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Answers from a Heart Expert

Get answers to some of the most frequently asked heart questions:

Lifestyle

What is a normal heart rate and what should be my maximum heart rate?
Why does it take longer for the heart rate in an older person to recover from exercise?
What precautions or restrictions are associated with heart disease?
Should I get a cardiac evaluation before beginning an exercise program?
What exercises are appropriate for cardiovascular health?
How does smoking affect the likelihood a person will have a heart attack?
What steps should I take to lower my blood pressure?
What effect does caffeine have on your heart rate?

Conditions

What does it mean when you have a leak in your heart?
How low can a person's heartbeat go and still sustain a life?
What is atrial rhythm compared to ventricular rhythm on an ECG? What does it mean in relation to cardiac synchronization?
What is the term for stopping and restarting the heart?
I was told I have a heart murmur or a stiff heart valve. What is the difference in these terms?
I had quadruple bypass surgery. What would be considered a normal blood pressure reading for me?
Can a person have a high resting heart rate and not have any type of medical problem?
Can blood clots calcify or harden permanently if they were not able to be dissolved and can they break off or break apart at a later date?
Can panic attacks hurt the heart?
What is the average life span for men after a major heart attack?
What is angina?
What is tachycardia and why does extreme tachycardia prevent the heart muscle from getting the blood supply that it needs?
What is left ventricular hypertrophy?
What is right ventricular hypertrophy?
Can smoking cause enlargement of the heart?
What is hypertension?
What is meant by fluid around the heart (pericardial effusion)?

Symptoms

Is atrial-fibrillation a walk-in clinic or ER situation?
What does it mean when your heart valves are giving you an extra beat?
What are the signs of a heart attack?
Is it normal to have emotional changes after bypass surgery?
Could nausea, vomiting and diarrhea be symptoms of an impending heart attack?
Why does your left arm hurt before a heart attack?
Will a high fever make your heart beat faster ?
Should I be concerned about a "fluttering" feeling on the left side of my chest?
What is the typical pulse of a person with an enlarged heart?
What causes dizziness and rapid heart beat during sleep?

Tests & Treatment

What happens when the saphenous vein used as a bypass graft wears out (hopefully 10 to 20 years)? Does the patient then have a replacement installed?
What do I need to be concerned about for having counterclockwise precordial low voltage?
Can stopping the heart and starting it again with defibrillators cause damage?
When bypass surgery is needed, is it better to use synthetic veins or arteries?
During heart bypass surgery, do the surgeons commonly place a 'marker' on your heart that shows up in a subsequent X-ray?
How many times can angioplasty be done in a person's lifetime?
How many times can bypass surgery be done?
If you have been diagnosed with a coronary blockage, is there always some kind of treatment?
What medications are used for an enlarged heart?
What is the method used to repair heart valve leakage?
Is minimally invasive mitral valve repair offered by Providence?
What is the average lifespan of a pig valve replacement?
How long do mechanical heart valves last?
How long does atrial fibrillation last after heart surgery?
What is the average time in years that bypass veins are expected to last?
Why does nitroglycerin relieve pain associated with a heart attack?
When a leg vein is removed, what happens to the blood that flowed through it?
What is the success rate for stopping & restarting the heart to control its rhythm?
What is the average length of life after having a cardiac pacemaker inserted?
Are there any special precautions for a patient with a pacemaker who is going into surgery?
What is defibrillation?

Question: What does it mean when you have a leak in your heart?

Answer: I suspect the question applies to a leak of a valve in the heart. There are 4 valves in the heart, which are one way doors keeping the blood moving forward from one chamber to the other. These valves are like thin pieces of skin which open and close about 100,000 times a day. Over the years, these valves get pretty beat up, and can leak. Most all of us have some leak by late middle age. A mild or moderate leak is no big deal. A severe leak can cause heart failure. For more information, the American Heart Association website is great.

Dr. Frank (Mac) Sheridan, Cardiologist, The Everett Clinic


Question: How low can a person's heartbeat go and still sustain a life?

Answer: Usually we like to keep it 40 beats per minute or more, up to 90 beats per minute. If your heart rate gets lower than 40, you usually need a pacemaker. The really odd occurrences of people and low heart rates are the highly trained athletes with resting heart rates as low as 30 without problems.

Dr. Chris Price, Cardiologist, The Everett Clinic


Question: What do I need to be concerned about for having counterclockwise precordial low voltage?

Answer: This could mean one of two things. The first is benign in that the tech put the leads for the EKG in the wrong rib space which would cause this finding. The other is your heart is actually on the right side of your chest instead of the left. The best way to determine this is to have a chest X-ray. If your heart is on the proper side, then the EKG was done incorrectly.

Dr. Chris Price, Cardiologist, The Everett Clinic


Question: Is atrial-fibrillation a walk-in clinic or ER situation? Also, since a-fib symptoms are usually not the same as chest pain, what do you answer when a triage nurse asks if you are having chest pain?

Answer: A-fib can actually be both a walk-in clinic or an ER situation. It really depends on how fast your heart rate is. If it is less than 140, I would say the walk-in clinic should be good. Anything faster than that, I would recommend going to the ER. In terms of discussing chest pain with the triage nurse, I would tell that them that you are having chest pain.

Dr. Chris Price, Cardiologist, The Everett Clinic


Question: What is atrial rhythm compared to ventricular rhythm on an ECG? What does it mean in relation to cardiac synchronization?

Answer: Atrial rhythm comes from the top of the heart, and ventricular rhythm from the bottom. Cardiac synchronization has to do with the electrical signal progressing through the heart from the top to the bottom in an efficient timing. Sometimes this is affected by pacemakers.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: What is the term for stopping and restarting the heart?

Answer: The heart is only stopped during heart surgery which is called asystole. Converting an abnormal heart rhythm such as atrial fibrillation or ventricular fibrillation back to a normal rhythm (sinus rhythm) is called cardioversion. This later procedure does not stop the heart but stimulates all heart muscle to contract at the same time by giving an electrical shock across the chest.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: Can stopping the heart and starting it again with defibrillators cause damage?

Answer: Defibrillators do not stop the heart. They shock the heart back into normal rhythm when it goes into ventricular fibrillation. It does not appear that the low voltage shock from the defibrillators causes any significant damage.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: I was told I have a heart murmur or a stiff heart valve. What is the difference in these terms?

Answer: Murmur is the name we give for hearing the turbulence of blood flow in the heart with a stethoscope. Somestimes these are benign, such as blood flowing over valves which have stiffened with age, and sometimes they are due to a leak or inadequate opening of the valves.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: I had a heart attack in 1988 and later had quadruple bypass surgery. I changed my diet and I exercise but I still have problems with my blood pressure. What would a normal blood pressure reading be for me?

Answer: For those with a history of a heart attack (myocardial infarction) and left ventricular dysfunction, it is recommended that the blood pressure be maintained below 120/80.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: When bypass surgery is needed due to blocked arteries and the patient also has atherosclerosis, why would a diseased vein or artery be used as a replacement? Wouldn't it be better to use synthetic veins or arteries in the heart bypass?

Answer: We use arteries and veins that are spared from the effects of atherosclerosis (hardening of the arteries). Synthetic bypasses clog up very quickly.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: How long does it take for left ventricular hypertrophy to occur with untreated hypertension?

Answer: It is unknown. Usually, you have to have had the condition for at least five years.

Dr. Chris Price, Cardiologist, The Everett Clinic


Question: During heart bypass surgery, do the surgeons commonly place a 'marker' on your heart that shows up in a subsequent X-ray?

Answer: We commonly place a small surgical clip near the connection of the bypass graft to the aorta. This helps to identify the location of the graft if another angiogram is needed later.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: What does it mean when your heart valves are giving you an extra beat?

Answer: We all have what are called premature beats. These come from the heart muscle, not the valves, which are just passive, one-way doors. Premature beats often feel like a skipped beat, but are common and benign. Our usual heartbeat comes from muscle cells at the top of the heart, but on occasion an early beat can come from any muscle cell in the heart.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: What steps should I take to find out a change in my heart beat?

Answer: If you notice a change in your heart rhythm, see your primary care physician and have an EKG taken to determine if your heart rhythm is abnormal. For some abnormal rhythms, further treatment is needed and you may be referred to a cardiologist for this treatment.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is angina?

Answer: Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It is a discomfort in the upper body resulting from a lack of adequate blood supply to the heart muscle. Typical angina is uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts for a few minutes. The discomfort also may be felt in the neck, jaw, shoulder, back or arm. These symptoms usually come on initially with exertion or stress and are relieved by rest. Angina may occur in people with valvular heart disease, hypertrophic cardiomyopathy or uncontrolled high blood pressure. These cases are rare, though. People with episodes of chest discomfort should see their physician for an evaluation.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is left venticular hypertrophy? Can it reverse itself or get better with the right medication and diet? Will it affect my life expectancy?

Answer: Left ventricular hypertrophy (LVH) is enlargement (hypertrophy) of the muscle tissue that makes up the wall of your heart's main pumping chamber (left ventricle). Left ventricular hypertrophy develops in response to some factor, such as high blood pressure, that requires the left ventricle to work harder. The effect of LVH on life span depends on the cause of the hypertrophy and your age. When the cause is determined, appropriate medication (if indicated), regular exercise (if indicated), and diet will increase life expectancy. The older you are, the less effect LVH will have on life expectancy.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: If you have been diagnosed with a coronary blockage, is there always some kind of treatment?

Answer: Yes, there is always some kind of treatment if there is a blockage in one or more of the coronary arteries. If the blockage is severe enough then angioplasty or surgery may be indicated. All patients with blockage should do the following:

  • Stop smoking
  • Eat a heart healthy diet
  • Exercise regularly
  • Be sure that your blood lipids are in the optimal range (LDL, HDL, triglycerides)
  • Be sure that your blood is in a normal range
  • Loose weight if necessary to get into a healthy weight
  • Be sure that your blood sugar is in normal range

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: How many times can angioplasty be done in a person's lifetime?

Answer: There is no upper limit on the number of times angioplasty can be done.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: What is sterile fluid and why does it collect around a pacemaker pocket?

Answer: Sterile fluid will leak into any cavity created by an operation. Usually it is a trivial amount , but on occasion it can accumulate and threaten the incision. The pressure in large accumulations can open the suture line and "dehiss" or open the wound. So, sometimes drainage is recomended, although this can infect the site as well. Your doctor can weigh the risk of placing a needle or drain in the wound against the risk of infecting the wound.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: How does smoking affect the likelihood a person will have a heart attack?

Answer: Age, sex, hypertension, smoking, dyslipidemia, and diabetes are major risk factors for cardiovascular disease (CVD). When these risk factors cluster (two or more), an individual's risk is substantially higher.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: Does a scar on your heart mean you have had a heart attack?

Answer: If you are told that you have a scar on your heart it usually means that in the past you have had a heart attack. This assumes that you have not had heart surgery or trauma to the chest severe enough to cause damage to your heart which may leave a scar.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: I'm having ventricular ectopic beats, especially when I am lying down on my side; more on the left side than on the right side. What is the relationship between ectopic beats and body position?

Answer: Generally there is not a relationship between position and worsening or improvement of ventricular beats. Sometimes there is a greater sensation of the heart beat while on the left side because the heart is closer to the chest wall on that side.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: Why does it take longer for the heart rate in an older person to recover from exercise?

Answer: Generally, as a person ages, his/her vagal tone decreases. Decreased vagal tone means that the blood vessels become more “stiff” and lose their ability to dilate as well as they used to. Part of this is due to the natural aging process, but decreasing physical fitness and vascular disease make this worse. During and immediately following exercise, blood vessels need to dilate in order to deliver more oxygen-rich blood to the working or recovering muscles and heart. If blood vessel dilation is limited due to aging, poor fitness, and/or disease, the heart rate remains higher because the heart receives a “message” that not enough oxygen is getting to the muscles and itself. So, the heart compensates by beating faster in order to try to deliver more oxygen-rich blood. Heart rate recovery (HRR), defined as the fall in HR during the first minute after exercise, is a marker of vagal tone, which is a powerful predictor of mortality in patients with coronary artery disease and in older patients. Even with cardiovascular disease, an older person can improve vagal tone and improve heart rate recovery if he/she is able and willing to exercise regularly---as little as 30 minutes, most days of the week.

Greg Lawson, Program Specialist, Heart Life Services, Providence Regional Medical Center Everett


Question: I am a woman in her 70s who had a triple bypass a year ago. Why do I have a lack of energy and have to push myself in everyday activities?

Answer: This is a great question and one that my mother asked me a few years ago after her bypass. The operation was a massive stress to the body and it is not unusual to feel fatigued for several months to maybe even a few years. It depends on the condition of the heart before the operation as well. One of the first things to do is to have your doctor look at all of your medications to see if there is a way to decrease them. The beta blockers in particular can have this effect. I am not saying that they should all be discontinued as much as that the dose being lowered sometimes helps. A good physicial exam and bloodwork to make sure of no anemia or other issues is a good thing as well. And finally depression after this life threatening event should be addressed if present. It is much more common than you think after bypass.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: What is the success rate for stopping & restarting the heart to control its rhythm for a person in their late 70s?

Answer: The success is over 90% for restoring normal rhythm during an electrical criterion. The big issue is can the heart remain in normal rhythm after this procedure is completed. Sometimes anti-arrhythmic drugs or beta blocker drugs are needed to keep the heart in normal rhythm after the procedure. A cardiologist can discuss the benefits and risks of these medications. The risk of this procedure is less than 1% so it's even for older patients under mild anesthesia.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: What medications are used for an enlarged heart?

Answer: The treatment depends on the cause of the enlarged heart. For example, if the cause is a heart attack then the medicine would be those that control the risk factors of atherosclerosis; if the cause is congestive heart failure then the treatment would be medicines that would control the heart failure.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is right ventricular hypertrophy?

Answer: This condition is not as common as left ventricular hypertrophy, which is seen commonly with high blood pressure. When the right ventricle gets "large" or becomes hypertrophied, it usually means that there can be either a congenital problem with the heart or that a lung disease is present. Most common forms of right ventricular hypertrophy(RVH) are due to emphysemia or other problems with the lungs . Sometimes congenital disease such as a "hole in the heart" can cause this. In any case your cardiologist can preform certain tests to figure out why it may be present and an echocardiogram will be needed.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: What is the method used to repair heart valve leakage?

Answer: The most commonly repaired heart valve is the mitral valve. The repair technique generally includes making the valve opening smaller with a reinforcing ring and may also include removal of a section of the diseased valve leaflet.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: What causes dizziness and rapid heart beat during sleep?

Answer: Dizziness is unusual when you're actually asleep but not uncommon when you lie down. The dizziness could be from a problem with the middle ear. It could be a problem with the brain and the nerves from or to the balance center behind the ear. If you're only dizzy when lying down and not when standing up its unlikely to be your heart. A fast heart beat or rapid heartbeat during sleep could be from anxiety, dreaming, any arrhythmia, heart disease or heart failure or sleep apnea-not necessarily in that order. The combination of the two (dizziness & rapid heart beat) is not likely to be from your heart itself but more likely to be from whatever causes the dizziness.

Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Regional Medical Center Everett


Question: What precautions or restrictions are associated with heart disease?

Answer: Precautions and restrictions for heart disease will vary by the kind of heart disease and by the particular individual. For instance, a very active individual who has a heart attack may need to restrict their activity for a while but an inactive person will need to increase their activity level. In general, a healthy lifestyle is good for all forms of heart disease. These would include no smoking or second hand smoke, a healthy diet (lots of fruits and vegetables, [9-10 helpings a day], 100% whole grains and low in saturated and trans fat, refined flour and salt), regular exercise and control of blood pressure, weight and blood lipids. Each individual should review these topics with their physician to get the proper guidance for their situation. Those with coronary heart disease will almost always require medication to obtain optimal risk reduction.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: How long do you hurt after having a heart attack?

Answer: It varies in each individual. Many people can have a heart attack and not even experience any pain, some perhaps feeling fatigue or shortness of breath instead. Others may have pain off and on for years, even after the best available therapy, if parts of the heart remain without adequate blood supply. Prevention remains the best choice.

Dr. Steve Maxood, cardiologist, Western Washington Medical Group


Question: Will a high fever make your heart beat faster ?

Answer: Assuming that everything else is functioning normally, a fever will increase the heart rate.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: When a vein is taken out of the leg for use in bypass surgery, what happens to the blood that had been flowing through that vein. Is it automatically re-routed by the body through other veins?

Answer: When a leg vein is removed, the blood is automatically rerouted to other veins. This may take some time and leg swelling can occur during this time period.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: What is a normal heart rate and what should be my maximum heart rate?

Answer: When resting, the adult heart beats at about 70 bpm (males) and 75 bpm (females), but this rate varies among people (between 60 bpm (if less termed bradycardia) and 100 bpm (if greater, termed tachycardia). Resting heart rates can be significantly lower in athletes. The infant/neonatal rate of heartbeat is around 130-150 bpm, the toddler's about 100–130 bpm, the older child's about 90–110 bpm, and the adolescent's about 80–100 bpm.

The body can increase the heart rate in response to a wide variety of conditions in order to increase the cardiac output (the amount of blood ejected by the heart per unit time). Exercise, environmental stressors, psychological stress, or disease can cause the heart rate to increase above the resting rate. Some diseases will cause the heart rate to slow.

Maximum heart rate ( MHR) is the maximum heart rate that a person should achieve during maximal physical exertion. Research indicates it is most closely linked to a person's age; a person's MHR will decline as they age. Some research indicates the speed at which it declines over time is related to fitness—the more fit a person is, the more slowly it declines as they age.

A quick way to estimate MHR is to subtract your age from 220, but MHR can vary significantly between same-aged individuals.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: If you have cardiac bypass surgery, and you have had heart surgery before, where will they get the veins if both leg veins have already been used?

Answer: Mammary arteries in the chest and radial arteries from the arms may also be used for bypass grafts.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: How long do mechanical heart valves last?

Answer: Mechanical valves usually last a lifetime. There is probably a 2-5% lifetime risk of needing re-replacement.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: I'm a 21-year-old female who had a baby a year ago. I have heart palpitations when I'm laying there trying to go to sleep and my heart is slow. Is this something I need to check into? I went to a cardiologist when I was pregnant and they found nothing!

Answer: The sensation of one's heart beating, either fast, irregularly or even skipping, is what is frequently known as palpitations. These are usually benign (not worrisome) heart beats, and may even be normal beats that are felt. It is hard to know exactly what you are feeling. Stress, or stimulants (such as caffeine or decongestants) can bring them on, or they can occur for no reason at all. These heart rhythm abnormalities can sometime be picked up with an EKG in the doctor's office, or other times require wearing a 24 hour heart rhythm monitor(holter monitor), or even a monitor that you keep for a week or more. I suggest checking this out with your family doctor. Certainly, any heart rhythm abnormality that causes dizziness or fainting or loss of conciousness; or significant other symptoms (chest pain, shortness of breath) should be evaluated immediately.

Dr. Grace Buono, Cardiologist, The Everett Clinic


Question: Can smoking cause enlargement of the heart?

Answer: Smoking can cause enlargement of the heart in several ways: by causing a heart attack which may make the left side of the heart enlarge or by damaging the lungs which may make the right side of the heart enlarge.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: Is minimally invasive mitral valve repair offered by Providence?

Answer: "Minimally invasive" means different things to different people. Mitral valve repair can be done through a variety of incisions using a variety of cannulation techniques. These include partial sternotomy, and mitral repair through a small right thoracotomy incision. Both of these incisions have their merits and drawbacks, both when compared to each other and when compared to the more conventional median sternotomy incision. All of these techniques have been used by our surgeons. The choice of incision is important and should be discussed fully with the consulting surgeon at the time of consultation.

Dr. Timothy Byrnes, Cardiac Surgeon, Everett Cardiac Surgical Associates


Question: Should I get a cardiac evaluation from a licensed professional before beginning an exercise program?

Answer: If you've been sedentary for a long time, are overweight, have a high risk of coronary heart disease or some other chronic health problem, see your doctor for a medical evaluation before beginning a physical activity program.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is the average lifespan of a pig valve replacement?

Answer: Durability of porcine prosthetic valves depends on a number of factors. The younger the patient at time of implantation, the shorter the lifespan of the valve. This is thought to be due to the more active calcium metabolism in the younger patients. Porcine valves are rarely implanted in young patients unless there is a specific contraindation to anticoagulation with coumadin, for example, if a young woman wishes to get pregnant, or if the patient is unable to take coumadin regularly and reliably due to alcohol or drug problems.

The longevity of the valve also depends on the valve replaced. Porcine valves tend to last longer in the aortic position than in the mitral. The underlying issue for valve replacement is to determine the likelihood of having repeat surgery to replace a malfunctioning prosthetic valve. The younger you are at time of implantation, the more likely you are to "outlive" your valve. This has to be weighed against the risks of longterm anticoagulation for a mechanical valve.

These risks are approximately one per cent per year of major bleeding complications or clotting problems. Many surgeons and their patients would prefer to consider the prospect of repeat surgery in fifteen to twenty years in exchange for freedom from the risks and complications of lifelong anticoagulation.

Dr. Timothy Byrnes, Cardiac Surgeon, Everett Cardiac Surgical Associates


Question: Why does nitroglycerin relieve pain associated with a heart attack?

Answer: Nitroglycerin works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen. It relieves pain from esophageal spasm and possibly other pain originating from smooth muscle spasm or tightness.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: I understand that about 40% of patient have atrial fibrillation after bypass surgery. How long does this usually last and what treatment is advised?

Answer: Atrial fibrillation occurs in 15% to 30% of patients following heart surgery. It is rarely life-threatening and resolves within 30 days.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: I have borderline high blood pressure. What steps should I take to lower my blood pressure?

Answer: The American Heart Association recommends the following to help lower your blood pressure:

  • Lose weight if you’re overweight.
  • Eat a healthy diet low in saturated fat, cholesterol and salt.
  • Be more physically active.
  • Limit alcohol to no more than one drink per day for women or two drinks a day for men.
  • Take medicine the way your doctor tells you.
  • Know what your blood pressure should be and work to keep it at that level.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: Are there any precautions or special needs for a patient with a pacemaker who is going into surgery?

Answer: This is a very commonly asked question and one that can best be answered by your physician. Here is a link to a Web site from one manufacturer of pacemakers with some general guidelines.

Dr. Jeffrey Rose, Medical Director, Clinical Cardiac Electrophysiology, Providence Regional Medical Center Everett


Question: What are the signs of a heart attack?

Answer: Here are signs that can mean a heart attack is happening: 1) Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. 2) Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. 3) Shortness of breath. May occur with or without chest discomfort. 4) Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is the typical pulse of a person with an enlarged heart?

Answer: There are many reasons for an enlarged heart. Whatever the reason however, the heart rate (pulse) should be within the normal range (50-100 beats per minute). Well trained athletes may have a mildly enlarged heart and they may safely have a much slower heart rate.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What are the dangers of accidentally reaching a pacemaker's maximum programmed rate during training? Letting aside battery consumption and assuming that heart functionality would be ok at that rate plus 5-10 bpm, should I avoid it at any cost, or just be careful?

Answer: Some patients with slow heart rates need a rate-responsive pacemaker to increase their heart rate with physical exertion. Assuming that the pacemaker is programmed correctly, there should not be any danger if you reach the maximum programmed rate with training. I recommend that you discuss this in more detail with your cardiologist.

Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic


Question: What is the average life span for men after a major heart attack?

Answer: There are many factors that affect the life span of someone after a "major" heart attack. Some of these factors are: blood pressure, residual function of the heart muscle (ejection fraction), blood supply to the heart, heart rhythm, heart rate, hemoglobin, kidney function, lung function, serum lipids (LDL, HDL, triglycerides), weight, fasting blood glucose, diet and activity level. Your own physician is the best one to put all of these factors together for you.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is the average length of life after having a cardiac pacemaker inserted?

Answer: Early recognition and treatment of the underlying heart disease has allowed patients to live much longer with a pacemaker than previously. The pacemaker is now only part of a larger more complex and comprehensive treatment of heart disease. Programming of the device is now software-based rather than hardware-based, making it possible to change "what kind of pacemaker it is" based on the physiologic needs of the patient. In addition, patients at high risk for sudden death are now treated with devices that are combination pacemakers, implantable arrhythmia management devices and defibrillators. Learn more about Pacemakers.

Dr. Jeffrey Rose, Director, Clinical Electrophysiology, Heart Institute at Providence Regional Medical Center Everett


Question: I recently had bypass surgery. After returning to work, I have had several panic attacks. My blood pressure meds have been doubled and I get emotional at times. I have a very stressful job but I never had a problem with emotions before. Are these symptoms normal?

Answer: Emotional changes are common after bypass surgery but usually resolve after 2-3 months. See your primary care physician if these symptoms persist longer.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: I recently had triple coronary bypass involving both saphenous and mammary artery grafts. What is the average time in years that bypass veins are expected to last? I also take medication for high blood pressure.

Answer: The average patency rates for saphenous vein grafts is 50% at 10 years. The 10 year patency rate of the mammary artery graft is 97%. Saphenous vein grafts are more prone to atherosclerosis; the reason is unknown. Overall, about 15% of patients will require a second operation in their lifetime. Adequate control of high blood pressure is important to slow the progression of coronary disease.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: Could nausea, vomiting and diarrhea be symptoms of an impending heart attack?

Answer: Nausea can be the only symptom or one of several symptoms of a heart attack. Vomiting and diarrhea would not be very common.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What effect does caffeine have on your heart rate?

Answer: Caffeine is a mild stimulant in most people. Therefore, you would expect to see a mild increase in heart rate in some people and it would tend to be dose dependant.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is meant by fluid around the heart?

Answer: Fluid around the heart is within the pericardial sac and is called pericardial effusion. Under normal conditions, minimal fluid (just enough for "lubrication") is present. If, however, the pericardial sac fills with additional fluid, a condition known as Pericardial Effusion occurs. Small amounts of additional fluid usually do not cause any symptoms. Larger amounts may cause symptoms such as shortness of breath, cough, lightheadedness or fainting. Additional fluid around the heart is usually caused by a virus. There is nothing you can do to avoid it except stay healthy and exercise.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is the normal level of potassium in a blood test?

Answer: The reference range (normal test result values) for potassium in an adult is 3.5 to 5.0 mmol/L.

Dr. William J. Monteforte, Laboratory Medical Director, Providence Regional Medical Center Everett


Question: What is defibrillation?

Answer: Defibrillation indicates the change of a heart chamber's rhythm from fibrillation to another rhythm, usually sinus. This usually refers to the use of a cardiac defibrillator to give a precordial direct current shock.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: Why does your left arm hurt before a heart attack?

Answer: This a question that often difficult to understand. For example, when you hit your finger with a hammer, you know exactly where it hurts and why. When it comes to the heart "hurting," it has a very different nervous innervation (nerve supply) that cannot distinguish exactly where it hurts. It doesn't need to be as precise as your finger and shares the same innervation as the left arm and chest wall. Therefore, during a heart attack, or a bout of angina, your arm can hurt as well as other structures such as the jaw or even a tooth. It's different for everybody, and not all arm pain is from the heart.

Dr. Jeffrey P. Gress, Cardiologist, Providence Physican Group


Question: What exercises are appropriate for cardiovascular health?

Answer: The best exercises for cardiovascular health are "aerobic" exercises. Aerobic means "with oxygen." These are exercises that use the large muscles of the body for a sustained period of time. Brisk walking, biking, swimming top the list. The ideal exercise program for cardiovascular health should include aerobic exercise for 30 to 60 minutes on most days of the week. If you are a beginner to exercise, you may not be able to start out with 30 minutes. Try for 10-15 minutes once or twice per day, then gradually (10% per week) add more time to work up to 30 minutes. Intensity (speed) should be such that you can do the activity for 10-15 minutes without getting so breathless that you have to stop. It's better to slow down and be able to finish your time goal, rather than go so fast that you have to stop before your time goal. As your cardiovascular fitness improves, you will be able to go faster and still meet your time goal.

Examples of exercises that are NOT aerobic are: golf, bowling, and any activity that is so vigorous that YOU could not sustain it for more than 10 minutes. Activities like golf and bowling are great recreation, but the physical activity required for those sports is not sustained; there is too much rest between the activity bouts.

Gregory J. Lawson, MS, FAACVPR, Supervisor and Clinical Exercise Physiologist, Providence Regional Medical Center Everett


Question: When a heart beat changes from its normal beat to a pounding, hard beat, does it have a particular significance?

Answer: The significance of a "pounding, hard beat" depends on many factors and coexisting medical conditions. For instance, an occasional feeling of "skipped" or "strong heart beat" in an otherwise healthy person with a normal heart may be a normal occurrence. However, the same may not be true for another person with heart disease. The frequency, duration and speed of the pounding heart rate, as well as the symptoms these beats generate, are also important factors in determining if anything needs to done about evaluating or treating them.

Dr. Sanjeev Garhwal, Clinical Electrophysiologist, Western Washington Medical Group


Question: For the past week, I've been having a fluttering feeling on the left side of my chest, above my stomach just below my breast. It happens several times during the day. Could this be something I need to have checked out?

Answer: You may have an abnormal heart rhythm. I recommend that you see your primary care physician. An electrocardiogram and a holter monitor (a device that records the heart rhythm for 24 hours) may be necessary to determine the cause of your "fluttering".

Dr. Martin Heisen, Cardiologist/Electrophysiologist, The Everett Clinic


Question: What is hypertension?

Answer: Hypertension is the term used to indicate that the resting blood pressure is higher than "normal". Normal varies with age and also in association with other diseases. In the past, 140/90 has been considered the upper limit of normal. Recent data suggests that 135/85 is a more desirable cutoff.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: What is tachycardia and why does extreme tachycardia prevent the heart muscle from getting the blood supply that it needs?

Answer: The normal heart rate is between 60 and 100 beats per minute. Tachycardia is defined as a heart rate greater than 100 beats per minute. Part of the heart's blood supply comes from the blood inside of the heart by osmosis. The other part comes when the heart is at rest. If the heart is beating really fast (tachycardia) the heart muscle needs more blood and there is insufficient time for the heart arteries to get the necessary blood supply to the heart muscle.

Dr. Chris Price, Cardiologist, The Everett Clinic


Question: Can panic attacks hurt the heart?

Answer: Panic attacks probably do no damage to the normal heart. However, a person with heart disease could suffer heart-related problems from a panic attack.

Dr. David Stewart, Medical Director, Heart and Vascular Institute, Providence Regional Medical Center Everett


Question: How many times can bypass surgery be done? My father has had two and has been told that is the limit.

Answer: There is no limit. He might not be a candidate for other reasons such as lack of vein or artery for the next bypass.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: Can blood clots calcify or harden permanently if they were not able to be dissolved and can they break off or break apart at a later date?

Answer: This is a complex question, with many book chapters written on the topic. The short answer is yes, clots form on atherosclerotic plaques when they are inflammed or eroded. Sometimes, they completely occlude the artery and cause a heart attack or stroke, but sometimes they only partially block and can cause serious or no symptoms. And yes, they can travel or embolize and they can become part of the plaque and fibrosis or calcium may form.

Dr. Frank Sheridan, Cardiologist, The Everett Clinic


Question: Why do I have a pain in the left side of my neck when I move my left arm, 28 days after my triple bypass surgery?

Answer: It could be that the nerves in the shoulder muscle are strained from stretching in front. If the pain is severe, see your surgeon. Massage therapy can also be helpful.

Dr. Pat Ryan, Cardiothoracic Surgeon, Everett Cardiac Surgical Associates


Question: Can a person have a high resting heart rate (normally between 94-120) and not have any type of disease or other medical problems? My medical tests (MRI, bloodwork, x-rays) have all come back normal.

Answer: The normal range of heart rate is simply a range; there are always people outside of this range. If your tests have come back normal, there is nothing to worry about.

Dr. Christopher Price, Cardiologist, The Everett Clinic


Question: What happens when the saphenous vein used as a bypass graft wears out (hopefully 10 to 20 years)? Does the patient then have a replacement installed?

Answer: These grafts do not “wear out”, they are always there. But they can become clogged with clots or atherosclerotic plaque. The better care you take of yourself (regular exercise, low fat diet, optimum weight, not smoking, keeping blood pressure and cholesterol low) will help them to stay open longer. Many patients have these functioning for more than 30 yrs. If they plug and cause symptoms, they can be opened with stents. Also repeat bypass can be done.

Dr. Frank (Mac) Sheridan, Everett Clinic Cardiologist