Coronary Heart Disease Patient Education

Doctors Who Treat CHD – Patient Education

The first physicians that will be caring for the patient are those that are intimately engaged in the individual’s care and history already. These include:

• Family Practitioner (General practice) - This physician is involved in the daily general care of the patient, dealing with all organ systems of every age group in both preventive health and treatment of chronic medical conditions.
• Pediatrician - This doctor focuses on the health of infants, children and adolescents.
• Geriatrician - This physician specializes in the care of seniors and elders.
• Internist - Physician who deals with prevention and treatment of medical conditions among adults. In addition to helping diagnose and treat medical problems on a daily basis, the internist will refer patients

Once there is a suspicion of coronary heart disease, the following specialists may be recommended for your team:

• Interventional Cardiologist - This physician performs angiograms, catheter and stent insertions. One would be referred to this physician if a blood vessel leading to the heart or damage to the heart itself is suspected.
• Cardiologist - Physician in the branch of medicine dealing with the heart and vascular system. This doctor focuses on prevention and therapy of circulatory problems and blood vessel conditions along with the heart.
• Cardiothoracic Surgeon - Performs surgeries on heart, lungs, esophagus, diaphragm and blood vessels of the chest. Conditions include tumors, vessel repair or unblocking vessels, cancer, heart transplant, and valve repair.
• Endocrinologist - Focuses on the diagnosis and treatment of medical conditions involved with hormones and glands. Diabetes and thyroid dysfunction is associated with cardiac problems. The endocrinologist may monitor and control the level of cholesterol, which causes increased plaque formation in the blood vessels, or enlist the aid of a separate cholesterol specialist.
• Nutritionist - Dietician creates and manages the special diet plans as well as the appropriate vitamins and supplements to ensure the patient’s health and prevent a progression of a medical condition.
• Physical Therapist - This is a healthcare provider that creates and executes exercises that help patients maintain and improve endurance, coordination, muscle strength and motor skills.

 

How to Prepare for Your Coronary Heart Disease Doctor Visit

When coronary heart disease is suspected in a patient, they will be sent for several tests and labs. An echocardiogram and a stress cardiogram are the common measures, however, for heart disease. To get the most accurate reading on the day of your exam, follow the patient education advice below.

 

	Echocardiogram	Stress Echocardiogram
Preparatory Advice	No special fasting required.Wear loose, comfortable clothing from the waist up.	Abstain from caffeine or non-prescribed drugs with caffeine for a full day. Do not consume food or beverages for 4 hours prior to the exam.  Do not take the following medications for 24 hours prior to the test (clear with your physician): Beta Blockers Nitroglycerin Isosorbide dinitrate Isosorbide mononitrate

If the patient wears a pacemaker, it is prudent to discuss this with the doctor prior to any exams for any specific advice.
 

Questions to Ask Your Doctor About Coronary Heart Disease

From your initial diagnosis throughout your treatment and care, you will have questions about your coronary heart disease. Our patient education guide lists important questions to discuss with your doctor so you can make informed decisions about your condition.

Questions About My Diagnosis

• What is causing my heart disease? Can I reverse it? Will it progress?
• What is my long-term prognosis?
• What symptoms should I be concerned about?
• Will my condition improve if I stop smoking and/or using alcohol?

Questions About My CHD Treatment

• Will I need surgery? What would happen if I didn’t have it? What are the risks?
• What other treatment options are available?
• Can I be treated with a special diet and medications?
• What medications would treat me? What are their side effects?
• Can I take this medication with the drugs that I am currently on?
• Should I be taking a daily aspirin?

Questions About My Lifestyle and Family

• Is heart disease genetic?
• What can my family do to decrease the risk of CHD?
• What activities must I give up? Can I still have sex? Can I still work? Can I still drive?
• What diet should I be on?
• What exercise do you advise? Is there a rehabilitation program I should join?

 

Common Tests or Labs to Diagnose Coronary Heart Disease

There are several tests and labs used to diagnose heart disease and monitor a patient’s ongoing condition. Below are listed the most common tests and labs ordered, why patients need them, and what they can tell about your condition.

 

Test Site	Test Name	What it Measures	Normal Range
Chest/Torso	Electrocardiogram(ECG, EKG)	Records the heart’s electrical activity.Measuring: Rhythm Rate of beats Interval of beats and recovery Pattern of beats	A normal EKG is a pattern with a P wave followed by a QRS wave, with an interval rest period whereupon the pattern recurs.P wave rate = 60-100 bpm P height < 2.5 mm in lead II P width < .11 in lead II PR interval= .12-.20 s QRS complex < .12 s Normal ST segment= no elevation or depression
Torso/Legs	Stress Test	Follows the heart and lung reactions during exercise. Measures: Abnormal change in rhythm, rate, pattern Abnormal blood pressure Chest Pain Shortness of Breath	Normal blood pressure is 120/80 with a high reading of 140/90.Normal EKG readings as above.
Chest/Torso	Chest X-Ray	Visualizes the lungs, heart and blood vessels, looking for masses, obstructions, abnormal sizes.  Heart failure can be detected.	No narrowing or obstruction of blood vessels.No tumors/masses Consistent blood flow Proper filling of atria and ventricles Clear lungs with proper inflation
Chest/Torso	Electron-Beam Computed Tomography(EBCT)	Measures calcium deposits and plaque inside cardiac arteries.*Test not routinely done *Accuracy unknown	No plaque formation in blood vessels with normal flow
Blood	Screening and Diagnostic Blood tests	(CRP) C-Reactive Protein is a good predictor of: heart attackStroke Sudden death Low risk= 1-3 mg/L High risk= > 3 mg/L   Homocysteine (used to make protein)   Cholesterol Panel: Low-density lipoprotein (the “bad” cholesterol)   (HDL) High-density lipoprotein (the good type)   Triglycerides   Fibrinogen   (CBC) complete blood count Hemoglobin Hematocrit WBC RBC	CRP C-Reactive ProteinNormal =<1 mg/L   Homocysteine: Normal = 4.4-10.8 micromoles/L   Cholesterol Panel: Total Cholesterol=<200 mg/dL   LDL<130 mg/dL   HDL>60 mg/dL   Triglycerides<150 mg/dL   Fibrinogen= 200-400 mg/L   CBC (complete blood count)   Hemoglobin Men: 13-18 gm/dL Women: 12-17 gm/dL Hematocrit Men: 45-52 Women: 37-48 WBC= 4300-10,800 cmm RBC= 4.2-5.9 million cells/cubic millimeter
Blood/Chest	Angiogram,Cardiac Catheterization	Dye is injected through a tube (catheter) into your blood stream after being threaded into the coronary arteries. X-rays are then taken to visualize the inside of the cardiac arteries.  Obstructions are diagnosed or ruled out.	No obstruction or narrowing seen in the blood vessels visualized

 

Common Medications and Treatments – Coronary Heart Disease

Lifestyle changes are recommended to any patient who has heart disease, but sometimes medications and/or surgery is also necessary to prevent heart attacks or further heart damage.

Medications

Drug Category	How The Medication Works
Diuretics(Water Pill)	Lowers blood pressureTreats Congestive Heart Failure Rids body of excess fluids Rids excess salt through urination
Aspirin	Inhibits arterial blood clotsDecreases heart attack and stroke risk
Statins	Lowers cholesterol
Nitrates	Enhances blood to the heartStops Chest Pain
Beta-Blockers	Decreases: Heart rate Blood Pressure Oxygen demands Arrhythmia risk (abnormal rhythm)
Calcium Channel Blockers	Relaxes arteries Lowers blood pressure Decreases heart strain
ACE Inhibitors	Lowers blood pressure by inhibiting the enzyme causing blood vessel narrowing

  

Surgical Procedures

	What Is It	Benefits	Risks
Angioplasty/ Stent Insertion	Procedure that opens narrowed or blocked coronary arteries by feeding a balloon catheter into the blockage and then inflating the balloon to open the blood vessel and allow for proper blood flow.  This is followed by placing a small tube (usually metal mesh) inside to prevent the vessels from closing again.  There are stents with embedded medicine that aids to prevent the artery from closing.	Markedly improves blood flow to the heartMay prevent the need for coronary artery bypass surgery	Blood ClotsValve or vessel damage Heart attack Stroke (rare) Kidney failure (for those who have kidney problems) Allergic reaction to stents, drugs within the stent or dyes
Coronary Artery Bypass	Surgical procedure where arteries and veins (usually the legs) are grafted to the coronary arteries, bypassing the plaques or narrowing segments to increase blood flow to the heart muscle.	Alleviates chest pain.Rescues someone having a heart attack	Brain damageHeart attack Stroke Arrhythmia (abnormal heart rhythm) Blood clots Infection (of chest, lungs, urinary tract, site of vessel retrieval)
Minimally Invasive Heart Bypass	Procedure designed for those suffering from angina (chest pain) due to blockage in one or two coronary arteries in the front of the heart.  In this procedure, the chest incision is smaller and the vessel for use comes from the chest itself.  Unlike the coronary artery bypass above, it is not necessary to place a person on a heart-lung machine.	Alleviates chest painLess risk to individual than coronary artery bypass	Heart attackStroke Blood loss Blood clots Infection of chest incision and surgery site Low-grade fever Chest pain from surgery Memory loss Arrhythmia  (abnormal heart rhythms)