Our years of experience have led us to anticipate some of the questions that you may be having. Many patients just like you have asked the same ones before. Here are the straightforward answers from Illinois cardiac procedure experts.

If you have a question that is not answered here please consult your cardiac specialist or contact us directly.

What are the major risk factors of heart disease?

Why is high blood pressure dangerous
and how is it treated?

What is cholesterol and why is it so important?

What are triglycerides?

What is atherosclerosis?

What is coronary artery bypass graft surgery (CABG)?

Besides CABG, what other treatment options
are available to a patient with narrowed
or blocked arteries?

What is a heart arrhythmia?

What is atrial fibrillation?

What is a pacemaker and how does it work?

What is mitral valve prolapse?

What is congestive heart failure?

What is cardiac catheterization?

What is a thallium stress test?

What is an electrophysiology study (EPS)?

What is the difference between a "beta blocker"
and a "clot buster"?

What is carotid artery disease?

What is an aneurysm and how is it treated?

What is a stroke and what are the warning signs
of a stroke?

What are the major risk factors of heart disease?

Major Risk Factors

Other risk factors include stress and excessive alcohol use.

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Why is high blood pressure dangerous and how is it treated?
Blood pressure measurements are read as two numbers. The higher number is called the systolic pressure. The lower number is called the diastolic pressure. Normal systolic pressure is 120 or less, and normal diastolic blood pressure is 80 or less.

"High blood pressure" is defined as systolic pressure greater than 140 and/or diastolic pressure greater than 90. People with systolic blood pressures between 120 and 139, or diastolic pressures of 80 to 89 are considered "pre-hypertensive" and need medical monitoring and lifestyle changes.

High blood pressure puts stress on the heart, lungs, brain, kidneys, and blood vessels. Over time, high blood pressure can damage these organs and tissues, and may lead to heart disease, heart attack, stroke or kidney damage.

Treatment for high blood pressure includes making lifestyle changes, such as:

Medication also help to lower blood pressure. These medications include :

•	Diuretics
•	Beta blockers
•	Angiotensin converting enzyme inhibitors (ACE inhibitors)
•	Calcium channel blockers
•	Alpha blockers
•	Alpha-beta blockers
•	Nervous system inhibitors
•	Vasodilators

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What is cholesterol and why is it so important?
High cholesterol levels are associated with an increased risk of coronary heart disease, hardening of the arteries, and stroke. A total level of less than 200 milligrams per deciliter (mg/dL) is desirable, 200-239 mg/dL is borderline high, and over 240mg/dL is high.

There are two main types of cholesterol:

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What are triglycerides?
Triglycerides are often measured as a reflection of fat (lipid) ingestion and metabolism, or as part of an evaluation of coronary risk factors.

Triglycerides are a strong form of energy. They are stored in adipose tissue and muscle, and gradually released and metabolized between meals according to the energy needs of the body.

Normal: Less thank 150 mg/dL
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 mg/dL or above

What abnormal results mean
High triglyceride levels may be associated with a higher risk for heart disease and stroke. This is especially true because many people with high triglycerides often have other conditions, such as diabetes and obesity, that increase the likelihood of developing cardiovascular disease.

High triglyceride levels may indicate:

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What is atherosclerosis?
Atherosclerosis is a form of hardening of the arteries affecting large and medium-sized arteries. Fatty deposits, called "atheromas" or plaques, damage the lining of arteries, causing them to narrow and harden. As plaque deposits gradually enlarge, they interfere with blood flow. This often leads to pain or decreased function in those tissues supplied by the affected arteries. Depending on which arteries are influenced, atherosclerosis can cause a number of serious health problems. These include:

Due to the repeated damage to the inner arterial wall, blood clots often form. These clots, called thrombi, lead to a further decrease in blood flow. In some cases, a thrombus may become so large that it completely closes off the artery. Or, it may break into clumps, called emboli, that travel through the bloodstream and lodge in arteries downstream, blocking them off. In these cases, the tissues supplied by the artery receive no oxygen and quickly die. When this occurs in the heart, it is called a heart attack. In the brain, it is called a stroke.

Long-term atherosclerosis can also cause arteries to weaken. In response to pressure, they may bulge, leading to the formation of an aneurysm. If untreated, an aneurysm can rupture and bleed.

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What is coronary artery bypass graft surgery (CABG)?
CABG is a type of surgery that restores blood flow to the heart muscle. This is done by moving blood vessels from other parts of the body into the heart, to provide a route around obstructed coronary (heart) arteries.

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Besides CABG, what other treatment options are available to a patient with narrowed or blocked arteries?
Aside from CABG, your doctor may recommend coronary angioplasty. This is done to help clear and open arteries that have narrowed. A catheter is inserted into the artery of your arm, leg, or groin. The catheter, which has a tiny balloon at the tip, is guided into the affected artery using X-ray pictures, displayed on a television monitor. Once in the artery, the balloon is quickly inflated and deflated to stretch open the narrowed portion of blood vessel and to thereby improve passage of blood. Then the balloon and catheter are removed.

Depending on the location, shape, and type of blockage, the doctor may place a mesh "inner tube" or stent in the artery to keep it open. The procedure takes about one to two hours to complete, and you will be awake, but sedated this time.

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What is a heart arrhythmia?
Arrhythmias are abnormal beats of the heart, such as:

•	Heartbeats that are too slow (bradycardia)
•	Heartbeats that are too fast (tachycardia)
•	Extra beats
•	Beats coming from abnormal areas of the heart

The heart is a muscular pump with its own power supply and internal controls. It generates its own electrical signals to prompt each heartbeat and can therefore beat independently of the rest of the body. The electrical signal begins in a "pacemaker" called the sinoatrial, or sinus node, which is in the back of the right atrium (upper right heart chamber). Arrhythmias can arise from any part of the heart's circuitry. Those that come from the atria are called atrail and are usually benign. Most of the dangerous arrhythmias start in the ventricles (lower chambers) or are due to failure of conduction though the atrioventricular (AV) node. The AV node is the electrical connection points between the atria and ventricles.

Treatment of arrhythmias depends on the type and seriousness of the particular rhythm disturbance. For example:

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What is atrial fibrillation?
Atrial fibrillation is an abnormal heart rhythm. The heart's electrical system normally sends regularly spaced, predictable signals, telling the heart muscle to contract, or beat.

The heart has two upper chambers, called atria and two lower chambers, called ventricles. Each signal starts in the atria and travels to the rest of the heart. In atrial fibrillation, the electrical signals from the atria are fast and irregular. The atria quiver, rather than contract. Some signals do not reach the ventricles and the ventricles continue pumping, usually irregularly and rapidly. This fast, uncoordinated rhythm prevents the heart from efficiently pumping blood out to the body. Blood left in the heart chambers can form clots. These clots may cause the abnormal rhythm. In some cases, the cause is unknown.

The goals of treatment are to:

If an underlying cause of atrial fibrillation is found, it may be treated. Some patients return to a normal rhythm without treatment.

Treatments include medication, cardioversion, or lifestyle changes.

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What is a pacemaker and how does it work?
The surgical insertion of an artificial pacemaker, which is a small, battery-operated device that helps maintain a normal heartbeat by sending impulses to the heart.

An artificial pacemaker is inserted when the body's natural pacemaker -- the sinoatrial (SA) node -- becomes defective due to heart disease, and cause the heart to beat too fast, too slow, or irregularly. Artificial pacemakers may also be used for malfunctions in the atrioventricular (AV) node -- the portion of the heart's electrical system that conveys signals from SA node to the ventricles. Pacemakers can also be used in the setting of cardiac surgery.

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What is mitral valve prolapse?
Mitral valve prolapse (MVP) is a common, usually benign heart disorder. The mitral valve controls blood flow between the upper (atrium) and lower (ventricle) chambers on the left side of the heart. Normally, blood should only flow in one direction, from the upper chamber to the lower chamber. In MPV, the valve flaps don't work properly; part of the valve balloons into the atrium, allowing blood to leak the wrong direction, back into the atrium.

Mitral valve prolapse can be heard through a stethoscope. A small leakage will sound like a murmur. When the mitral valve balloons backward, it may produce a clicking sound. Both murmurs and clicks are telltale signs of MVP. An echocardiogram can confirm the diagnosis. You may also be asked to wear a holter monitor for a day or two, to continuously record the electrical activity of your heart (EKG).

In most cases, no treatment is necessary. Speak with your doctor about whether you should take antibiotics prior to dental work or surgery. Antibiotics may help to prevent endocarditis, an infection of the membrane that covers inside of the heart.

If symptoms include chest pain, anxiety, or panic attacks, a beta-blocker medication can be prescribed. Ask your doctor whether you may continue to participate in your usual athletic activities.

In very rare cases, the blood leakage may need to be surgically repaired or replaced.

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What is congestive heart failure?
Congestive heart failure is a condition in which the heart is unable to pump the necessary amount of blood throughout the body. This causes blood to back up in the veins. Fluid pools in the liver and lungs. Swelling occurs first in the feet, ankles, and legs, and then through the body as the kidneys begin to retain fluid.

Causes may vary, and treatment usually consists of lifestyle changes, medications, or surgery.

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What is cardiac catheterization?
This procedure is generally done as a diagnostic test after a person experiences chest pains or other symptoms that could point to a problem with the heart.

Cardiac catherization helps doctors to:

•	Identify narrowed or clogged arteries leading to or within the heart
•	Measure blood pressure within the heart
•	Evaluate the heart valve's functioning
•	Determine how well the four chambers of the heart are functioning
•	Check for congenital heart defects
•	Evaluate an enlarged heart
•	Decide on an appropriate treatment

You'll be awake, but given a sedative so that you'll be more relaxed and less anxious. Your doctor asks you to perform basic functions such as coughing, exhaling, and holding your breath. A clear plastic hood may be placed briefly over your head to measure the air you exhale and determine your heart's pumping efficiency. If you feel any chest pain, dizziness, nausea, tingling, or other discomfort, tell your doctor.

The catheter is treated over a guide wire, inserted into an artery in your arm or leg, and fed into the heart. Your doctor watches the threading and placement of the catheter via a fluoroscope, which is a type of X-ray that takes pictures of moving organs.

Once in the heart, the guide wire is removed. The catheter is then used to measure blood pressure within the heart's different chambers and to take blood samples.

Dye is injected though the catheter and the coronary arteries. Multiple X-ray images are taken to allow identification of any disease in the coronary arteries. An aortogram, which gives a clear image of the aorta, may be performed at this time. The catheter is then removed.

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What is a thallium stress test?
A thallium stress test is a nuclear imaging method that provides a view of the blood flow into the heart muscle. The thallium test is used to evaluate how well your heart is perfused (supplied with blood) at rest, as compared with activity.

During this test, heart images can be obtained because the patient receives an injection of a substance that is labeled with a radioactive marker or radiotracer to make it visible in the bloodstream.

In comparison to the standard treadmill stress test, thallium stress tests are more accurate and provide additional information.

How the test is performed?
In a special room or lab at a medical center, you will be instructed to exercise as hard as you can on a treadmill or bicycle. If your doctor considers that exercise is not safe for you, or that you may be unable to exercise enough because of orthopedic problems, then you will be given an intravenous medication that will challenge your heart as if you were exercising. When you reach your maximum level of exercise, a nurse will inject in your vein a small amount of thallium. The radiotracer will travel in the bloodstream through the coronary arteries, and will enter into the heart muscle as you complete your exercise session. After you finish exercising, you will lie down on a special table under a camera called a gamma camera. The gamma camera can scan your heart and detect the radiotracer. The distribution of the radiotracer in your heart will be processed by a computer to create a picture of your heart. The first pictures are made shortly after the exercise test, to show the circulation of the blood to your heart during exercise. This is the part considered "a stress test" and is the most challenging for your heart.

Then you will need to lie quietly for 2-3 hours, and at that point the scanner will make another series of pictures of your heart. These images will show the circulation of the blood through your heart muscle at rest.

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What is an electrophysiology study (EPS)?
An electrophysiology study is a procedure that examines the heart's electrical activity and pathways. An electrophysiology study may be performed to:

•	Diagnose the source of abnormally slow heart rhythms (bradycardias)
•	Diagnose the source of abnormally fast heart rhythms (tachycardias)
•	Provoke and diagnose heart arrhythmias that occur infrequently
•	Reveal suspected arrhythmias
•	Evaluate a person's risk for sudden death
An electrophysiology study may also be helpful in assessing:
•	Symptoms of unknown cause, including:
	•	Chest pain
	•	Shortness of breath
	•	Fatigue
	•	Dizziness/fainting (syncope)
•	Response to anti-arrhythmic therapy
•	Your need for a pacemaker or implantable cardioverter defibrillator.

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What is the difference between
a "beta blocker" and a "clot buster?"
Beta blockers are used in the treatment of high blood pressure -- or hypertension. Some beta-blockers are also used to relieve angina and, in heart attack patients, to help prevent additional heart attacks. "Clot busters" are used to dissolve blood clots that have formed in certain vessels. These medicines are used primarily when a blood clot seriously lessens the flow of blood to certain parts of the body.

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What is carotid artery disease?
Carotid artery disease occurs when a major portion of one or both carotid arteries (the arteries in the neck that supply blood to the brain) is narrowed or blocked. When oxygen-rich blood cannot make it to the brain, this can cause a stroke. Lifestyle changes, medications and surgical intervention can help to lower your risk for carotid artery disease.

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What is an aneurysm, and how is it treated?
An aortic aneurysm is a weak, bulging area in the wall of the aorta. The bulging develops from a weakness or defect in the aortic wall and tends to get bigger with time. The aorta is the body's largest artery. It carries blood from the heart for delivery to the rest of the body. The aorta travels through the chest (thoracic aorta) and the abdomen (abdominal aorta). Abdominal aortic aneurysms are more common than thoracic aortic aneurysms.

The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding (hemorrhage). Aortic aneurysms can also occur with aortic dissection. Dissection is defined as a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall, eventually leading to rupture of the vessel.

Aneurysms can develop anywhere, but are most common in the aorta, iliac artery and femoral artery.

Atherosclerosis is frequently associated with aneurysm. However, it is not thought that this disease alone causes the growth of an aneurysm. It is believed that other factors, such as high blood pressure or connective tissue disorders, must be present for an aneurysm to form.

Treatment includes surgery or stenting.

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What is a stroke, and what are the warning signs of a stroke?
A stroke is a brain injury that occurs when the brain's blood supply is interrupted. Without oxygen and nutrients from blood, brain tissue starts to die rapidly, resulting in a sudden loss of function.

A stroke most often occurs when blood flow to the brain becomes blocked (called ischemic stroke). One of the following problems may cause this blockage:

•	A build-up of fatty substances (atherosclerotic plaque) along an artery's inner lining causes it to narrow, reduces its elasticity, and decreases its blood flow.
•	A clot forms in an artery supplying the brain.
•	A clot forms somewhere in the body (often the heart) and breaks free, traveling to and becoming lodged in an artery supplying the brain.

A stroke may also occur if a blood vessel breaks and bleeds into or around the brain. This is called hemorrhagic stroke.

Symptoms occur suddenly and differ depending on the part of the brain affected. Multiple symptoms generally arise simultaneously. Do not delay calling for emergency medical help. Brain tissue dies quickly when deprived of oxygen.

Symptoms include

Immediate treatment is needed to

Other stroke care aims to

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