medicine to take and when to start taking them.

Is it normal for there to be some bruising at the site of my heart catheterization?
It is not uncommon for patients to notice a small amount of bruising at the catheterization insertion site. The catheter enters an artery where the pressure is high and there is always a small amount of blood that escapes into the tissue. If there is a large, painful area around the catheterization site that worsens or becomes more painful with time, notify your cardiologist.

How do I prepare for an echocardiogram?
There is very little prep for an echocardiogram. You will need to get undressed from the waist up. Women will be given jonnies to wear. You will lie on a table on your left side. Images of your heart will be taken with an ultrasound machine. You will be able to hear the sound of your blood as it goes through your heart. There may be a 20% chance that you would need a contrast echo, which would involve starting an IV. We would then inject a contrast agent through the IV to better see the lining of the heart.

How long will my echocardiogram take?
We schedule an hour for an echocardiogram. This is the average time the test will take.

What is a contrast echocardiogram?
Twenty percent (20%) of the population has difficult acoustic windows, the space between a patient’s ribs. When this happens, we can perform an echocardiogram using a contrast agent, administered through and IV. This helps the physician reading the study to better see the walls of your heart.

How do I prepare for a stress test?
You may be asked to hold certain medications, usually Beta Blockers. You will be asked to have a light breakfast or lunch depending on the time of your stress test. You will need to wear rubber soled shoes, sneakers are great. You will have to get undressed from the waist up. Women will be given jonnies to wear.

How long will my stress test take?
A regular stress test takes about a half an hour. A nuclear stress test takes about three hours. A stress echo takes about one hour.

How do I prepare for a nuclear stress test?
Patients must be fasting for three hours prior to the test. Patients must also be free of caffeine of any type for 12 hours prior to testing. This includes coffee, tea, chocolate, white chocolate, aspirin compounds that contain caffeine, decaffeinated coffee or tea and other sodas which contain caffeine. Patients who are taking medications for lung problems, diabetes or congestive heart failure may need to alter their medications. A complete set of written instructions will be given to patients when the test is scheduled.

What substance/tracer is used in nuclear stress tests?
The nuclear imaging agent is a radioactive tracer; this is not a dye. Rarely do patients have an allergic reaction or adverse effect to this substance.

How long will my nuclear stress test take?
Nuclear stress testing can take anywhere from 3-4 hours to complete.

How long will it take for me to get my test results?
Pioneer Valley Cardiology attempts to have your test results ready for reporting within two working days.

I have had a permanent pacemaker implanted. Can I use a cell phone? What about going through a metal detector?
There is no hard and fast rule about cell phones and pacemakers. It is felt that you can use a cell phone, but use the ear opposite the pacemaker or defibrillator. Metal detectors will not harm a pacemaker or defibrillator as long as you are passing quickly through the detector. If you are concerned you can notify the people at the detector, and they will usually allow you to pass around the detector.

Why does my dentist want to know if I need antibiotics before dental work?
Patients who have valvular heart disease or have had a valve replaced are at increased risk for infection of the heart valve. Any manipulation of the gums may cause release of bacteria into the blood stream and set up the risk for infection. Guidelines have recently changed. Our physicians determine if this is necessary for each patient with these medical conditions.

Are the commercial blood pressure machines in stores accurate?
Blood pressure machines in large stores are okay for screening purposes and are usually fairly accurate; however, if your blood pressure reads high, you should have it checked by your physician to be sure of the accuracy.

Can I use the little nitro pills under my tongue if I am using the nitro patch?
Yes, you may use nitro pills under your tongue for chest pain while you are wearing a nitro-patch. The pills are fast acting and rapidly dilate your blood vessels to allow more blood to pass through the vessel. Nitro-patches are long acting and do not cause the rapid dilation needed for relief of chest pain.

If I have chest pain, how many nitro pills may I take at once?
Nitroglycerine tablets under the tongue are usually taken, one tablet, every five minutes up to a total of three tablets. If the patient is still having chest pain, they should call 911.

Why do I have to weigh every day with congestive heart failure?
Congestive heart failure, or CHF, is a condition in which the heart muscle is weak and cannot pump effectively. If the heart is not able to keep up with the amount of fluid it has to pump, the fluid will escape into the tissue causing swelling. The earliest sign that this is occurring is weight gain because of the extra fluid.

Will my cardiologist refill all my medications?
Pioneer Valley Cardiology cardiologists prefer to refill only those medications having to do with your heart. Medications for conditions such as elevated blood pressure, elevated cholesterol, blood thinners or other medications which our doctors prescribe will also be refilled. Medications having to do with other conditions which have been prescribed by your primary care doctor should be refilled by that doctor.

Can I take generic brand medicines?
Most generic medications are fine for you to take. There are a few medications that we prefer be given as name brand. Your cardiologist will indicate this, if necessary.

Can I take over the counter medication for colds/sinus?
Over the counter medications for colds and sinus may contain medications that act as cardiac stimulants and/or cause constriction of your blood vessels. It is best to call and ask what medications you may take.

I have an appointment with a mid-level provider – who/what is that?
Mid-level provider is a term used to apply to advanced trained professionals who are physician assistants or nurse practitioners. They offer high quality, cost effective health care through a team approach by collaborating with physicians. They obtain medical histories and conduct physical examinations. They are trained to assess the health status of a patient, deliver preventive care, counsel patients on psychosocial and health problems diagnose and treat acute illnesses, and manage chronic illnesses.

Why am I seeing a mid-level provider?
Mid-level providers are licensed professionals who work in conjunction with the physicians to provide care on a timely basis, improve patient access, assist with patient care follow-up and provide patient education. Mid-level providers are supervised by a physician. This means all services are rendered under a physician’s supervision and control.

What if I cant walk on a treadmill?
For patients who are unable to walk on a treadmill, a chemical stress test may be performed and the same results will be achieved.