Cardiology

This looks at the electrical activity of your heart using 10 stickers and wires on bare chest, abdomen, legs, and arms. This is a quick test lasting under 5 minutes. You may get this done by walking into building F2 Monday through Friday 0800-1600.

This is a small device worn for 1-4 weeks that monitors your heart rate and rhythm consistency. There is a button to press when symptoms are experienced, and you are asked to take notes during this process. This device can be slept, showered, and exercised in. Your technician or nurse applying your device will give you specific instructions. Placement of this device can be scheduled by calling 720-723-6370. 

This is an ultrasound of your heart and looks at the structure and how well it is beating and how strong the muscle is. This is done in a dark room with ultrasound gel on your chest. It usually takes about thirty minutes; there is no walk in availability. This test may be scheduled by calling 720-723-6370.

This is a test to determine how your heart tolerates exercise and how it reacts to increasing the rate using a treadmill. It is a great test to determine if you have stress-induced changes to the heart and can really see how well your heart can tolerate working out. You will be constantly monitored with a healthcare provider, and we can use medications if you are unable to tolerate treadmill exercise. This test may be scheduled by calling 720 723 6370.

This is a specific CT scan for the heart and vessels inside and surrounding the heart. A nurse will call to schedule you and give you specific instructions on how to prepare for this test. 

Based on results of these tests, additional testing may be recommended, this is not a one size fits all approach. 

Hypertension, or high blood pressure, is a condition managed through medication and lifestyle changes. Without proper treatment, it can lead to severe complications like strokes and heart attacks.

What is Hypertension?

Hypertension is defined as consistently high blood pressure, with prehypertension indicated by readings above 120/80 mmHg.

Risk Factors

• Smoking
• Alcohol Use
• Recreational Drug use – including marijuana edibles
• Poor diet – processed foods, high sodium and low potassium intake
• Obesity
• Lack of exercise
• Poor sleep
• High stress levels 
   

Medications

• Beta Blockers: Block the beta receptors in the heart to decrease heartbeats per minute, in turn this lowers blood pressure.
  Metoprolol is the most common, but carvedilol and propranolol are other commonly prescribed ones.
• Angiotensin Converting Enzyme (ACE) Inhibitors: These block an enzyme that constricts the vessels to keep them open and keep blood pressure lower. Think of your arteries as a garden hose, the skinnier the hose the greater the pressure and vice versa. 
  Lisinopril is the most prescribed, you may also see enalapril.
• Angiotensin Receptor Blockers (ARB) – Work very similarly to ACE inhibitors, these may be used instead of ACE inhibitors if you experienced the severe facial swelling and a cough. The side effects, otherwise, are very similar. 
  Losartan is the most common of these medications, valsartan is another common one.
• Calcium Channel Blockers (CCB) – These work exactly like the name, they block calcium channels and decrease the flow of calcium ions (not the same kind of calcium that’s good for the bones). This decreases excitability of the heart and lowers the heart rate and vasodilate, which will lower blood pressure.
• Amlodipine and verapamil are most used.
• Hydrochlorothiazide (HCTZ): This is a diuretic, which works to decrease the amount of fluid moving through the vessels to lower blood pressure. 
  Common side effects: low blood pressure, electrolyte depletion. 

Improving Blood Pressure

To lower blood pressure, quitting smoking is one of the most effective lifestyle changes you can make. Additionally, adopting a healthy diet, regular exercise, and stress management can also help.

Consequences of Untreated Hypertension

If hypertension is not treated, it can lead to serious health issues such as heart attacks and strokes.

Long-term Medication Use

Not everyone with hypertension will need to be on medication permanently. With significant lifestyle modifications, some individuals can reduce or even eliminate the need for medications.

Side Effects of Medications

These are common side effects of all medications

• Dizziness
• Below normal blood pressure – usually due to volume depletion, stay hydrated.
• Beta Blockers (Metoprolol, carvedilol, propranolol) – low heart rate
• ACE Inhibitor: Dry cough, elevated potassium, change in kidney function. EMERGENCY SIDE EFFECT: Swelling of face nose and throat affecting breathing if this occurs visit an emergency room.
• ARB: There are lower risks of facial swelling and no dry cough associated with these medications though otherwise they are very similar to ACE inhibitors.
• CCB: Swelling of arms and legs, headache

Your doctor will ensure you have semi-regular blood work done while on this medication to make sure it is healthy for your organs. It is important you complete these as soon as you can. You will receive these results in the mail if they are completely normal or you may get a call from the nurse.

Maintaining a proactive approach to managing hypertension through lifestyle changes and adherence to prescribed treatments is crucial to prevent long-term health complications.

Chest pain, known as angina, could be a sign of an impending heart attack or myocardial infarction. It is crucial to understand the risks, preventive measures, and treatments associated with these conditions.

What is Angina?

Angina is a type of chest pain caused by reduced blood flow to the heart.

What is a Myocardial Infarction?

A myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart is blocked for a prolonged period, causing damage to the heart muscle.

Risk Factors

• Smoking
• Hypertension
• Hyperlipidemia (high cholesterol)
• Diabetes
• Abdominal obesity
• Recreational Drug use – especially cocaine and marijuana
• Poor diet – processed foods, high sodium and low potassium intake
• Lack of exercise
• Poor sleep
• High stress levels

Preventive Measures

• Limit alcohol intake
• Quit smoking
• Adopt a healthy diet and exercise plan
• Maintain treatment for the other risk factors: take your medications for cholesterol, hypertension, anxiety, diabetes, etc.

Understanding Angina and Heart Attacks

Angina signifies that the heart is not getting enough oxygen-rich blood, typically indicative of underlying heart problems. While angina does not always mean a heart attack is occurring, it should be taken seriously as it could eventually lead to one.

Do chest pains always indicate a heart attack?

Not necessarily. Chest pain can result from various causes and does not always signal a heart attack. However, it is essential to assess and monitor chest pain, especially if it occurs frequently.

Does a heart attack cause permanent damage?

A heart attack can cause permanent damage to the heart muscle, but with prompt medical treatment, lifestyle changes, and medication, the extent of the damage can be minimized.

Common Treatments

• Nitroglycerin opens blood vessels to ensure more oxygen rich blood is reaching the heart to preserve its abilities.
• Medications to lower heart rate
• Medications to lower blood pressure
• Anticoagulants to prevent blood clotting
• Invasive treatment may involve placement of a stent – this is a metal tube that opens the vessels back up to return blood flow to the heart.
• You may be referred to cardiac rehab to begin a heart safe work-out plan

Common treatments may include:

• Beta-blockers
• Aspirin
• Nitroglycerin for chest pain relief

It is crucial to identify chest pain early and seek medical attention to prevent potential complications such as heart attacks or strokes. By quitting smoking and leading a heart-healthy lifestyle, you can significantly reduce the risk of these conditions.

Atrial fibrillation (AF) and atrial flutter (AFL) are common cardiac rhythm disturbances affecting the heart's upper chambers (atria). Although not immediately life-threatening, without proper treatment, these conditions can lead to serious complications.

Normal Heart Function

Understanding normal heart function is crucial. The heart’s upper chambers (atria) normally pump blood to the lower chambers (ventricles) with the help of electrical signals, creating the familiar "lub-dub" heartbeat sound. The electrocardiogram (EKG) measures these signals, showing a P-wave for atrial function and a QRS complex for ventricular function. Normal sinus rhythm, or a regular heart rate, typically ranges around 60-100 beats per minute.

What is Atrial Fibrillation?

Atrial fibrillation occurs when the atria quiver due to an electrical malfunction, impairing their ability to pump blood efficiently. Despite this, the ventricles usually continue to function, ensuring blood reaches the body.

What is Atrial Flutter?

Atrial flutter is similar to atrial fibrillation but more organized in its electrical activity. Treatment for both conditions is generally the same.

Signs and Symptoms

You may notice palpitations, a fast heart rate, or intolerance to daily activities. If these symptoms persist for over an hour, visit the emergency room. Intermittent symptoms should prompt a medical appointment. Learn to check your pulse: count beats for 60 seconds and if it exceeds 120 beats per minute, seek emergency care.

Major Concerns

Two primary concerns with untreated AF/AFL are blood clots and rapid heart rates. Blood clots can form when blood pools in the atria, potentially causing strokes, heart attacks, or deep vein thrombosis if they reach the brain, lungs, or extremities. Rapid heart rates may lead to rapid ventricular rate, a medical emergency requiring immediate attention. Ventricular fibrillation, a more serious condition, necessitates emergency intervention.

Potential Complications

• Stroke
• Heart attack
• Ventricular dysrhythmias
• Deep vein thrombosis
• Pulmonary embolus

Risk Factors

• Smoking
• Hypertension
• Recreational stimulant use (cocaine, methamphetamine)
• Elevated cholesterol

Treatments

Your doctor will tailor the most appropriate plan for you, usually starting as conservative as possible. Common treatments include anticoagulants to prevent blood clots and medications to lower heart rates, such as beta blockers. Common anticoagulants include Warfarin (Coumadin), Apixaban (Eliquis), Rivaroxaban (Xarelto), and Aspirin, while Metoprolol is a frequently used beta blocker. If medications are ineffective or unsuitable, more invasive treatments may be considered.

Additional Treatments

• Cardioversion: This is an external shock that hopes to reset the heart rate and help it beat correctly; this is done with mild anesthesia as it can be painful
• Ablation: This is a procedure done by accessing the electrical nodes on the inside of your heart and burning or freezing them in hopes to correct the rhythm, this is done with anesthesia as well. 
• Appendage closure: This is more for those with atrial fibrillation but are not great candidates for anticoagulation, it involves a protective clip to prevent blood clots from forming and exiting the body. 

Long-term Management

Some individuals may remain in AF/AFL rhythm permanently, but maintaining a treatment plan and adhering to medication regimens is key to managing the condition effectively.

Understanding the effectiveness of your treatment involves monitoring various factors and using tools to help manage your condition at home. This guide will explore necessary home monitoring tools, situations that may require hospital visits, and best practices for managing your health.

Blood Pressure Cuff

An electronic blood pressure cuff is essential for monitoring any cardiac condition. An upper-arm cuff is more accurate than wrist devices. You can obtain one through the VA prosthetics clinic or purchase one from retailers like Walgreens, Walmart, or Amazon for approximately $40. For accurate readings, ensure correct placement of the cuff, sit with uncrossed legs, and rest for 15-30 minutes in a calm environment. Normal blood pressure is between 90/60 and 120/80 mmHg, and a typical heart rate ranges from 50-100 beats per minute. Initially, check your blood pressure three times a week; once stabilized, weekly checks are sufficient.

Standing Scale

Daily weighing, particularly for conditions like congestive heart failure, helps detect rapid weight gain which could indicate fluid overload. Weigh yourself consistently at the same time each day, ideally upon waking and with minimal clothing. Record your weight, and in cases of heart failure, a sudden weight gain of 3-5 pounds overnight necessitates an emergency room visit. Additionally, monitor for ankle swelling and regulate fluid and salt intake.

Medication Stewardship

Adherence to prescribed medication is crucial. Understand the purpose of your medications and ensure you don’t run out by contacting the healthcare provider a week before your supply finishes. A daily pill box can help track medications. Consult with your healthcare provider before adding new supplements to prevent interactions with existing treatments. If receiving care outside of the VA, bring a list of medications to appointments and inform the VA of any new prescriptions.

Healthy Diet

For cardiac health, focus on reducing fat and salt intake. Sodium should be limited to avoid high blood pressure and fluid retention. Avoid adding table salt, opt for low-sodium food options, and use salt substitutes like spices for flavor. Limit saturated and trans fats found in processed foods, beef, and dairy. Instead, incorporate healthy fats from sources like olive oil, salmon, nuts, and avocados. Be mindful of processed "low-fat" foods that might have increased sugar or salt.

Heart Healthy Exercise

Engage in daily cardiovascular exercise like walking, biking, or jogging to improve heart health. Aim for at least 30 minutes a day, which can significantly lower dementia risk. Strength training, especially for women, maintains bone density. A balanced routine of cardiovascular and strength exercises supports effective cardiac treatment. Your doctor may recommend a cardiac rehabilitation program in the community, this would be highly recommended as a workout plan is tailored just for you and monitored by health care professionals. 

Heart Healthy Exercise

Engage in daily cardiovascular exercise like walking, biking, or jogging to improve heart health. Aim for at least 30 minutes a day, which can significantly lower dementia risk. Strength training, especially for women, maintains bone density. A balanced routine of cardiovascular and strength exercises supports effective cardiac treatment.

Lifestyle Modifications

Quit smoking and limit alcohol to maintain heart health. Ensure adequate sleep and manage stress to prevent adverse effects on blood pressure and overall health. Avoid recreational drugs, including marijuana, which could worsen cardiovascular conditions. Recognize and address lifestyle factors such as unhealthy relationships or job stress that may contribute to poor health. Seek help from the VA for mental health support if needed and surround yourself with positive influences to support healthy habits.

When to visit the emergency room 

Possible heart attack signs:

• Chest pain not resolved by rest
• Sudden squeezing in the chest – may or may note be caused by activity
• Radiating pain that increase in severity in shoulder, arm, abdomen, jaw, neck or back
• Feeling of heartburn without eating anything or eating anything new
• Sharp pains in the chest worse with breathing or lying down

Heart failure signs:

• Significant overnight weight gain of 3-5 lbs
• Difficulty breathing
• Coughing up pink foamy sputum
• Increase of O2 needs (if you are using supplemental oxygen)
• Significant swelling of the hands, feet and ankles

Abnormal vital signs: 

• Persistent fast heart rate greater than 120 BPM (1-2 hours) or feeling of intense palpitations with symptoms that include but aren’t limited to, shortness of breath, difficulty speaking, difficulty completing activity, lightheadedness or dizziness.
• HR consistently below 50 with symptoms that include but aren’t limited to, dizziness, inability to concentrate, light-headedness, feeling the need to immediately sit down upon standing.
• Passing out, blacking out, also called syncope
• Consistent Hypertension (1-2 hours) above 170/90 with or without symptoms

Possible signs of stroke:

• Facial drooping on one side
• Difficulty speaking or understanding others
• Inability to use one side of body/limited use of one side of the body. 

Not Sure? 
Call cardiac RN Tuesday-Friday 0700-1730
After hours or on Monday call nurse triage line (303) 399 8020 – Option 3