Cardiology

Arrythmias are irregularities with the rate or rhythm of your heartbeat. Many people live with arrythmias without any issues, but for some, they can be quite serious. Arrythmias can lead to a number of health problems, including heart failure and stroke. The most common type of arrythmia is atrial fibrillation (A-Fib), which affects more than 2 million Americans each year. If you have any of the symptoms of an arrythmia, it is important to see your doctor right away for diagnosis and treatment.

Symptoms of arrythmias include:

• Shortness of breath
• Chest pain or discomfort
• Heart palpitations
• Dizziness or lightheadedness
• Fatigue

If you experience any of these symptoms, it is important to see your doctor right away. Arrythmias can be serious and even life-threatening, so early diagnosis and treatment is critical. Treatment for arrythmias can range from lifestyle changes to medication and surgery.

The first step in treating an arrhythmia is to identify the underlying cause. If the arrhythmia is due to an underlying heart condition, such as heart disease or hypertension, treating the underlying condition will often help to control the arrhythmia. In some cases, medications may be necessary to help control the heart rate or rhythm. Medications used to treat arrhythmias include beta blockers, calcium channel blockers, and anti-arrhythmic medications.

For some people, a pacemaker may be necessary to help control the heart rate or rhythm. A pacemaker is a small device that is placed under the skin and sends electrical impulses to the heart to help it maintain a normal rhythm. Pacemakers are usually only necessary for those with more serious arrhythmias.

Arrhythmias can be a serious condition, but there are many treatment options available. If you are living with an arrhythmia, be sure to talk to your doctor about the best treatment option for you.

Coronary artery disease occurs when the arteries that supply blood to the heart become narrowed or blocked. This can happen as a result of plaque buildup, which is made up of cholesterol, fat, and other substances. Plaque can harden and narrow the arteries, making it difficult for blood to flow through them. This can lead to chest pain, shortness of breath, and other symptoms. If the arteries become completely blocked, it can cause a heart attack.

There are several treatments for coronary artery disease. These include lifestyle changes, medication, and surgery. Lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly can help to reduce the risk of CAD. Medications such as aspirin, statins, and beta blockers can also help to treat the condition. In some cases, surgery may be necessary to open blocked arteries.

A heart attack occurs when the blood supply to the heart is blocked. This can happen if the arteries that supply blood to the heart become narrow or blocked. When this happens, the heart cannot get enough oxygen, and the muscle begins to die. Heart attacks are a medical emergency, and can be fatal if not treated immediately.

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

There are many symptoms of a heart attack, and they can vary from person to person. The most common symptom is chest pain or discomfort. This pain may feel like squeezing, fullness, or pressure. Other common symptoms include shortness of breath, nausea, lightheadedness, or dizziness. If you are experiencing any of these symptoms, it is important to seek medical help immediately!

What can be done to prevent or treat a heart attack?

There are many things that can be done to prevent or treat a heart attack. One of the most important things is to maintain a healthy lifestyle. This includes eating a healthy diet, exercising regularly, and avoiding smoking. If you are at risk for a heart attack, your doctor may also prescribe medication to help prevent one. If you are having a heart attack, it is important to seek medical help immediately! Treatment for a heart attack often includes medications or surgery to restore blood flow to the heart.

High blood pressure, also known as hypertension, is a condition in which the force of your blood against your artery walls is high enough that it may eventually cause health problems. While you can have high blood pressure for a short period of time without any damage to your health, if it is left untreated, high blood pressure can lead to heart disease, stroke, and kidney disease.

There are many things that can cause your blood pressure to rise. Some of these include:

• Being overweight or obese
• Smoking cigarettes
• Drinking too much alcohol
• Not getting enough exercise
• Eating a diet high in salt
• Having a family history of high blood pressure

If you have high blood pressure, there are things that you can do to lower it and reduce your risk of developing health problems. Some of these include:

• Losing weight
• Quitting smoking
• Cutting back on alcohol
• Exercising more often
• Eating a healthy diet
• Taking medications prescribed by your doctor

You can also help prevent high blood pressure by doing the same things that are recommended for treating it. In addition, you can:

• Limit your salt intake
• Avoid processed foods
• Eat more fruits and vegetables
• Get enough sleep
• Manage stress levels

If you have high blood pressure, or if you are at risk for developing it, make sure to talk to your doctor about ways that you can lower your blood pressure and improve your health. With the right treatment and lifestyle changes, you can keep your blood pressure under control and reduce your risk of developing serious health problems.

Cholesterol is a type of lipid or fat molecule that is found in the blood. It is important for normal body functions, such as the production of hormones and cell membranes, but when there is too much cholesterol in the blood it can cause health problems. High cholesterol is a major risk factor for heart disease and stroke. Let's discuss what high cholesterol is, how it is treated, and some prevention tips.

There are two types of cholesterol: LDL and HDL. LDL, or low-density lipoprotein, is the "bad" cholesterol because it can build up on the walls of arteries and cause blockages. HDL, or high-density lipoprotein, is the "good" cholesterol because it helps remove LDL from the arteries. A person's total cholesterol level is the sum of LDL and HDL.

High cholesterol is treated with lifestyle changes and, if necessary, medication. Lifestyle changes include eating a healthy diet, exercising regularly, and quitting smoking. If these changes are not enough to lower cholesterol levels, then medication may be prescribed. The most common type of medication is a statin, which works by blocking the liver's ability to produce cholesterol.

There are some things you can do to prevent high cholesterol. First, eat a healthy diet that includes plenty of fruits, vegetables, and whole grains. Second, exercise regularly. Third, don't smoke. And finally, see your doctor for regular check-ups so that you can be checked for high cholesterol and other risk factors for heart disease.

High cholesterol is a serious condition that can lead to heart disease and stroke. But it is treatable and preventable. By making lifestyle changes and, if necessary, taking medication, you can lower your cholesterol levels and reduce your risk of developing these serious health problems.

The aorta is the largest artery in the body. It’s located in the chest and abdomen, and is responsible for helping to transport oxygenated blood from the heart to the body's vital organs and limbs.

An abdominal aortic aneurysm (AAA) is when the wall of the aorta becomes weak and may distort part of the blood vessel into a balloon-like shape. The risk is that, over time, a large or fast-growing AAA, left untreated, may rupture and cause potentially fatal internal bleeding. An estimated 15,000 people a year die from a ruptured AAA.

Risk Factors

The disease process that leads to developing an aneurysm is not completely understood. The leading theory is that the aneurysm may begin with inflammation in the aorta, which damages the cells lining the artery walls and causes the wall to weaken. This inflammation can be associated with atherosclerosis and the risk factors that contribute to atherosclerosis, including:

• Being a man 60 years older and up. Your risk of developing AAA increases as you age. AAA is more common in men than in women.
• Having an immediate relative, such as a mother or brother, who has had AAA. If you have a family history of AAA, you should have a screening test.
• High blood pressure
• High cholesterol
• Smoking cigarettes

Signs & Symptoms

Most of the time, there are no symptoms associated with an AAA. These aneurysms are frequently found by chance during a routine physical examination, or on a CT scan or ultrasound ordered to evaluate another condition. Occasionally, a person may experience low back pain or abdominal pain. Symptoms associated with an AAA require urgent attention.

Diagnosis

Abdominal aortic aneurysms are most often diagnosed with an ultrasound, CT scan, or MRI. An arteriogram is sometimes needed to gain more information about the aneurysm and associated blood vessels. This involves the injection of a contrast dye so that more detailed images of the aneurysm can be obtained.

Treatment

If you have a small abdominal aortic aneurysm, your vascular surgeon will recommend "watchful waiting." This means you will be monitored every 6-12 months for any changes in the size of the aneurysm. Ultrasounds are usually the imaging test of choice to evaluate the aneurysm. If you also have high blood pressure, your physician may prescribe blood pressure medication to lower the pressure on the weakened area of the aneurysm. Medications called statins are often prescribed to lower elevated cholesterol levels, as well as decrease inflammation in arteries that leads to atherosclerosis. If you smoke, you must stop immediately. Smoking causes inflammation in the walls of the arteries.

It is extremely important to continue to follow up with your vascular surgeon as directed, because the aneurysm may enlarge to a dangerous size over time. It could eventually rupture if this is not detected and treated. Surgical treatment is considered when an aneurysm causes symptoms, grows rapidly, or reaches a specific size limit.

• Endovascular stent graft: New endovascular grafting technology allows your vascular surgeon to repair the AAA by a less invasive procedure that delivers a graft inside the blood vessel via a small incision in each groin where catheters are threaded to the target site. Endovascular repair is not possible for every AAA. Your vascular surgeon will determine what type of surgery is most appropriate for your situation based on the extent of the aneurysm, its relationship to the arteries that supply your kidneys, and any other medical conditions that may affect your surgical risk.
• Open surgical aneurysm repair: Your vascular surgeon may recommend that you have an open aneurysm repair if your aneurysm is causing symptoms, is larger than about 2 inches (roughly 5.0-5.5 centimeters), or is growing quickly. The incision is made on the abdomen or the flank. During surgery, the weakened portion of the aorta is replaced with a Dacron or Teflon graft that is carefully matched to the shape of the aorta and sewn into place.

The carotid arteries are the primary arteries, located on either side of your neck, that supply blood to your brain. Carotid artery disease is caused by atherosclerosis. Atherosclerotic plaques accumulate in the walls of the arteries and cause them to narrow (stenosis) or become so thick they completely block the flow of blood (occlude). This disease process increases your risk of having a stroke. Approximately 20% of strokes are related to carotid artery disease.

Risk Factors

The risk factors for carotid artery occlusive disease and the recommended lifestyle modifications are the same as for other vascular diseases:

• Family history of stroke
• Coronary artery disease
• Previous myocardial infarction (heart attack)
• Peripheral vascular disease
• Diabetes
• Obesity
• High cholesterol
• High blood pressure
• Smoking

Signs & Symptoms

Most people with carotid artery disease don’t have any symptoms. The condition may be picked up on during a physical exam when your physician listens to the carotid arteries in your neck and hears a noise called a “bruit.” This may represent rough or rapid blood flow through narrow arteries. Patients with a bruit or with high risk factors for stroke should be screened for carotid artery disease.

The most common symptoms are transient ischemic attacks (TIAs), which are often called “mini-strokes.” The symptoms of a TIA can last from a few minutes to 24 hours. A TIA occurs when a piece of plaque or blood clot from the surface of the plaque breaks free and travels to the brain. Imaging scans of the brain don’t show any signs of a stroke. The symptoms are transient because the body is able to break up the blood clot or plaque and blood flow is restored to the area of the brain that was affected. Common symptoms include:

• Slurred speech
• Weakness, numbness, or tingling of an arm and leg on the same side of the body
• Visual loss in one eye
• Unsteady gait
• Loss of coordination

A person suffering a TIA is at increased risk for a major stroke. You should report TIA symptoms to your physician immediately. Do not dismiss them. One in three people who have a TIA will go on to have a stroke. A TIA is a warning sign to have a complete evaluation and learn what changes you and your physician can make to prevent stroke. Approximately 50% of people who suffer a stroke will die from the event. Of those who survive a stroke, approximately 50% will have some permanent neurological damage such as loss of use of an arm or leg or inability to speak.

Diagnosis

A carotid ultrasound is used for screening and monitoring carotid artery occlusive disease. This test detects most cases of carotid artery disease. It provides information about how narrowed the carotid arteries are and how quickly blood flows through them.

Occasionally, additional studies are needed to confirm the blockage or to look at the brain itself. These may include:

• CT scan and CT angiography (CTA): CT and CTA scans take X-ray images in the form of many thin slices. CT scans can show an area of the brain with poor blood flow. CTA scans show the arteries in the neck and head and will identify areas of arterial narrowing.
• Magnetic resonance angiography (MRA): MRA uses radio waves and magnetic fields to create detailed images of arteries.
• Angiography: Vascular surgeons use angiography to better visualize the anatomy and routinely use this during carotid angioplasty and stenting procedures. A contrast dye is injected through a catheter that is threaded into your arteries, and then live X-ray images are viewed. The images show the blood flow through the arteries and where they are narrowed.

Treatment

Treatment plans for carotid artery disease are intended to prevent further stenosis, occlusion, and stroke. A plan begins with correcting modifiable risk factors such as controlling diabetes and high blood pressure. Statins are medications prescribed to lower cholesterol levels as well as decrease the inflammation in arteries that causes increased plaque development. Aspirin or another medication to keep blood platelets from sticking to plaque and causing occlusion is commonly recommended, as well. Smoking cessation is absolutely necessary to prevent progression of the disease.

If there is mild to moderate stenosis in the arteries, but you don’t have any symptoms, you will be monitored regularly with ultrasound studies of the arteries to evaluate the stability of the blood flow through them. You can have severe narrowing and not have any symptoms. If the plaque enlarges and the stenosis becomes severe (more than 80% narrowing), surgery may be recommended to decrease the risk of stroke, whether or not you have symptoms.

• Carotid endarterectomy: This procedure removes the plaque that is causing stenosis from the artery. It is performed through a small incision on the affected side of the neck. The artery is opened, and the plaque is removed. The artery is closed by sewing a patch of vein or artificial material onto the artery after the plaque is removed. Use of the patch closure reduces the risk of repeat stenosis or occlusion. Most patients are able to return home 1-3 days after surgery.
• Carotid artery balloon angioplasty and stenting: This is a minimally invasive procedure that is usually performed using a local anesthetic. It has been approved for the treatment of patients with symptomatic carotid artery disease who are considered to be too high-risk for carotid endarterectomy. To perform this procedure, your vascular surgeon inserts a long, thin tube called a catheter through a small puncture made over a groin artery and uses angiography to guide it through your blood vessels to the carotid artery. The tip of the catheter has a tiny balloon that the surgeon inflates and deflates, flattening the plaque against the walls of the artery. The surgeon places a tiny mesh tube called a stent in the artery to hold it open. The stent will remain in the artery.

When you have diabetes, you probably hear a lot about taking special care of your feet. Unless you've already had a serious foot ulcer or infection, you may not understand why this is such an important element of your care. The most critical part of protection of your feet and health is working closely with a physician to control your blood glucose levels. Elevated blood sugar will damage nerves and blood vessels, which can result in loss of vision, kidney failure, heart attack, stroke, and amputation of limbs.

Diabetics also frequently have peripheral arterial disease. Elevated glucose levels also cause damage to the cells lining the inside of blood vessels, resulting in poor circulation and arterial blockages. This condition delays wound healing and causes tissue death or gangrene.

Regular monitoring from a team of specialist physicians is recommended for the care of a diabetic who has long-standing disease or a history of any diabetes-associated complications. You should always be aware of what your HgA1C values are and be able to report these to your medical care team.

Vascular surgeons become part of the team when arteries are blocked, and wounds occur that will not heal.

Dialysis is a treatment that can temporarily or permanently take over the job of your kidneys. During dialysis, your blood is directed from the body to a machine, which cleans the blood and returns it to the body.

Vascular access is a way to gain access to your blood in order to perform dialysis. This access allows blood to travel through soft tubes to the dialysis machine, where it is cleaned as it passes through a special filter, called a dialyzer. Vascular access is created with a minor surgery.

For example, a fistula may be needed for long-term dialysis, to allow better access to blood flow during dialysis. A surgery is required to create the fistula. It will take 4 to 6 months before the fistula can be used. Your care team will connect directly to blood vessels until it is ready.

Peripheral arterial disease (PAD) is caused by atherosclerosis and affects the extremities, most frequently the legs. Commonly known as hardening of the arteries, atherosclerosis is a build-up of cholesterol and calcium deposits on the inside walls of the arteries. These deposits are called plaques, which can accumulate and cause narrowing of the arteries that supply blood to the arms and legs. Eventually, this plaque can become so thick that it completely blocks the flow of blood through the arteries.

Risk Factors

Many of the risk factors for PAD are modifiable. This means they can be treated or controlled to prevent disease symptoms from progressing. A family history of PAD is a genetic risk factor that can’t be changed, but there are lifestyle changes that can be made to keep your circulation healthy and decrease your risk of developing the disease, including:

• Stop smoking
• Control diabetes
• Control high cholesterol or triglycerides
• Treat high blood pressure
• Maintain a healthy weight (BMI < 30)
• Regular exercise

Success in the treatment of PAD is often measured by how far you can walk without pain. Regular exercise improves your circulation and helps condition your muscles to use oxygen more efficiently.

Signs & Symptoms

PAD doesn’t often cause any symptoms early on. Symptoms typically begin to occur once the affected arteries have become significantly narrowed and blood flow is restricted. The first symptom is usually pain in the legs when walking or exercising that goes away with a short period of rest. This is called intermittent claudication. One or both legs may be affected. As the disease worsens, pain occurs with shorter walking distances. Additional peripheral artery disease symptoms may include:

• Leg numbness or weakness
• Coldness in lower legs or feet
• Sores on feet or legs that won't heal
• A change in the color of lower legs or feet
• Hair loss or slower hair growth on feet and legs
• No pulse or a weak pulse in legs or feet
• Erectile dysfunction in men

In addition, when PAD progresses to advanced stages, it can cause some serious symptoms and health problems, such as:

• Ischemic rest pain occurs when PAD progresses, and pain begins to occur even when you're at rest. It may occur at night and disrupt your sleep. Hanging your legs over the edge of the bed or walking around the room may temporarily relieve the pain.
• Critical limb ischemia occurs when PAD is severe. Painful ulcers develop on your toes. These are signs of poor oxygen supply to the tissues. If the blood supply does not improve, these ulcers can turn into gray or black sores called gangrene and the tissue dies. Prompt evaluation by a vascular specialist is warranted to determine what can be done to address this problem and to avoid amputation.
• Stroke and heart attack. The same artery narrowing that causes PAD can also occur in the arteries that supply the heart and brain. Having PAD increases your risk of heart attack and stroke.

Diagnosis

A vascular specialist will review your medical history and ask for details about your symptoms and risk factors. After an examination of your vascular system, if the physician suspects PAD, they may order diagnostic tests to help determine the severity of your disease. These may include:

• Ankle-brachial index (ABI) and pulse volume recording (PVR) are common tests using a blood pressure cuff to compare the blood pressure in your arms to your legs. It also includes use of a Doppler ultrasound to create a tracing of your pulse.
• Arterial duplex ultrasound is frequently used to evaluate the blood flow in arteries for any blockages.

Additional tests may be ordered to evaluate more serious disease:

• Magnetic Resonance Angiography (MRA)
• Computed Tomographic Angiography (CTA)
• Angiography

Treatment

Early PAD can be treated with lifestyle modifications and control of risk factors. Statins are medications prescribed to lower cholesterol levels as well as decrease the inflammation in arteries that causes increased plaque development. Aspirin or another medication to keep blood platelets from sticking to plaque and causing blockages is commonly recommended, as well. A regular walking program to improve circulation is essential. Proper foot care is important, with routine examinations to detect injuries or poorly healing wounds that may require immediate medical attention.

Advanced disease may require surgical interventions, including:

• Angiography is the best way to see if there are blockages in the arteries. Through an artery in the groin, your vascular specialist uses a thin tube called a catheter to take X-ray images of the inside of your arteries. This can also help identify what options are available to treat any blockages, which can be performed at the same time, if appropriate.
• Angioplasty and stenting are used to treat localized blockages in larger arteries. After an angiography confirms that an endovascular (less invasive) approach is possible, your surgeon will guide a wire through the arteries to the blocked area. Once at the site of the blockage, a special balloon, which is attached to the end of the catheter, is inflated. The balloon pushes the plaque in the artery against the artery walls, widening the opening for better blood flow. When stenting is necessary to keep a narrowed area open, your vascular surgeon may place a tiny mesh-metal tube in the artery. After this procedure, blood can flow more freely through your artery. The stent remains permanently in your artery.
• Bypass surgery is used when a less invasive approach is not available. It creates a detour around a narrowed, or blocked, section of the artery. To create this bypass, your vascular surgeon will use one of your own veins as the graft. However, if you don’t have a healthy, useable vein, a synthetic graft will be used. Your vascular surgeon will attach the bypass graft above and below the blocked area. Blood flow is rerouted to the new path to supply tissues previously injured by insufficient blood supply.

Varicose veins affect both women and men – and are more than just a cosmetic problem. Varicose veins are a common medical problem that affects 25% of women and 10% of men. Left untreated, these damaged veins may progress to a more serious form of venous disease called chronic venous insufficiency.

Varicose veins are caused by broken or missing valves inside the veins. The valves are normally one-way, directing blood from the feet back up to the heart. Once damaged, some blood flows back down the vein and can pool. This is called venous reflux. As pressure builds up in the veins from blood pooling, the walls of the vein stretch and become thin and twisted. Some veins can show beneath the skin as deep blue, raised, and crooked lines.

Risk Factors

Risk factors for varicose veins include:

• Family history of varicose veins
• Obesity
• Pregnancy
• Occupations that require prolonged standing or sitting
• Aging
• Being female

Diagnosis

Not all varicose veins require treatment. As with any medical condition, it is best to have a complete evaluation with a vein specialist to determine the appropriate way to manage your symptoms. This evaluation may include a duplex ultrasound to assess the speed and direction of blood flow in your veins.

If you can answer yes to two or more of the following questions, you may have varicose veins with significant venous reflux disease and may be a candidate for treatment to remove the damaged veins that cause symptoms:

• Do you experience leg pain, aching, or cramping?
• Do you experience leg or ankle swelling, especially at the end of the day?
• Do you feel "heaviness" in your legs?
• Do you experience restless legs?
• Do you have skin discoloration or texture changes in your lower legs?
• Do you currently, or have you ever had, open wounds or sores on your legs?
• Do you stand for long periods of time?
• Do you frequently perform heavy lifting?

Treatment

Vascular Surgery & Endovascular Services at Upstate University Hospital offers minimally invasive procedures to treat varicose veins that allow for a short recovery and a quick return to everyday activities.

Some symptoms caused by varicose veins can be managed with compression stockings. In other cases, the damaged veins may need to be removed to alleviate pain and swelling, and to prevent more serious complications. Most insurance plans cover treatment for varicose veins that cause pain or swelling in the legs.

After a complete evaluation by a vascular specialist or vascular surgeon, a treatment plan will be created that is most appropriate for your condition. Treatment may include:

• Sclerotherapy is used to treat smaller varicose veins and spider veins.
• Endovenous ablation therapy uses lasers or radio waves to create heat to close off a varicose vein. Endovenous thermal ablation is a minimally invasive treatment that involves the insertion of a thin, flexible tube called a catheter into a diseased vein and uses heat to seal it shut. Blood that would normally return toward the heart through these veins will then travel through other veins instead. Over time, the treated vein shrinks and is absorbed by the body. Compared with surgical options like vein stripping, endovenous thermal ablation results in less pain and a quicker-than-average recovery time.
• Ambulatory micro-phlebectomy is a procedure to remove the larger varicose veins closest to the surface of your skin. Very small cuts are made in your skin over the veins, and the veins are removed in segments. The small wounds heal quickly and don’t require sutures.
• Laser vein ablation involves the use of lasers to treat superficial varicose veins and spider veins that are 4 mm or smaller in size. Lasers can effectively remove cosmetically troubling veins and are an alternative to sclerotherapy. As a cosmetic treatment, this option is not covered by insurance plans and is often performed without a diagnostic evaluation of the venous system. Removing superficial varicose veins may only temporarily resolve the issue – especially if there is an underlying venous reflux problem in the larger veins that remains untreated.

Spider veins are very small blue, purple, or red varicose veins that lie just beneath the skin. These veins tend to occur in people with a family history of varicose veins or spider veins. Spider veins become more common with age, in those with occupations that require standing, after pregnancy, or in those who are overweight.

Treatment

When was the last time you showed off your bare legs? Do spider veins on your legs make you hide them from a walk in the sun? Sclerotherapy is effective in removing unsightly spider veins and small varicose veins. It's a great way to give you back the confidence to show off your legs.

Sclerotherapy is used to treat spider veins and some smaller varicose veins. A solution called a sclerosant is injected into to veins causing inflammation that makes the veins scar and collapse. Eventually, the body reabsorbs the treated veins and blood flow is redirected to other, healthy veins. This process occurs over several weeks, so it takes time to see the final benefits of treatment. Depending on how many spider veins are involved, more than one sclerotherapy treatment session may be necessary.

Sclerotherapy is an affordable treatment for small varicose veins. While varicose veins are considered a medical problem when they are causing pain or swelling, spider veins and the smaller varicose veins are generally considered a cosmetic problem. Thus, most spider vein treatments will not be covered by insurance.

If you have varicose veins, those veins will need to be evaluated and treated before we can treat the spider veins – or the spider veins could return. Most varicose vein problems are covered by medical insurance.