Programs & Services
Patients come to us with heart and vascular conditions that span the entire breadth of cardiovascular medicine.
When cardiovascular disease threatens their health, we believe they should expect and receive the best modern medicine has to offer. To make that a reality for tens of thousands of patients who visit our offices annually, we have pioneered dozens of “firsts” ; technologies and interventions we were first to develop, first to use or first to adapt to patient care.
|Abnormal blood cholesterol||Heart failure|
|Abnormal heart rhythms||Heart valve disorders|
|Atherosclerosis||Narrowing of the carotid arteries|
|Cardiovascular infection/inflammation||Peripheral vascular disease|
|Heart attack||Stroke and pre-stroke disorders|
Atherosclerosis is a condition where the arteries begin to harden and narrow. This process begins with the build-up of fatty substances or cholesterol. This build-up is referred to as plaque. The plaque may partially or totally block the blood’s flow through an artery. This is what causes a heart attack.
Heart attacks are the leading cause of death in men and women in the United States. Every year, more than 1.5 million heart attacks are diagnosed. A heart attack, or myocardial infarction occurs when the blood supply to part of the heart muscle (the myocardium) is severely reduced or stopped. This occurs when one of the coronary arteries that supply blood to the heart muscle is blocked. The blockage is usually from the buildup of plaque (deposits of fat-like substances) due to atherosclerosis . The plaque can eventually tear or rupture, triggering a blood clot to form that blocks the artery and leads to a heart attack. Such an event is sometimes called a coronary thrombosis or coronary occlusion.
If the blood supply is cut off severely or for a long time, muscle cells are deprived of oxygen and die. Disability or death can result, depending on how much heart muscle is damaged.
Approximately 400,000 Americans are diagnosed with heart failure each year. Heart failure is often a result of heart attack, high blood pressure, infection of the heart muscle, heart valve disorders or alcohol abuse.
When a patient has heart failure, his or her heart is unable to pump as efficiently and effectively as it should. Generally, the main pumping chamber (or left ventricle) enlarges and becomes weakened. Therefore, the heart has a difficult time meeting the demands of the body. As blood flow from the heart slows, blood returning to the heart through the veins, backs up, causing congestion in the body. Often swelling (edema) results, most commonly in the legs and ankles. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a patient is lying down.
Peripheral vascular disease (PVD) refers to diseases of blood vessels outside the heart. PVD is identified and treated by cardiologists and radiologists at MHS.
It is a condition similar to coronary artery disease. In PVD fatty deposits build up along artery walls and affect blood circulation, to the brain, kidneys and legs. People with PVD have a higher risk of death from stroke and heart attack, due to the risk of blood clots.
When a patient has an abnormal blood cholesterol level, it means his or her total cholesterol is elevated. This is determined through a laboratory test. This number is taken from a report, often called a lipid panel. A lipid panel is a comprehensive analysis of the various factors that determine a patient’s overall risk for high cholesterol.
There are three main components of cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides:
|LDL or "bad" cholesterol is the component that clogs the arteries. Elevated levels of LDL increase the risk of heart disease, stroke or other health problems. |
|HDL or "good" cholesterol, helps remove the LDL from the bloodstream. Higher levels of HDL help decrease the risk of heart disease, stroke and other health problems.|
|Triglycerides is the fatty substance found in fat tissues of the body and in fatty foods. Elevation of trigylcerides can be caused by increased weight gain, excessive intake of alcohol, diabetes, hypothyroidism, kidney disease or liver disease.|
The heart contains four valves ensuring that blood flows forward as the heart contracts and relaxes.
Conditions affecting the four valves of the heart (mitral valve, tricuspid valve, pulmonary valve and aortic valve), are either acquired or congenital in nature. In adults the most common cause of valvular disease is due to aging. In children, the most common cause is congenital, or birth malformation. Valvular disorders vary in severity and symptoms and the recommended treatment. The valve can narrow and this is called stenosis, decreasing the flow of blood through the heart. The valve can also leak, which makes the heart work harder as blood is pumped forward.
In many conditions medical management is sufficient, however in more severe cases surgical repair or replacement may become necessary.
Abnormal heart rhythms, or arrhythmias, are problems with the heart’s electrical system, which causes the heart to pump less effectively.
Normally the heartbeat starts in the right atrium when a special group of cells sends an electrical signal. (These cells are called the sinoatrial or SA node, the sinus node or "pacemaker" of the heart.) This signal spreads throughout the atria and to the atrioventricular (A-V) node. The A-V node connects to a group of fibers in the ventricles that conduct the electric signal. The impulse travels down these specialized fibers to all parts of the ventricles. This exact route must be followed for the heart to pump properly and efficiently.
An arrhythmia may occur for one of several reasons:
|The sinus node develops an abnormal rate or rhythm|
|A patient has a heart block.|
Patients who have arrhythmias may experience dizziness, feel the heart skip a beat or feel fluttering in the chest.
Some commonly diagnosed arrhythmias include:
(Originating in the Atria)
Atrial fibrillation. Electrical signals in the atria are fired in a very fast and uncontrolled manner. Electrical signals arrive in the ventricles in a completely irregular fashion, so the heart beat is completely irregular.
Atrial flutter. A rapid short circuit rhythm in the top part of the heart. The atria contract at 300 beats per minute. The lower chambers (the ventricles) contract at multiples of this (150, 100, or 75 beats per minute). The usual rate is 150 beats per minute.
Premature supraventricular contractions or premature atrial contractions (PAC). A beat occurs early in the atria, causing the heart to beat before the next regular heartbeat.
Sinus arrhythmia. Cyclic changes in the heart rate during breathing. Common in children and often found in adults. This is normal.
Sinus tachycardia. The sinus node sends out electrical signals faster than usual, speeding up the heart rate. Causes include exercise, fever, excitement, certain medications, dehydration and an overly active thyroid gland.
Sick sinus syndrome. The sinus node does not fire its signals properly, so that the heart rate slows down. Sometimes the rate changes back and forth between a slow (bradycardia) and fast (tachycardia) rate.
Supraventricular tachycardia (SVT), paroxysmal atrial tachycardia (PAT). A series of early beats in the atria speed up the heart rate (the number of times a heart beats per minute). In paroxysmal tachycardia, repeated periods of very fast heartbeats begin and end suddenly. Heart rates are generally in the 160 to 220 beat per minute range.
Wolff-Parkinson-White syndrome. Abnormal pathways between the atria and ventricles cause the electrical signal to arrive at the ventricles too soon and to be transmitted back into the atria. Very fast heart rates may develop as the electrical signal ricochets between the atria and ventricles.
(Originating in the Ventricles)
Premature ventricular contractions (PVC). An electrical signal from the ventricles causes an early heart beat that generally goes unnoticed. The heart then seems to pause until the next beat of the ventricle occurs in a regular fashion. This is frequently felt as a "skipped" beat or "strong" extra beat.
Ventricular tachycardia. The heart beats fast due to electrical signals arising from the ventricles (rather than from the atria).
Ventricular fibrillation. Electrical signals in the ventricles are fired in a very fast and uncontrolled manner, causing the heart to quiver rather than beat and pump blood.
An infection or inflammation in the heart muscle (myocarditis) or heart valve (endocarditis), which has been caused by a virus or bacteria.
Atherosclerosis or hardening of the carotid arteries, which supply blood and oxygen to the brain. The carotid arteries are located on either side of the neck. If these arteries become completely blocked, it could result in a stroke.
A stroke, often referred to as a "brain attack", is an event that occurs in the brain as a result of inadequate blood flow, and hence oxygen supply. Strokes generally can be classified into one of two groups; ischemic or hemorrhagic. Ischemic strokes, are a result of debris from blood vessels or blood clots which obstruct blood flow in a vessel to the brain. Hemorrhagic strokes are a result of a blood vessel bleeding inside the brain.
The severity and symptoms of a stroke depend upon how much brain tissue is affected and where it is located. Often times, full function may be regained after a "mild" stroke although sometimes function is never fully recovered. There are many medical as well as surgical options, which need to be explored in a patient who is suspected of having a stroke.