Ask an Expert

Treatments

Learn how heart conditions are treated and the benefits and possible risks that come along with each type of treatment.

  • What are "revascularization" procedures?

  • In some cases, the blockage in the artery cannot be sufficiently reduced with medication alone and a surgical remedy is needed. The less-invasive option is to inflate a balloon catheter in the artery at the point of the blockage to open the channel for blood flow. Often a wire mesh device called a stent is place in the artery to prevent it from closing again. If the blockage is severe or blood flow is reduced in several arteries, coronary artery bypass surgery (CABG) may be needed. This operation involves opening the chest cavity and surgically attaching a new piece of vessel to reroute blood flow around the damaged arteries.
  • What do I do if my physician doesn’t refer me to cardiac rehabilitation and I think I’m eligible to participate in it?
  • Unfortunately, many doctors and nurses still just plain forget to mention cardiac rehabilitation during busy office visits or when people are discharged from the hospital. They may also think that another care provider has already mentioned it. Don’t be afraid to ask about whether cardiac rehab is right for you. Feel free to print out information about cardiac rehabilitation from the Cardio Smart or AACVPR websites to show them. Not only will they welcome the reminder to help you find a program, but you’ll be glad you did.
  • What aspirin dose is prescribed for patients with history of heart attack and stroke?

  • Patients with a history of cardiovascular events are typically prescribed 75–300 mg/day of aspirin to help reduce their risk for heart attack and stroke.
  • Why are patients receiving valve replacement reliant on blood thinners?

  • Most valve replacement patients need to be on lifelong anticoagulation therapy because their surgery puts them at increased risk for blood clots. The body is more likely to create blood clots on or around a foreign object like a replacement valve. If a blood clot forms, breaks off and travels to the heart, it can get stuck in a vein or artery and block the flow of blood, causing a heart attack or stroke. Therefore, taking blood thinners helps prevent the formation of blood clots and decreases risk for heart attack and stroke.
  • Who should take statins?

  • Statins are commonly prescribed to patients with high cholesterol. Most often, patients who need to lower their LDL cholesterol the most are prescribed stronger doses of statins, while those needing to lower their cholesterol slightly may be prescribed lower doses.
  • Who needs statins?

  • Statins are often prescribed to patients with high LDL (“bad”) cholesterol, who are at increased risk for heart disease. Statins help eliminate bad cholesterol from the body and reduce cardiovascular risk.
  • Who should use ambulatory blood pressure monitoring?

  • Currently, most patients using ambulatory blood pressure monitoring are those susceptible to the “white coat effect,” resistant hypertension that does not respond well to traditional therapy, and those with episodic hypertension. However, use of ambulatory monitoring may become more widespread if found useful in proper blood pressure control.
  • Where can I find nicotine patches?

  • Nicotine patches can be purchased over the counter at most drug stores. However, it is important that you check with your doctor before using the patch, especially if you take other medications. Pregnant women should not use the patch unless advised to do so by their doctor.
  • Who is eligible to participate in a cardiac rehabilitation program?

  • Medicare and most private insurers cover cardiac rehabilitation generally for 24–36 sessions over a 3– to 6–month period for people who have had recent heart attacks; angina; bypass or valve surgery; coronary angioplasty or stents; or heart transplants. However, some insurance companies also recognize the benefits of cardiac rehabilitation to help people with heart failure and cover participation for people with heart failure and other diagnoses.
  • Why does door-to-balloon time vary among patients?

  • Door-to-balloon time can vary for many reasons, such as availability of operating rooms and/or staff. Based on the size of a hospital, number of staff and influx of patients, the promptness of care can differ as a result of the hospital’s ability to meet the demand of patients.
  • Why is the radiation dose higher in complex procedures and in people with artery disease?

  • It’s really a matter of the time the x-ray machine is used for creating pictures inside the arteries. Challenging procedures take longer to perform, which increases the total amount of x-rays passing through the body, and the total radiation dose. It’s the same situation with artery disease. If a person has had coronary bypass surgery in the past, angioplasty is more complicated and time-consuming. If the leg arteries are full of cholesterol deposits, it takes more time to thread a tube from a groin artery and into the heart. Both significantly increase the radiation dose.
  • Why is the radiation dose higher in people who are obese?

  • A stronger x-ray beam is needed to penetrate through a large body while still creating high-quality pictures of the coronary arteries. In addition the angles that are used for directing the x-ray beam into the body may be different in obese people. This can cause the x-rays to travel a longer path inside the body. Both of these factors increase the radiation dose.
  • Why is shared decision making so important in heart failure care?

  • With a number of treatment options for heart failure patients, choosing which therapies are best for each patient has become increasingly confusing. And with many heart failure patients living longer lives than ever before, there are many treatment decisions to be made over the course of the disease. That's why it's important that heart failure patients work together with their doctors to choose the best treatment options in accordance with their preferences, goals and values.
  • Why is TAV-in-SAV used primarily for high-risk patients only?

  • Redo aortic valve surgery is the safest option for most patients with failing surgical aortic valves, associated with only a 2–7% risk of operative mortality. However, for patients that are high-risk, redo aortic valve surgery is much more dangerous, increasing risk of mortality to more than 30%. Therefore, TAVI may be a better and safer option for high-risk patients.
  • Will policy changes come about soon in the healthcare industry to improve patient-provider communication?
  • The idea of shifting healthcare policies from “fee-for-service” to “pay-for-performance” has been in the works for years. This means that healthcare organizations would provide incentives for physicians to spend more time with patients, providing higher quality care to the individual, rather than just seeing the highest number of patients possible. The implementation of these changes will take time, but as more and more patients, providers, and leaders recognize the importance of communication and high-quality care for patients, the likelihood of policy changes increases as well.
  • Why is communication not an important skill taught to physicians?

  • With so much for students to learn during medical school, patient-provider communication is addressed, but can be overshadowed by the wealth of information that students must learn throughout their education. Later, when students move onto residency programs, few programs have structured programming in communication, and supervisors do not have the time to observe residents’ patient interactions for evaluation and feedback. During this cycle, patient-provider communication often takes a backseat to the many other responsibilities that physicians hold.
  • Why is having regular teeth cleanings important to maintaining oral health?

  • Having regular teeth cleanings lowers bacteria in the mouth that cause chronic inflammation. It can also help identify any problems that patients may have, such as cavities or gum disease, and encourage better oral hygiene, such as flossing and brushing regularly.
  • Why is femoral access currently used more often than radial access for percutaneous coronary intervention (PCI)?

  • Many medical professionals believe that radial access may have significant medical benefits over femoral access. However, there has not been substantial research comparing the two access points on a larger-scale until now, through the RIVAL study. As a result, a lack of research and practice with radial access has led most surgeons to favor femoral access for PCI.
  • What medications are recommended to treat patent foramen ovale (PFO)?

  • Antiplatelet and anticoagulant medications have both been used to treat patients with PFO who have heart conditions or history of stroke. While both types of medication have helped reduce risk of recurrent stroke in patients, the optimal medication therapy for patients with PFO is unknown.
  • What lifestyle changes should patients with heart disease make to improve their health?
  • Depending on the severity of heart disease, patients can make numerous lifestyle changes to reduce their risk for cardiac events, including reducing weight, quitting smoking, increasing physical activity and maintaining a heart healthy diet (low-fat, low-sodium). Depending on the severity of heart disease, doctors may also recommend that patients take certain medications or undergo medical procedures or surgery to further improve health and reduce cardiovascular risk.
  • What is the difference between pulmonary embolism and deep-vein thrombosis?

  • Deep-vein thrombosis is clotting in the veins deep within the body. Pulmonary embolism is often a complication of deep-vein thrombosis, which occurs when the clot travels to the lungs, blocking the flow of blood. Both conditions require immediate treatment with anticoagulant medications to help break up the clot and restore normal blood flow.

  • What is the difference between an ICD and a pacemaker?
  • The biggest difference between an ICD and pacemaker is that an ICD continually monitors heart rhythm and can send low- or high-energy electrical pulses to correct an abnormal heart rhythm. ICDs will initially send low-energy pulses to restore heart rhythm but switch to high-energy pulses when the low-energy shocks are ineffective. Pacemakers, however, only give low-energy electrical pulses to restore regular heartbeat. Therefore, ICDs are more effective in patients at high-risk for or history of sudden cardiac arrest, who may need these more powerful, high-energy electrical pulses to restore their regular heartbeat.
  • What is the difference between elective and emergency percutaneous coronary intervention (PCI)?

  • Emergency PCI is performed on patients suffering a serious type of heart attack known as a STEMI, in which there is complete blockage of a coronary artery, preventing blood flow and killing heart muscle. In this case, emergency PCI is used to restore blood flow to avoid long-term damage or death. Elective PCI, on the other hand, is when the procedure is planned ahead of time due to significant blockage of the arteries, in an effort to prevent future heart attack or stroke.
  • What should I do if I have red, inflamed gums?

  • Even if you’re not worried about heart disease—but especially if you are—you should see your dentist or periodontal specialist. It’s important to follow their recommendations for treating your gum disease. Good care of your teeth and gums requires some effort every day, but it will keep you healthier. Remember, it’s not just your smile that’s at stake—it could be your heart.
  • What should I do if I have side effects from high-dose simvastatin?

  • If you are experiencing muscle pain, tenderness, weakness, tiredness, or dark or red colored urine, call your doctor immediately. These are signs of possible muscle injury and should be discussed with your healthcare provider.

Ask an Expert

Please note that every question submitted will not receive a direct response from a Cardiologist. However, we will follow-up with suggested ways to find appropriate information related to your question. Please do not use your last name or any other confidential information in your question.

Meet our Expert

Your questions are answered by more than two dozen members of the American College of Cardiology who volunteer their time with CardioSmart.

Learn more about our volunteers