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FAQs

What are the signs of a heart attack?
It is important to recognize the signs of a heart attack because they can mimic other, less serious, maladies and, as such, may be ignored by the unsuspecting individual. This could delay needed treatment and increase the likelihood of major complications of heart attack, including death. They include:
  1. Chest pain and/or pressure. This is of particular concern if the pain or pressure radiates to another area, like the arm, jaw, shoulder blade, etc.
  2. Neck, shoulder, jaw or arm pain (especially in the left arm)
  3. Palpitations, often described as the “heart racing”
  4. Shortness of breath
  5. Diaphoresis (sweating, “cold sweat”)
  6. Dizziness
  7. Nausea with or without vomiting
  8. Indigestion
  9. Anxiety/Panic
  10. Fatigue

Back to TopCan I take Viagra?The PDE5 inhibitors Viagra, Cialis and Levitra, were originally created to treat patients with cardiac disease. Their creators stumbled upon something with some beneficial side effects. The problem with PDE5 inhibitors is that they interact with other cardiac drugs that cause a similar action in the body. Nitrates, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate) and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite (“poppers”), cause blood vessels to dilate, increase in size and carry more blood with less resistance. Nitrates help heart muscle work less hard while allowing more blood to the muscle tissue, which means patients experiencing heart-related chest pain (angina) may take nitroglycerin to make their pain go away.

PDE5 inhibitors work in a similar way. Unfortunately, when you mix PDE5 inhibitors and nitroglycerin, the effects can double or triple and cause a sudden dangerous drop in blood pressure. The combination of these two types of drugs is so dangerous that the American Heart Association suggests patients should not take nitroglycerin within 24 hours of taking PDE5 inhibitors.

Before you ever take a PDE5 inhibitor, you need to have a conversation with your doctor to understand the interaction between this class of medication and other medicines you may be taking. Taking Viagra, Cialis or Levitra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke heart attack or death.

Before taking any PDE5, tell your doctor if you are allergic to any drugs, or if you have:

  • heart disease or heart rhythm problems;
  • a recent history in the past 6 months of a heart attack, stroke or heart rhythm disorder;
  • congestive heart failure:
  • high or low blood pressure:
  • coronary artery disease;
  • liver disease;
  • kidney disease;
  • a blood cell disorder such as sickle cell anemia, multiple myeloma or leukemia;
  • a bleeding disorder such as hemophilia;
  • a stomach ulcer;
  • retinitis pigmentosa, an inherited condition of the eye;
  • a physical deformity of the penis, such as Peyronie’s disease; or
  • if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to see if you can safely take Viagra, Cialis or Levitra. Back to TopWhat is a nuclear stress test?A nuclear stress test lets doctors see pictures of your heart while you are resting and shortly after you have exercised. The test provides information about the size of the heart’s chambers, how well the heart is pumping blood and whether the heart has any damaged or dead muscle. Nuclear stress tests can also give doctors information about your arteries and whether they might be narrowed or blocked because of coronary artery disease. If there is decreased blood flow, usually because of blockages, less uptake of the radioactive substance is seen on the images. Please note that the radioactive substance is well-tolerated and relatively safe if total lifetime exposures are limited.

These are images from a nuclear stress test. On the left is an image showing good blood flow while the heart is at rest. On the right is an image of the same area with decreased blood flow ( the dark area) to an area of the heart when it is under stress. As stated above this suggests that there is a blockage in the artery supplying this territory of heart muscle. Back to TopHow do I prepare for a nuclear stress test?

  1. Do not eat or drink anything for 4-6 hours before the test. It is best to evaluate your heart’s performance on an empty stomach. You will be less likely to experience nausea and/or abdominal cramping with exertion.
  2. Do not consume caffeinated beverages or foodstuffs (e.g. chocolate) within 48hours of testing, because this can affect the results.
  3. Wear loose, comfortable clothing and comfortable shoes, preferably tennis shoes.

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How long will the nuclear stress test take?Total time is 4-6 hours. Most of the time is spent waiting between the two portions of the test.

 

Initially, the health care provider will inject you with a non-harmful radioactive substance and take pictures of your heart under resting conditions. This substance is taken up by your heart muscle and shows how well the different areas of the heart are getting blood flow. (See “What is a nuclear stress test?”). If there is decreased uptake (darkened area), that means the blood flow is lacking to that area.

Next, you will rest for a few hours. You will be allowed to have a caffeine-fee lunch or snack nearby while you wait.

During the second part of the test, you will either exercise on a treadmill, or be injected with a medication that causes your heart rate to increase and your arteries to dilate (open up). Your heart will be monitored with a continuous EKG tracing. The doctor will look for changes on the EKG that indicate ischemia (decreased blood flow) he/she will also monitor you for any abnormal heart rhythms that may develop with exercise.

Then more pictures are taken of your heart after exercise. This is done to see if you have reversible ischemia, meaning that blood flow to the heart, normal at rest, may become abnormal with exercise. Back to TopHow long will it take to get my test results?Stress Test and Echocardiogram results are usually available within a week. Our office will call you and the results will be thoroughly explained. You will have the opportunity to ask any questions related to the results and/or your plan of care. Back to TopWhat is atrial fibrillation?Atrial fibrillation is a heart arrhythmia that results in an irregular, often rapid heartbeat. The small chambers of the heart, the atria, do not contract normally due to the presence of an erratic, disordered series of electrical stimuli. The heart is no longer controlled by the natural pacemaker, the Sino Atrial (SA) Node, but rather by many rogue stimuli. The Atrio Venticular (AV) Node, the relay station for signals traveling from the top of the heart to the bottom (ventricles) may fail to filter most of the many electrical stimuli coming from the top of the heart, thereby allowing the heart to race. Atrial fibrillation needs to be evaluated and treated as not only does it pose the risk of complications from chronic tachycardia (high heart rate) but it also poses a risk of stroke. The small chambers of the heart do not contract but squiggle like a bag of worms. This leads to stagnation of blood, which could lead to formation of blood clots in the heart. These clots can potentially migrate out of the heart and travel to the brain through the arteries, thereby causing a stroke. The same clots could bypass the heart and go to other vital organs such as the intestines, kidneys, etc. Back to TopWhat causes an increased heart rate known as tachycardia (greater than 100 beats per minute)?Please look at the “Signs of a Heart Attack” tab. If you have any other symptoms, you need to be evaluated, as this is potentially dangerous.

See if the heart rate is regular. An irregular heartbeat needs to be evaluated as soon as possible. Please see the atrial fibrillation FAQ, above.

If not associated with any other symptoms, make sure you are taking your medications as prescribed. Some heart medications that lower your heart rate can cause a rebound effect (increased heart rate) if you stop taking them abruptly; so please don’t let your prescriptions run out.

Tachycardia can be caused by fever. Check your temperature.

Tachycardia can also be caused by dehydration. Caution should be taken, because severe dehydration can lead to kidney damage.

There are a multitude of other causes of tachycardia that must be evaluated by your physician. Back to TopHow do I reach my doctor?Office hours are Monday through Thursday from 8am to 5pm and Friday from 8am-3pm. After hours, Dr. Klein can be contacted via the answering service, 972-612-4730.

Harmony Heart Group also employs a nurse practitioner who is readily available to answer questions and to assist you in any way possible. She is licensed and credentialed to diagnose diseases, prescribe medications and play a large role in patient education. Her name is Susan Deavers, RN, CNS, ANP Back to TopWhat kinds of tests are available in your office?

  • EKGs – A short, several second long surface tracing of the electrical activity of the heart used to diagnose coronary disease and other cardiac issues, such as arrhythmias, etc.
  • Holter and Event Monitors – a wearable monitor attached to the body much like an EKG would be; can record electrical events of the heart for up to a month . Used most usually to find abnormal heart rhythms.
  • Echocardiograms – noninvasive ultrasound test of the heart which can show the structure and function of the heart muscle, valves, etc
  • Stress Echocardiograms – an ultrasound test of the heart performed before and after exercise on a treadmill to diagnose lack of flow to the heart muscle
  • Nuclear Stress Tests- another method of imaging the heart in a noninvasive manner before and after exercise for purposes of diagnosing lack of flow(ischemia) to the muscle
  • Venous Dopplers – a noninvasive method of diagnosing the presence of blood clots in the deep veins of the lower extremities
  • Screening for PVD (peripheral vascular disease); Ankle Brachial Indices (ABI’s) – a noninvasive method used to screen for evidence of arterial blockages in the legs;utilizes comparison of blood pressure levels in the arms and legs
  • Treatment for Varicose Veins – multiple methods for closing both the large and small varicose veins that trouble many people
  • Pacemaker follow up

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What insurance plans do you accept?Most insurance plans are accepted. Please contact our office to verify your coverage. Back to TopWho do I call if I have questions about my bill?Our billing service can be reached at 888-559-2666 X112. Back to Top