Vacation

I've always found vacation to be such sweet and sour activity.

I love getting away from work. Traveling or just bumming around at home with the kids is always such a treat.

However, it is hard to leave my patients. Some of them will get sick and need my help. Others have test results that they will want to discuss with me. Colleagues will have issues that need discussing as well.

As a member of a large practice, I know that my patients will have coverage 24 hours a day. Yet, I do feel bad that there are times that they need me most and I am unable to be with them.

I'm sure that many of my colleagues feel the same way. Funny, we do not really talk about it amongst ourselves.

E-mail has really changed things though. In the past, message from patients and test results were just left on my desk with the patients chart. Now, I can get an email pushed to my BlackBerry sitting on the beach or at the sidelines of my daughter's soccer game. This clearly has its good and bad sides. Things will get even more complicated when we fully migrate to an EMR, so I can be sitting in my home an be able to have full access to a patients entire chart.

Overall, I remain a huge fan of technology and its direct impact on the modern day practice of medicine. However, it is hard to put down my BlackBerry and enjoy vacation as a true "time away" from the office and my practice. I usually still choose to pick it up once or twice a day to answer emails regarding patient care and keep up with the business side of my practice.

Well - vacation - here I come!!!
Sent from my Verizon Wireless BlackBerry

August will be Dr Portnay's "Get Moving" Month

Get ready for August.

I'm proposing that we designated it "get moving month".

I want al my followers to get motivated to be active - together we can get fit and maybe shed a pound or two.

We wil definitely feel better by months end.

I'll be tweeting my daily activity and hopefully you will too.

I'll be blogging about my motivation, my struggles and the choices I made.

Together we can motivate each other.

Wear a pedometer - tell us your steps for the day. Tell us how you exercised or, for example, how you decided two take the stairs instead of the elevator.

Week one will be hard for me since I will be on vacation with my family but if I can do it then, think how much easier it will be to just try and make it a part of your daily routine

Let's do it!!!!!

New Logo

I've just updated this blog as well as my twitter account with a new logo. I think it captures conceptually everything I try to blog about - heart, health, nutrition and exercise. What do you think? I hope you like it

What Breakfast Cereal Has To Do With Heart Failure

Very good article explaining the connection between breakfast cereal and heart failure I previously blogged about - hope this is helpful

http://feedproxy.google.com/~r/wsj/health/feed/~3/h2D0sT9ItkQ/

Stoke as a complication of angioplasty and stenting

As I have described previously, angioplasty and stenting are two of the most common procedures performed in a Percutaneous Coronary Intervention.

While the procedure is generally safe, it does carry with it some inherent risks.

One of the most feared by both patient and physician is stroke.

Luckily, research has revealed that this is indeed a very rare occurrence

In recently published data, researchers examined all patients undergoing PCI from January 1, 2004, to March 30, 2007 who registered in the National Cardiovascular Data Registry, 706,782 patients. Of these patients, stoke only occurred in 1540 patients or 0.22%. Of those who developed stroke, the strongest conditions associated with it were prior cerebrovascular disease, older age, acute coronary syndromes (unstable angina, ST- and non–ST-elevation myocardial infarction), and use of an intra-aortic balloon pump.

Despite this low risk, when it did occur, the results were serious. In-hospital mortality was 30% for patients who developed a stroke compared with 1% for those without stroke.

In conclusion: Stroke remains a very rare complication of modern PCI, yet when it occurs, it is a serious event.

Source: http://viigo.im/0kit

E-cigarettes?

I must admitted that although I consider myself a pretty up-to-date guy, every now and then I get surprised by something I have never hear of.

This occurred justa few minutes ago when I read about e-cigarretes on kevinmd.com.

"E-cigarettes are battery operated, and contain nicotine and other flavors that the user can inhale. Advertisements claim they are safer since they don’t burn tobacco."

I totally agree with Dr Kevin Pho and Dr Matthew Mintz. These devices are a bad idea.

Healthy Lifestyle CAN Lower Your Lifetime Risk of Heart Failure

A recent article from JAMA has shown that there is a significant association between a healthy lifestyle and your lifetime reisk of heart failure

Researches followed 20,900 men enrolled in the Physicain's Health Study who were healthy at baseline. They then compared those who adhered to a healthy lifestyle to those who did not.

The six modifiable risk factors they included in the "healthy lifestyle" were:

1. Body weight
2. Smoking
3. Exercise
4. Alcohol intake
5. Consumption of breakfast cereals
6. Consumption of fruits and veggies

The overall lifetime risk for heart failure among the study participants was 13.8%.

The highest risk of heart failure was in those participants who did not adhere to any of the six above lifestyle factors - 21.2%

The lowest risk of heart failure was in those participants who adhered to 4/6 of the above lifesyle factors - 10.1%

Conclusion -- adhering to a healthy lifesyle (including the 6 above mentioned factors) can dramatically lower your lifetime risk of developing heart failure

WEAR SUNSCREEN

This is taken directly from the CDC's webite.

Skin cancer is the most common form of cancer in the United States.

The two most common types of skin cancer—basal cell and squamous cell carcinomas—are highly curable. However, melanoma, the third most common skin cancer, is more dangerous, especially among young people. About 65%–90% of melanomas are caused by exposure to ultraviolet (UV) light or sunlight.

In 2005, 53,792 people in the United States were diagnosed with melanomas of the skin

Research shows that most skin cancers can be prevented if people are protected from UV light

The future is coming!!!!

I am very excited for the next major breakthough in medicine. I am convinced it will be the identification of the genetic substrate behind many medical conditions and then the even more exciting developement of tailored therapies for these conditions based on the genetic disorder.

Just this past week I read three reports linking genetics to heart disease:

1. Genetics of BP in African-Americans Identified
2. Second common genetic variant in AF identified - A sequence variant in the ZFHX3 gene is linked with a 20% increased risk of atrial fibrillation in people of European ancestry
3. Cardiac Ankyrin Repeat Protein Gene (ANKRD1) Mutations in Hypertrophic Cardiomyopathy - CARP abnormalities may be involved in the pathogenesis of HCM

While we are a long way from my dream of tailoring therapies based on genetics, these findings (along with hundreds of others) are the very important first step in this exciting process.

eFitnessNow.com

I just discovered this great website. When I went to read the information "about" it - I could not believe it - they are preaching exactly the same message that I have been trying to preach here in this blog. Here is what they say:

"Our Mission:To provide people with leading-edge knowledge and tools necessary for a healthy and active life at any age.

Our Beliefs:The current US healthcare system, with its focus on treating the symptoms of disease rather than its underlying causes, has led to a population with the highest levels of chronic disease and obesity in the country’s history.

There is hope. People have the ability to improve their health, halt chronic illness, and lessen the need for prescribed medications. With the right combination of improved eating habits, regular activity, and established good-health practices, anyone can enjoy a life of enhanced health.
A healthy eating plan is not a diet; healthy eating means choosing the right foods in the correct proportions. With the proper balance of protein, complex carbohydrates, and nutritious fats, a healthy eating plan is one of the fastest ways to achieve optimal health.

Regular physical movement is a vital component of a program for excellent health. A combination of activities that encourage cardiac and lung health, flexibility, and muscle resistance can lead to a fitter, stronger body.

Our objective is to provide a guide to healthy practices for you to lead an energetic, vital, and fulfilling life."

Hallelujah!!!!!

We Are What We Eat and Do

With all the publicity regarding health care reform, the one thing that I saw as a positive move was the appointment of a primary care champion as the Surgeon General. With this in mind, here are my thoughts on just how important primary care and prevention are ...

Every day another report is published regarding the growing obesity epidemic in America (this week alone I read 5-10 news feeds).

We continue to smoke.

We continue to be a sedentary society.

The American diet and American way of life is truly killing us. If we do not change these three key things, we will never be able to control the cost of health care.

Please:
1. Watch what you eat
2. Stop smoking
3. Be active



Ted

For news, education, and opinion on heart disease and nutrition for the everyday person -- follow me @ drportnay.blogspot.com

What is: Cardiac Catheterization

Cardiac Catheterization - as known an Cardiac Cath, Coronary Arteriogram, Coronary Angiogram, Angiogram

What is cardiac catheterization?
Cardiac catheterization is performed to further diagnose coronary artery disease, valvular heart disease, congestive heart failure, and/or certain congenital (present at birth) heart conditions.

In cardiac catheterization (often called cardiac cath), a very small hollow tube, or catheter, is advanced from a blood vessel in the groin or arm through the aorta into the heart. Once the catheter is in place, several diagnostic techniques may be used. The tip of the catheter can be placed into various parts of the heart to measure the pressures within the chambers. The catheter can be advanced into the coronary arteries and a contrast dye injected into the arteries.
The use of fluoroscopy (a special type of x-ray, similar to an x-ray “movie”) assists the physician in the location of blockages in the coronary arteries as the contrast dye moves through the arteries.

Patients receive consious sedation during the procedure - this is sedative medications to keep them comfortable.

Reasons for the Procedure:

• atherosclerosis - a gradual clogging of the arteries over many years by fatty materials and other substances in the blood stream


• cardiomyopathy - an enlargement of the heart due to thickening or weakening of the heart muscle


• congenital heart disease - defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart)


• congestive heart failure - a condition in which the heart muscle has become weakened to an extent that blood cannot be pumped efficiently, causing buildup (congestion) in the blood vessels and lungs, and edema (swelling) in the feet, ankles, and other parts of the body
  valvular heart disease - malfunction of one or more of the heart valves that may cause an obstruction of the blood flow within the heart

A cardiac catheterization may also be performed if you have recently had an episode(s) of one or more of the following cardiac symptoms:

• chest pain or angina


• shortness of breath


• dizziness


• fatigue
  

Other reasons for a cath procedure include evaluation of myocardial perfusion (blood flow to the heart muscle) if chest pain or angina occurs after the following:

• heart attack


• heart bypass surgery


• coronary angioplasty (the opening of a coronary artery using a balloon or other method) or placement of a stent (a tiny expandable metal coil placed inside an artery to keep the artery open)

There may be other reasons for your physician to recommend a cardiac catheterization.

Risks of the Procedure:

Possible risks associated with cardiac catheterization include, but are not limited to, the following:

• Bleeding at the catheter insertion site (usually the groin, but the arm may be used in certain circumstances)


• blood clot or damage to the blood vessel at the insertion site


• infection at the catheter insertion site


• problems with heart rhythm (usually temporary)


• ischemia (decreased blood flow to the heart tissue),


• chest pain, or angina


• stroke (rare)

The amount of radiation used with fluoroscopy during a cardiac catheterization procedure is considered minimal; therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician due to risk of injury to the fetus from a cardiac catheterization. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your physician.
There is a risk for allergic reaction to the cath dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, shellfish, or latex should notify their physician. Also, patients with kidney failure or other kidney problems should notify their physician.

For some patients, having to lie still on the cardiac catheterization table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure:

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.


• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.


• Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.


• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).


• You will need to fast for a certain period of time prior to the procedure. Your physician will notify you how long to fast, usually overnight.


• If you are pregnant or suspect that you may be pregnant, you should notify your physician.


• Notify your physician if you have any body piercings on your chest and/or abdomen.


• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.


• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.


• Your physician may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.


• You may receive a sedative prior to the procedure to help you relax. If a sedative is given, you will need someone to drive you home afterwards.


• The area around the catheter insertion site (groin area) may be shaved.


• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure:

A Cardiac catheterization may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a cardiac catheterization follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aids if you use either of these.


• You will be asked to remove clothing and will be given a gown to wear.


• You will be asked to empty your bladder prior to the procedure.


• An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.


• You will be placed in a supine (on your back) position on the procedure table.


• You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.


• There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.


• You will receive a sedative medication in your IV before the procedure to help you relax. .


• Your pulses below the catheter insertion site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.


• A local anesthetic will be injected into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.


• Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart.


• The catheter will be advanced through the aorta to the left side of the heart. Fluoroscopy will be used to assist in advancing the catheter to the heart.


• Once the catheter is in place, contrast dye will be injected through the catheter to visualize the heart and the coronary arteries. You may feel some effects when the contrast dye is injected into the IV line. These effects may include a flushing sensation, a salty or metallic taste in the mouth, and/or a brief headache. These effects usually last for a few moments.
  You should notify the physician if you feel any breathing difficulties, sweating, numbness, nausea and/or vomiting, chills, itching, or heart palpitations.


• After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.


• Once sufficient information has been obtained, the catheter will be removed. The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.


• If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.


• You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint.


• If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and removed at the appropriate time as determined by your physician.

After the Procedure - In the hospital:

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.

Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration.

In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.

After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may resume your usual diet after the procedure, unless your physician decides otherwise.

When you have completed the recovery period, you may be discharged to your home unless your physician decides otherwise. If this procedure was performed on an outpatient basis, you must have another person drive you home.

After the procedure - At home:

Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your physician.

If your physician used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin at the site. This is normal. The knot should gradually disappear over a few weeks.

It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

• fever and/or chills


• increased pain, redness, swelling, or bleeding or other drainage from the insertion site


• coolness, numbness and/or tingling, or other changes in the affected extremity
  chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

What is: Angioplasty/Stent (PCI)

WHAT IS: PCI - Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) is performed to open blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery. PCI is usually comprised of both angioplasty (PTCA – percutaneous transluminal coronary angiolplasty), followed by stent placement. It is performed in either an emergency setting (for treatment of a heart attack or impending heart attack) or in an outpatient setting (to treat a severe blockage causing heart pain and reduced blood flow to the heart).

A special catheter is inserted through the major artery in the leg or arm and advanced up to the heart. Through the catheter, a tiny wire is inserted into the coronary artery and threaded across the blockage. Over this wire, a tiny balloon is advanced to the blockage. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

What is stent placement?
In the past few years, many refinements have been developed in the PCI procedure. One common procedure used in PCI is stent placement. A stent is a tiny, expandable metal coil that is inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again.

Newer stents (drug-eluting stents, or DES) are coated with medication to prevent the formation of scar tissue inside the stent. These drug-eluting stents release medication within the blood vessel itself. This medication inhibits the overgrowth of tissue that can occur within the stent. The effect of this medication is to deter the narrowing of the newly stented blood vessel.

Once the stent has been placed, tissue will begin to form over it within a few days after the procedure. The stent will be completely covered by tissue within a month to one year. It is necessary to take anti-platelet medications, such as aspirin or clopidogrel (Plavix™), which decreases the “stickiness” of platelets (a type of blood cells that clump together to form clots to stop bleeding), in order to prevent blood clots from forming inside the stent

Coronary artery disease:
Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries. This buildup causes the inside of the arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle.

To better understand how coronary artery disease affects the heart, a review of basic heart anatomy and function follows.

The heart is basically a pump. The heart is made up of specialized muscle tissue, called the myocardium. The heart's primary function is to pump blood throughout the body, so that the body's tissues can receive oxygen and nutrients and have waste substances taken away.

Like any pump, the heart requires fuel in order to work. The myocardium requires oxygen and nutrients, just like any other tissue in the body. However, the blood that passes through the heart's chambers is only passing through on its trip through the body - this blood does not give oxygen and nutrients to the myocardium. The myocardium receives its oxygen and nutrients from the coronary arteries, which lie on the outside of the heart.

Angina:
When the heart tissue does not receive an adequate blood supply, it cannot function as well as it should. If the myocardium's blood supply is decreased for a length of time, a condition called ischemia develops. Ischemia can decrease the heart's pumping ability, because the heart muscle is weakened due to a lack of food and oxygen.

Unfortunately, you may not have any symptoms of beginning coronary artery disease, yet the disease will continue to progress until sufficient artery blockage occurs, causing angina (chest pain or discomfort due to coronary artery disease). Angina feelings include chest or arm pain, chest pressure, fatigue, indigestion, palpitations, and shortness of breath.

Heart attack:
If a coronary artery is completely closed by a blood clot, a myocardial infarction (heart attack) may occur. The blood clot may occur when a plaque (build-up of fatty tissue inside the artery walls) ruptures. If the blood flow cannot be restored quickly to the particular area of the heart muscle affected, the tissue dies.

Reasons for the Procedure:
PCI is performed to restore coronary artery blood flow when the narrowed artery is in a location that can be reached in this manner. Not all coronary artery disease can be treated with PCI. Your physician will decide the best treatment of your CAD based on your individual circumstances.

Risks of the Procedure: Possible risks associated with PCI include, but are not limited to, the following:

• allergic reactions


• medication reactions


• bleeding


• chest pain or discomfort


• infection


• damage to the blood vessel(s) into which a catheter is inserted which could require surgical repair


• there is small risk (under 1%) of the coronary artery becoming narrowed during the procedure, resulting in the need for immediate, emergent coronary bypass (open heart) surgery.


• damage to the kidneys which could require dialysis


• heart rhythm disturbances


• myocardial infarction


• stroke


• nerve injury


• death

The risk of any one of these serious complications is less than 1% except in certain high-risk conditions that have been discussed with me as appropriate.

The amount of radiation used in fluoroscopy during a PTCA or stent procedure is considered minimal; therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician due to risk of injury to the fetus from a PCI. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your physician.

There is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications (ASPIRIN), contrast dye, iodine, or shellfish should notify their physician. Also, patients with kidney failure or other kidney problems should notify their physician.

Since this procedure requires you to take anti-platelet medications, please inform you physician if you currently have or have a history of bleeding problems. Please also tell your physician if have any surgical procedures planned in the near or distant future.

For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure: Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine, seafood, or aspirin.

Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

You will need to fast for a certain period of time prior to the procedure. Your physician will notify you how long to fast, whether for a few hours or overnight.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

Notify your physician if you have any body piercings on your chest and/or abdomen.

Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.

Your physician may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.

You may receive a sedative prior to the procedure to help you relax.

The area around the catheter insertion (groin area) may be shaved.

Based upon your medical condition, your physician may request other specific preparation.
During the Procedure

A PCI may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a PCI follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.


• You will be asked to remove clothing and will be given a gown to wear.


• You will be asked to empty your bladder prior to the procedure.


• An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.


• You will be placed in a supine (on your back) position on the procedure table.


• You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.


• There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.


• You will receive a sedative medication in your IV before the procedure to help you relax.
  Your pulses below the insertion site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.


• A local anesthetic will be injected into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.


• Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart.


• The angioplasty catheter will be inserted through the sheath into the blood vessel. The physician will advance the catheter through the aorta into the heart. Fluoroscopy will be used to assist in advancing the catheter to the heart.


• The catheter will be advanced to the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries in order to see the narrowed area(s). You may feel some effects when the contrast dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, and/or a brief headache. These effects usually last for a few moments.


• You should notify the physician if you feel any breathing difficulties, sweating, numbness, itching, nausea and/or vomiting, chills, or heart palpitations.


• After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.


• When the physician locates the narrowed artery, the interventional wire will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some chest pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any chest discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, tell your physician immediately.


• The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. In some cases, the stent may be inserted into the artery before the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.


• The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.


• The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.


• If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.


• Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off. You will need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medication to make you more comfortable.


• You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint.


• If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and then removed at the appropriate time determined by your physician.

After the Procedure - In the hospital:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration.

In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.

After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may resume your usual diet after the procedure, unless your physician decides otherwise.

You will most likely spend the night in the hospital after your procedure. Depending on your condition and the results of your procedure, your stay may be longer. You will receive detailed instructions for your discharge and recovery period.

After the procedure - At home:
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your physician.

If your physician used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was. This is normal. The knot should gradually disappear over a few weeks.

It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

• fever and/or chills


• increased pain, redness, swelling, or bleeding or other drainage from the insertion site


• coolness, numbness and/or tingling, or other changes in the affected extremity


• chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

FDA Approves Prasugrel

This approval is big news in the cardiology community. We have been waiting for this for some time.

Preasugrel is an anti-platelet drug (like Plavix) and is vital when used after a stent placement to prevent stent thrombosis (clotting within the stent).

We have been excited about its approval ever since the publication of the TRITON-TIMI 38 trial.

That trial showed a 19% reduction in composite cardiovascular death, MI, and stroke compared with clopidogrel (9.9% versus 12.1%, P<0.001).

The number of patients who had a subsequent nonfatal MI dropped to 7.0% with prasugrel compared with 9.1% with clopidogrel.

However, there are some safety concerns as well. In that trial, major bleeding events occurred in 2.4% of prasugrel patients compared with 1.8% of those in the clopidogrel arm.

Most of the bleeing was in patients over 75 years of age, those frail and very thin and those with a history of a stroke.

Therefore, while the drug is not for everyone, it will give use another tool to help lower the risk of major cardiac events after stenting.



Ted

For news, education, and opinion on heart disease and nutrition for the everyday person -- follow me @ drportnay.blogspot.com

Added sites to "Excellent Sites" links

I've added more links to my "Excellent Sites" section -- please refer to the right side of my blog for links to very useful/educational sites

Angioplasty and Stent Video

There are many videos where the angioplasty/stenting procedure is described and animated. I just spent some time on youtube and I found this one -- I thought it was a pretty good and accurate

Coffee and Heart Disease

Many patients ask me about the safety of drinking coffee. This is re-enforced when they are admitted to the hospital and only given decaf coffee.

For the most part, drinking coffee has not proven to increase mortality in men and women.

In the largest trial to date looking at coffee consumption in 41,736 men and 86,214 women -- there was no association in increased mortality (Ann Intern Med. 2008;148:904-914). In fact, there was a possible "modest benefit of coffee consumption on all-cause and CVD mortality."

This report adds heft to the hypothesis that coffee can stem heart disease, perhaps by battling the inflammatory damage associated with early stage illness.

This study was not the first to connect coffee drinking with good health. Over the years, other research has linked coffee consumption with lower rates of heart attack, liver cancer and diabetes.

While the above is true, there are certain situations where coffee consumption may be dangerous. Patients who have had a recent heart attack or someone prone to develop cardiac arrythmias should probably watch their coffee/caffeine intake.

Weekly Tweets - 1st addition

I'm going to start a weekly posting of all my "tweets" on twitter on a weekly basis - here goes:

Hypothesis Generating News: Chemical Exposure Key to Rising Death Rates in Diabetes, Other Diseases http://viigo.im/09znabout 10 hours ago from Viigo

Prevention News: Drug Prevents Stomach Ulcers from Low-Dose Aspirin (CME/CE) http://viigo.im/09zlabout 10 hours ago from Viigo

Exercise/Health News: Fatty Liver Disease Responds to Extra Exercise http://viigo.im/09ziabout 10 hours ago from Viigo

News: New Report Finds American Obesity Rates Climb Again - Fruits & Vegetables Important To Combating Obesity http://viigo.im/098Eabout 22 hours ago from Viigo

Heart News: Discovery Of Molecule That Regulates Heart Size By Using Zebrafish Screening Model http://viigo.im/098Babout 22 hours ago from Viigo

Vascular News: MicroRNAs Hold Promise For Treating Diseases In Blood Vessels http://viigo.im/098zabout 22 hours ago from Viigo

Vascular News: Gladstone Scientists Identify Genetic Factors That Hold Promise For Treatment Of Vascular Diseases http://viigo.im/098rabout 22 hours ago from Viigo

Nutrition News: Cutting Calories May Be Key To Evolutionary Fitness http://viigo.im/085M7:39 AM Jul 4th from Viigo

Policy News: We can't let this happen - proposed cuts to card payments in Medicare physician fee schedule for 2010 http://viigo.im/07Ww9:44 PM Jul 3rd from Viigo

Nutrition News: Vegetarians Have Lower Cancer Risk, UK Study http://viigo.im/07Bu10:01 AM Jul 3rd from Viigo

Poll: What Do You Think of Banning Drug Industry Gifts to Doctors? I would love to hear your comments http://viigo.im/07Bp10:00 AM Jul 3rd from Viigo

Preventio News: Food For Thought: Report Published Into The UK's Health - here in US we must do more http://viigo.im/07Bn9:58 AM Jul 3rd from Viigo

Nutrition News: Patient Money: Weight Loss on a Sliding Financial Scale http://viigo.im/07Bk9:57 AM Jul 3rd from Viigo

Is there a link between exercise and happiness? http://viigo.im/07w36:44 AM Jul 3rd from Viigo

For Research On Protective Effects Of Fish Oil In Stroke LSUHSC MD/PHD Student Awarded NIH Grant http://viigo.im/07vW6:42 AM Jul 3rd from Viigo

Nearly Half of U.S. States' Adult Obesity Rates Increased This Year http://viigo.im/07vT6:39 AM Jul 3rd from Viigo

Well: Eating to Fuel Exercise http://viigo.im/07vG6:33 AM Jul 3rd from Viigo

The Need for New Research to Include Old Patients http://viigo.im/07vB6:30 AM Jul 3rd from Viigo

ARMYDA-RECAPTURE published: Statin reload before PCI http://viigo.im/07vu6:25 AM Jul 3rd from Viigo

Warnings for smoking-cessation drugs varenicline, bupropion http://viigo.im/07vm6:24 AM Jul 3rd from Viigo

NYC: Aiming Wide in City War on Smoking. Anyone think this will work? Doesn't everyone who smokes no it is bad? http://viigo.im/05NQ10:20 PM Jun 30th from Viigo

Health Delivery Tops IOM's Comparative Effectiveness Research Priorities http://viigo.im/05B85:39 PM Jun 30th from Viigo

Original content: Massive vitamin-D/omega-3 trial for prevention of CardioVascular Disease http://viigo.im/04FT9:31 PM Jun 29th from Viigo

New Approach To Treating MI Reduces Risk Of severe Complications: my practice has bn doing this routinely for yrs http://viigo.im/04FJ9:28 PM Jun 29th from Viigo

Why Industry May Back Limits on Junk Food in Schools -- I'm all for whatever it takes to fight childhood obesity http://viigo.im/04Ff9:22 PM Jun 29th from Viigo

Wolves in sheep's clothing: Don't ignore white-coat and masked hypertension://www.theheart.org/article/982461.do9:02 PM Jun 29th from web

Thank You

I just received a thank you card from the family of a patient of mine. It was a card put out by the American Heart Association. On the back was the following (I could not have said it better): "A physically inactive lifestyle is a risk factor for coronary heart disease and stroke. Regular moderate-to-vigorous physical activity done for at least 30 minutes on a most or all days of the week helps prevent heart and blood vessel disease. The more activity, the greater your benefits."