Conditions

Merced Heart Associates provides expert diagnosis and treatment for a wide range of cardiovascular conditions.

Our cardiologists are experienced in diagnosing and treating the full spectrum of heart and vascular conditions. Below is an overview of the conditions we commonly treat.

Angina

Temporary chest pain caused by insufficient blood flow to the heart.

What is angina?

Angina (angina pectoris) refers to a temporary chest pain that is caused by not enough blood getting to the heart. It may be a feeling of tightness, heaviness, dull discomfort, numbness, burning, pressure, or crushing pain that is usually felt behind the breastbone. It can also spread to the arms, neck, and jaw. Angina is often brought on by exercise, eating, or stress. Not all chest pain is that of angina; only your doctor can make the proper diagnosis.

How long does it last?

In most cases an attack will last for less than five minutes, but can range from less than 30 seconds to more than 30 minutes. You will learn to recognize your own pattern – that is, when attacks are likely to occur, how long they will last, and what kind of pain you will feel. If your pattern of pain changes, you should notify your doctor.

When are you likely to have an attack of angina?

Angina usually occurs when your heart has to work harder like when you climb uphill, eat a big meal, go out in very hot or cold weather, or react to stress. This can be caused by atherosclerosis which is the buildup of fatty deposits within the arteries. This narrows the space through which the blood can flow. It can also be caused by vasospasm which is a spasm (sudden contraction) of one of the coronary arteries that causes it to narrow temporarily. A spasm can occur at any time in some patients, even when they are at rest. This type of angina is called variant or vasospastic angina.

Is an anginal attack the same as a heart attack?

No – an angina attack is not a heart attack. In a heart attack a portion of the heart receives little or no oxygen for a longer period of time. Without oxygen, that portion of the heart muscle dies. If angina is untreated a heart attack could happen. Be sure to contact your physician if your angina attacks begin to occur more often, are brought about by less strenuous activities than usual, your angina attacks last for a longer time, or feel different in any other way.

How can you tell if you are having a heart attack?

The symptoms of a heart attack are usually stronger than those of angina. Signs that a person is having a heart attack and should get emergency attention include: pain lasting more than 30 minutes, sweating, nausea, shortness of breath, severe anxiety, fatigue. Most people who suffer a fatal heart attack do so because they did not get help soon enough. So, if you think you are having a heart attack, call an ambulance, or get to a hospital immediately. Do not hesitate to seek help; it is always better to be safe than sorry.

Can angina be treated?

Yes. Several types of medication are available to treat angina such as oral nitroglycerin tablets, nitroglycerin ointments or pads, beta-blockers or calcium antagonist. In addition, you can make changes in your life-style to control various risk factors. With proper treatment and good living habits, you should experience fewer, less painful attacks, or even no attacks at all. Your doctor will prescribe the treatment that is appropriate for you. It is very important for you to stop smoking. A program of moderate exercise, under your doctor's guidance, can make your heart stronger and enable it to use oxygen more efficiently.

Heart Attack

Occurs when blood supply to part of the heart muscle is severely reduced or stopped.

What is a heart attack?

A heart attack occurs when the blood supply to part of the heart muscle itself – the myocardium – is severely reduced or stopped. The medical term for heart attack is myocardial infarction. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis. The plaque can eventually burst, tear or rupture, creating a "snag" where a blood clot forms and blocks the artery. A heart attack is also sometimes called a coronary thrombosis or coronary occlusion. If the blood supply is cut off more than a few minutes, muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged.

Heart attack symptoms and warning signs

If you think you're having a heart attack, call 9-1-1 or your emergency medical system immediately. Some heart attacks are sudden and intense but most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Signs include: Chest discomfort – most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body – symptoms can include pain or discomfort in one or both arms, the back, jaw or stomach. Shortness of breath – this feeling often comes along with chest discomfort. Other signs – breaking out in a cold sweat, nausea or lightheadedness.

What should you do?

If you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. Call 9-1-1 and get to a hospital right away. Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive – up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. You'll also get treated faster in the hospital if you come by ambulance.

Arrhythmia

A change in the rhythm of your heartbeat — too fast, too slow, or irregular.

What is arrhythmia?

An arrhythmia is a change in the rhythm of your heartbeat. When the heart beats too fast, it's called tachycardia. When it beats too slow, it's called bradycardia. Arrhythmia can also mean that your heart beats irregularly (skips a beat or has an extra beat). At some time or another, most people have felt their heart race or skip a beat. These occasional changes can be brought on by strong emotions or exercise. They usually are not a cause for alarm. Arrhythmias that occur more often or cause symptoms may be more serious and need to be discussed with your doctor.

What are the symptoms of arrhythmia?

Palpitations or rapid thumping in your chest, feeling tired or lightheaded, passing out, shortness of breath.

What causes an arrhythmia?

The heart has 4 chambers. The walls of the heart contract to push blood through the chambers. The contractions are controlled by an electrical signal that begins in the heart's natural "pacemaker" (called the sinoatrial node). The rate of the contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia. Minor arrhythmias may be caused by excessive alcohol use, smoking, caffeine, stress or exercise. The most common cause of arrhythmias is heart disease, particularly coronary artery disease, abnormal heart valve function and heart failure. However, arrhythmias can occur for no known reason.

Is an arrhythmia serious?

In most people, arrhythmias are minor and are not dangerous. A small number of people, however, have arrhythmias that are dangerous and require treatment. Arrhythmias are also more serious if you have other heart problems. In general, arrhythmias that start in the lower chambers of the heart (called the ventricles) are more serious than those that start in the upper chambers (called the atria).

What are some of the types of arrhythmias?

Atrial fibrillation – the heart beats too fast and irregularly; this type requires treatment and can increase your risk of stroke. Paroxysmal atrial tachycardia – the heart has episodes when it beats fast, but regularly; usually not dangerous. Ectopic beats – the heart has an extra beat; treatment usually is not needed unless you have several extra beats in a row. Ventricular tachycardia and ventricular fibrillation – the heart beats too fast and may not pump enough blood; these types are very dangerous and need immediate treatment.

What's the treatment?

Treatment depends on the type of arrhythmia you have. Some mild arrhythmias require no treatment. Other arrhythmias can be treated with medicines. An artificial pacemaker is an electronic device placed under the skin on the chest that helps the heart maintain a regular beat. Cardiac defibrillation (a very brief electric shock) can be used to stop an abnormal rhythm and restore a normal one. Surgery can correct certain types of arrhythmias.

Congestive Heart Failure

A condition in which the heart is unable to adequately pump blood.

What is congestive heart failure?

Congestive heart failure is a term used to describe any condition in which the heart is unable to adequately pump blood. When the left ventricle cannot adequately pump blood out of the left atrium, or when one or more of the heart valves becomes leaky or stenotic, blood can "back up" into the lungs. When this happens, the lungs become congested with fluid, making it difficult to breathe and interfering with the movement of oxygen from the lungs into the blood stream.

Signs and symptoms

Shortness of breath (dyspnea) with exertion, waking up at night short of breath. Because the heart is not pumping enough blood to the muscles of the body, some patients become fatigued easily and feel weak all the time. Swelling (edema) of the feet, ankles, legs and sometimes the abdomen are other common symptoms.

Lifestyle modifications

Diet: Intake of salt causes the body to retain fluid, which can worsen the symptoms of heart failure. Patients should restrict dietary intake of salt to no more than 2 to 3 grams daily. Alcohol: Patients with congestive heart failure generally should limit their alcohol intake to one drink a day. When heart failure is believed to be due to excess alcohol consumption, absolute abstinence is mandatory. Exercise: When there are only mild symptoms, regular exercise may help to prevent overall decline in fitness. Recommended exercise might include taking brisk walks or using a stationary bike 3 to 4 times a week for 20 to 30 minutes. Heavy lifting and extreme exertion are not recommended.

Medical and surgical treatment

A variety of medications that improve symptoms, decrease the need for hospitalizations, and even prolong life are available. Occasionally, patients whose heart failure symptoms persist after all forms of medical therapy may require insertion of a special device to assist the heart. An intra-aortic balloon pump (IABP) is a device inserted through an artery in the groin and placed within the aorta. A left ventricular assist device (LVAD) is a complex pump implanted in the body to assist the left ventricle in pumping blood. Heart transplant surgery is reserved for the most severely ill heart failure patients.

Atrial Fibrillation

An abnormality of heart rhythm in which the chambers no longer contract in an organized manner.

What is atrial fibrillation?

Atrial fibrillation is an abnormality of the heart rhythm in which chambers of the heart no longer contract in an organized manner. Heart rate often becomes irregular and may be very fast, producing palpitations. Atrial fibrillation can lead to symptoms of heart failure (shortness of breath, edema, palpitations) and chest pains, and when left untreated, occasionally can lead to stroke.

Signs and symptoms

As atrial fibrillation develops, the patient may be unaware of any symptoms. It may be discovered incidentally, when the patient or doctor at some point happens to notice that the patient's heart beat is no longer regular. Sometimes, the development of shortness of breath or of fatigue compels a patient to seek medical attention. Unfortunately, some do not see a doctor until they have suffered a stroke.

Complications

The most devastating complication of atrial fibrillation occurs when a blood clot forms in the left atrium, travels to the left ventricle, and is pumped to the brain. When a blood clot lodges in one of the arteries supplying the brain with blood, it can block blood flow to that part of the brain and cause a stroke. Strokes can be severe and can cause permanent paralysis of part of the body, speech impairment, and even death. Unfortunately, stroke can occur at any time and, usually without warning.

Treatment for stable patients

In stable patients, several general approaches may be taken. Those who are experiencing palpitations can be treated with certain medications that "slow" conduction of electrical impulses through the AV node. Long term treatment with Warfarin may decrease the chances of having a stroke. A more ideal approach to prevent stroke is to try to "convert" the heart rhythm from atrial fibrillation back into sinus rhythm. Not every patient can be successfully converted back into sinus rhythm, including those who have been in atrial fibrillation for a long period of time and those with a very enlarged (dilated) atria.

Treatment for unstable patients

In unstable patients experiencing severe shortness of breath, chest pains, or lightheadedness due to low blood pressure, it may be necessary to "shock" the heart into sinus rhythm. Cardioversion is used to attempt to convert the patient back into sinus rhythm by electrically shocking the heart. During this procedure, the patient is usually sedated through intravenous infusion of one of several short-acting medications. Special pads or paddles are then applied to the chest and increasing energy levels of electrical charge are produced in an attempt to shock the heart back into sinus rhythm.

Stroke

Occurs when a part of the brain experiences a disruption in blood flow, cutting off oxygen to brain cells.

What is a stroke?

A stroke happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die. Damage to the brain can cause loss of speech, vision, or movement in an arm or a leg, depending on the part of the brain that is affected. There are two main types of stroke: stroke caused by a blockage in the artery supplying blood to a particular region of the brain (the most common type), and stroke caused by bleeding within the brain.

What are "mini-strokes"?

Some people experience brief warning signals that a major stroke is going to happen in the future. The medical term to describe these symptoms is transient ischemic attack or TIA. Sometimes called "mini-strokes," TIAs are exactly like a stroke but last only a short time and leave no disability. A TIA happens when a blood clot clogs an artery temporarily, cutting off blood flow. The difference between a TIA and a stroke is that, with TIA, the blood clot dissolves on its own and blood flow is restored before permanent damage to the brain can occur.

Stroke caused by blocked blood flow

About 85% of all strokes happen because not enough blood gets to the brain. Blood flow stops when an artery carrying blood to the brain becomes blocked. The technical name for this type is cerebral infarction, also called ischemic stroke. The blockage can be caused either by a blood clot that forms in an artery in the brain, or by a blood clot formed elsewhere in the body that travels through the blood stream to the brain. Clots are more likely to form in arteries that are damaged by atherosclerosis.

Stroke caused by bleeding in the brain

The other 15% of strokes happen when an artery carrying blood to the brain bursts suddenly. The bursting can happen because of a weak spot in the wall of an artery called an aneurysm. This type of brain attack is called a hemorrhagic stroke. A stroke that damages the right side of the brain will affect the left side of the body.

Heart Disease

A variety of disorders and conditions that can affect the heart, most commonly coronary heart disease.

What is heart disease?

Heart disease describes a variety of disorders and conditions that can affect the heart. The most common type of heart disease is coronary heart disease (CHD), also called coronary artery disease. The coronary arteries supply the heart muscle with oxygen and nutrients. Coronary heart disease develops when one or more of the coronary arteries become narrower than they used to be due to a buildup of cholesterol and other substances in the wall of the blood vessel. Deposits of cholesterol and other fat-like substances can build up and become coated with scar tissue, forming a bump in the blood vessel wall known as plaque. Plaque build-up narrows and hardens the blood vessel, a process called atherosclerosis, or hardening of the arteries.

How is it detected?

It's not easy to tell if you have coronary heart disease, since the disease rarely causes symptoms in its early stages. That is why it's important to see your physician regularly and evaluate your diet and lifestyle habits. Your physician can detect early warning signs of CHD, such as high blood pressure or high cholesterol levels. Although we typically think of atherosclerosis as a disease of old age, the process begins as early as childhood, making prevention of coronary heart disease a priority for everyone.

High blood pressure (hypertension)

Blood pressure is measured in millimeters of mercury (mm Hg). A typical normal blood pressure is 120/80 mm Hg. Blood pressure greater than 140/90 mm Hg is considered high. When blood pressure is high all the time, the continuous increased force on blood vessel walls can damage blood vessels and organs, including the heart, kidneys, eyes and brain. The medical term for high blood pressure is hypertension. Treatment for high blood pressure consists of lifestyle modifications and drug therapy.

Cholesterol

Cholesterol is a waxy, fat-like substance made in the body by the liver. High levels of cholesterol in the blood can clog blood vessels and increase the risk for heart disease. All adults should have their blood cholesterol level measured at least once every 5 years. Cholesterol levels: Below 180 – ideal; 180–199 – acceptable; 200–219 – borderline high; 220 or higher – too high. HDL (good) cholesterol over 50 is ideal; under 35 is too low. LDL (bad) cholesterol 130 or less is ideal; 160 or greater is too high. High blood triglyceride levels can also increase risk for heart disease and can be quickly lowered with weight control and more exercise.