Cardiology Patient Page Research Articles

Heterozygous Familial Hypercholesterolemia.

Familial hypercholesterolemia (FH) is a genetic condition that causes high low-density lipoprotein (LDL) cholesterol (sometimes referred to as bad cholesterol) from birth. FH means high cholesterol that runs in a family. FH is caused by specific DNA changes that are passed on from parents to their children. It is not caused by lifestyle factors such as a high-fat diet or lack of exercise. There are 2 main types of FH, homozygous and heterozygous, that have different symptoms, risks, and treatments. In this Cardiology Patient Page, we focus on heterozygous FH, which we will call FH. FH affects 1 in 200 to 300 people. FH is usually inherited from 1 parent in an autosomal dominant pattern. This means a parent with FH has a 50% chance of passing it on to each child, regardless of sex. This also means all first-degree relatives (parents, siblings, and children) of a person with FH have a 50% chance to have FH, and a 50% chance to not have FH. Healthcare providers and the general public lack awareness about FH. Therefore, it is underdiagnosed and undertreated. A person with FH who is not treated is 20 times more likely to develop coronary artery disease than a person without FH. Coronary artery disease can lead to heart attacks and other major cardiovascular diseases, including stroke and sudden cardiac death. However, early diagnosis with universal lipid screening, cascade screening in families, and appropriate treatment with statins and other medications can reduce this risk. Most people with FH will not have any symptoms until complications of untreated high cholesterol arise years later. Rarely, patients may have visible signs of extremely high cholesterol, such as a corneal arcus or tendon xanthomas. A corneal arcus is a yellowish ring along the edge of the colored part of one or both …

Cardiology Patient Page. Omega-3 Fatty Acids and Heart Health.

Lifestyle intervention such as consistent aerobic exercise and a diet high in fruits and vegetables promotes cardiovascular health. A heart-healthy lifestyle decreases the risk of coronary heart disease and heart attack. Although it may seem intuitive that dietary fat is bad for the heart and that it must be avoided, certain unsaturated fats are heart healthy, and other saturated fats are not good for the heart. These heart-healthy unsaturated fats are known as omega-3 fatty acids. The 3 main omega-3 fatty acids that are beneficial for cardiovascular health are α-linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is primarily found in plant-based foods such as olive, soybean, canola, walnut, and flaxseed oils, and in walnuts and flaxseeds, as well. EPA and DHA are primarily found in marine-based foods that include the variety of fatty fish, such as tuna, salmon, mackerel, herring, trout, halibut, and cod. This Cardiology Patient Page will present the beneficial effects of omega-3 fatty acids …

Cardiology Patient Page. ABCDE Steps for Heart and Vascular Wellness Following a Prostate Cancer Diagnosis.

Prostate cancer is the most common cancer diagnosed in men in the United States, with more than 240 000 new cases expected in 2015. Fortunately, close to 90% of patients are diagnosed at an early stage. Over the past several decades, the 5-year median survival of patients with prostate cancer has increased to more than 99%, largely owing to both the improvements in early diagnosis and innovations in treatment. As a result, there are nearly 3 million prostate cancer survivors in the United States today, representing 4 out of every 10 male cancer survivors. In the last several years, there has been growing recognition of health care needs of cancer survivors. This is true with prostate cancer survivors and is especially relevant to cardiovascular (heart and vascular) disease in this patient population. Cardiovascular disease is common in prostate cancer patients and survivors for several reasons. Prostate cancer occurs at an age when men may already have cardiovascular disease or may have risk factors such as high blood pressure, high cholesterol, and diabetes mellitus. In fact, many prostate cancer patients actually die of heart disease rather than prostate cancer itself. In addition, several treatments for prostate cancer can have harmful effects on the heart and vessels. For example, inhibiting the male sex hormones (collectively called androgens) is an important means of treating prostate cancer. However, this hormone therapy (also called androgen deprivation therapy [ADT]) is associated with an increased risk of diabetes mellitus and may make men more susceptible to cardiovascular disease, especially older men. In light of this, experts from the American Heart Association, the American Cancer Society and the American Urological Society have come to a consensus that urges the surveillance of cardiac risk factors in men receiving ADT. In addition, the US Food and Drug Administration labeled ADT …

Elective cardioversion: is it a truly nurse-led service?

British Journal of Cardiac NursingVol. 10, No. 10 CommentElective cardioversion: is it a truly nurse-led service?Sally Baker, Emily TrevorSally BakerSearch for more papers by this author, Emily TrevorSearch for more papers by this authorSally Baker; Emily TrevorPublished Online:6 Oct 2015https://doi.org/10.12968/bjca.2015.10.10.484AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Boodhoo L, Bordoli G, Mitchell AR, Lloyd G, Sulke N, Patel N (2004) The safety and effectiveness of a nurse led cardioversion service under sedation. Heart 90(12): 1443–6 Crossref, Google ScholarHarrison SJ, Mayet J (2002) Physician administered sedation for DC cardioversion. Heart 88(2): 117–8 Crossref, Google ScholarLewis R (2001) Nurse-led Primary Care: Learning from PMS pilots. King's Fund. http://tinyurl.com/nd766yh (accessed 20 September 2015) Google ScholarRaipancholia R, Sentinella L, Lynch M (2001) Role of conscious sedation for external cardioversion. Heart 86(5): 571–2 Crossref, Google ScholarShea JB, Maisel WH (2002) Cardiology patient pages. Cardioversion. Circulation 106(22): e176–8 Crossref, Google ScholarWorcestershire Acute Hospitals NHS Trust (2014) Cardiac patients discharged in a heartbeat. http://tinyurl.com/oom926z (accessed 20 September 2015) Google ScholarYurchak PM, Williams PV, Achord AC (1993) Clinical competence in elective direct current (DC) cardioversion. A statement for physicians from the ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology. J Am Coll Cardiol 22(1): 336–9 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byThe impact of a nurse‐led elective direct current cardioversion in atrial fibrillation on patient outcomes: A systematic review5 May 2019 | Journal of Clinical Nursing, Vol. 10 2 October 2015Volume 10Issue 10ISSN (online): 2052-2207 Metrics History Published online 6 October 2015 Published in print 2 October 2015 Information© MA Healthcare LimitedPDF download

Cardiology Patient Page. Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common sleep disorder that affects 2% to 7% of the population. It is a serious medical condition that has many effects on health, happiness, and survival, beyond simple snoring and poor sleep. OSA often goes undiagnosed, and many patients with risk factors for OSA should be evaluated for the disease. OSA is initiated by inappropriate closure of the upper airway during sleep, leading to a cessation in breathing that is often terminated by a gasp and awakening (see Figure). Patients with OSA are prone to airway closure for a number of reasons. First, they have a smaller airway opening than those without OSA. They also have changes in the muscles surrounding the airway that make it more collapsible than normal. People who are obese or have a large neck circumference are at particular risk of airway closure because of the excess tissue that may compress the airway opening further. When awake, patients with OSA are able to keep the collapsible airway open, but when they are asleep, the airway muscles relax, putting the patient at risk of airway closure. Figure. Pathophysiological mechanisms of OSA. This is a schematic of the mechanism responsible for OSA. (1) The patient begins awake, and as he/she falls asleep, the upper airway tissues relax and start to close. (2) Once asleep, the airway closes completely. As a result, breathing stops. (3) When the patient’s oxygen levels fall and carbon dioxide levels rise, he/she is stimulated to breath. This stimulation results in awakening, in addition to gasping and rapid …

Homocysteine and MTHFR Mutations.

Homocysteine is a chemical in the blood that is produced when an amino acid (a building block of protein) called methionine is broken down in the body. We all have some homocysteine in our blood. Elevated homocysteine levels (also called hyperhomocysteinemia) may cause irritation of the blood vessels. Elevated levels of homocysteine show an increased risk for (1) hardening of the arteries (atherosclerosis), which could eventually result in a heart attack and/or stroke, and (2) blood clots in the veins, referred to as venous thrombosis. The purpose of this Cardiology Patient Page is to explain the relation between elevated homocysteine levels and blood clots in the arteries and veins; to discuss the causes of elevated homocysteine levels, including common genetic variants in the MTHFR gene (see the “What Do I Need to Know About a Hereditary Predisposition?” section); and to describe ways to monitor and lower homocysteine levels to possibly improve health. In 1962, it was reported that people with a rare genetic condition called homocystinuria were prone to develop severe cardiovascular disease in their teens and 20s. In this condition, a defective enzyme causes an accumulation of homocysteine in the blood, resulting in very high levels. Studies of children with homocystinuria led to the discovery that elevated homocysteine levels are a risk factor for developing atherosclerosis and blood clots in the arteries and veins. Although homocystinuria is a rare disease (affecting about 1 in 200 000 people), many more people have mildly or moderately elevated homocysteine levels. Some people have elevated homocysteine levels (Table 1) caused by a deficiency of B vitamins and folate in their diets. High homocysteine levels are also seen in people with kidney disease, low levels of thyroid hormones, psoriasis, and with certain medications (such as antiepileptic drugs and methotrexate).1 It has been recognized …

Cardiology Patient Page. Chelation therapy: a new look at an old treatment for heart disease, particularly in diabetics.

Don’t cringe when you hear the term chelation (key-LAY-shun) therapy. If you have heard about it at all, you may have heard that it is alternative medicine, quackery, expensive, and even dangerous. New research funded by the National Institutes of Health is suggesting that this old treatment has some real life in it and that it may particularly benefit patients with diabetes mellitus and prior heart attacks. Chelation therapy was first used in the early 20th century to treat metal poisoning. The treatment involves administering a drug called a chelator, which has a magnetically charged pocket that can “grab” a metal and hang onto it, kind of like a baseball mitt with a magnet in its pocket, allowing the metal to be excreted in the urine. One chelator, calcium ethylenediaminetetraacetic acid (EDTA), is approved by the US Food and Drug Administration to treat lead poisoning. Alternative medicine practitioners have been using a similar chelator, disodium EDTA, to treat heart disease, claiming to see benefits, since the 1950s. Disodium EDTA chelation therapy is usually administered intravenously each week for 20 to 40 sessions. Each intravenous infusion may last …

Cardiology patient page. Patient guide for taking the non-vitamin K antagonist oral anticoagulants for atrial fibrillation.

Having atrial fibrillation, an irregular heart rhythm, increases your risk of having a stroke. This irregular beating of the heart affects blood flow in the top chambers of the heart and can cause blood cells to collect and stick together, which increases the risk of a blood clot forming. These blood clots may then be carried in the bloodstream to the brain and, if large enough, can block an artery in the brain, resulting in a stroke. Oral anticoagulant drugs (commonly called blood thinners) are used to help prevent strokes by causing the blood to take longer to clot. Two groups of oral anticoagulant drugs are used, vitamin K antagonists (warfarin/Coumadin) and non–vitamin K antagonist oral anticoagulants (NOACs). This Cardiology Patient Page focuses on NOACs. There are currently 4 NOACs available for healthcare providers to prescribe for patients with atrial fibrillation (see Table 1): dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Lixiana/Savaysa). Each drug is available in 2 doses. Your healthcare provider will explain which is the most appropriate drug and dose for you, and why. View this table: Table 1. How and When to Take the NOAC and Reasons for Dose Reductions You may be eligible for a NOAC if you have atrial fibrillation, plus ≥1 of the following stroke risk factors: heart failure, high blood pressure, age ≥65 years, diabetes mellitus, previous stroke (or ministroke/pin stroke), or vascular disease (blockages in your leg arteries, a heart attack, or both), or if you are a woman. You can calculate your own risk of stroke by completing the questions in Table 2. You should discuss whether you are eligible to receive a NOAC for stroke prevention with your doctor, because these medications may not be suitable for everyone who has atrial fibrillation. View this table: Table 2. Calculating Your Own Risk of Stroke Using the CHA2DS …

ABCDE steps to prevent heart disease in breast cancer survivors.

Breast cancer is the most common invasive cancer diagnosed in women. Of every 8 women, 1 woman is diagnosed with breast cancer in her lifetime. In 2013, more than 230 000 women were diagnosed with breast cancer in the United States alone, resulting in nearly 40 000 deaths. Breast cancer can also occur in men, although the incidence is much lower, with a total of 2240 men diagnosed in 2013 (accounting for less than 1% of all breast cancers). Over the past 2 decades, death resulting from breast cancer has been declining each year. This decrease in mortality is due in part to improvements in cancer treatment. These treatments have come about as a result of collaborations among physicians in various specialties. These physicians include medical oncologists (who give systemic treatments like chemotherapy and hormonal therapy), surgeons (who perform surgery such as mastectomy and lumpectomy), and radiation oncologists (who treat patients with radiation therapy). Radiation therapy, in particular, has increasingly become an important part of management of most patients with breast cancer. Radiation therapy has been demonstrated not only to prevent recurrence of cancer in the breast or chest wall area but also to improve long-term survival in women. In addition, radiation therapy allows women to undergo a less radical form of surgery in which the breast tissue is conserved, thus improving body image for breast cancer survivors without compromising survival. As a result of this progress in treatment and improved detection of early breast cancer, in 2012, there were nearly 3 million breast cancer survivors in the United States alone, a number that will increase in the coming years. Women who survive breast cancer may face many health challenges, but the number 1 cause of death in breast cancer survivors (and, in fact, all women) remains heart disease. Unfortunately, although systemic …

Cardiology patient page. Activity recommendations for postaortic dissection patients.

Individuals who have survived an aortic dissection are often faced with the question of how life can be maximally and safely lived, with functional independence preserved. Routine exercise is important for both physical and emotional health. During exercise, blood pressure and heart rate increase in part related to the intensity, duration, and specific type of activity performed. The goal of this Cardiology Patient Page is to provide the postaortic dissection patient with an understanding of how blood pressure changes with different activities. We will provide information to patients and families that leads to a greater sense of comfort during physical activity, while possibly decreasing the risk of future aortic complications, thus improving overall quality of life. It is our goal that patients will continue to engage in consistent exercise, given its beneficial effects on mental, physical, and emotional health. When a handgrip (Figure) is squeezed maximally for 1 minute, the systolic blood pressure (SBP) increases by approximately 50 mm Hg. The diastolic pressure increases by about 30 mm Hg.1 When a handgrip is squeezed at 30% of maximal effort, the SBP increases by about 20 to 30 mm Hg, and the diastolic pressure increases by about 10 to 20 mm Hg. Although these studies are limited by small sample size, they do suggest that blood pressure may increase more than is appreciated …

Cardiology Patient Page: coronary artery revascularization in patients with diabetes mellitus.

Atherosclerosis is the disease process that narrows large arteries and limits blood supply to vital organs. Coronary artery disease results from atherosclerosis, may reduce blood supply to the heart muscle, and can lead to angina (chest pain with exertion), heart attack, and possibly sudden death. ### Diabetes and Coronary Artery Disease Patients with diabetes mellitus have more extensive atherosclerosis with more plaques susceptible to the breakdown that causes the artery to block and cause heart attacks. Coronary artery disease can be stabilized and treated through healthy living and the use of medications to control risk factors and symptoms. In some patients, the coronary arteries become more severely blocked and require a revascularization procedure. The 2 procedures to manage a blocked coronary artery are to implant a stent in the area of the blockage (angioplasty) or to entirely bypass the blocked segment of artery surgically (bypass surgery; Figure). Figure. A , Individuals with diabetes mellitus typically present with diffuse atherosclerosis that may be treated by percutaneous coronary intervention ( B ) or coronary artery bypass graft surgery ( C ). D , Coronary angiogram of a patient with diabetes mellitus showing the typical diffuse nature of the atherosclerotic disease with narrowings in multiple locations (i, ii, iii). ### Percutaneous Coronary Intervention (Angioplasty) Percutaneous coronary intervention (PCI; angioplasty) is a minimally invasive procedure in which a tube with an associated balloon is introduced via a peripheral artery (either the femoral artery in the groin or the radial artery at the …

Cardiology patient page. How to train for a marathon.

Although the title of this Cardiology Patient Page emphasizes “training” for a marathon, the ultimate goal of training for a marathon is not to start but to finish the 26.2 mile footrace. Consequently, the necessary steps to complete a marathon require a focus on 3 goals: injury avoidance, physical training, and psychological preparation (Figure 1). Because most popular marathon training programs focus on physical preparation, this article provides description of the general principles necessary to optimize the likelihood of crossing the finish line on race day. Figure 1. The three components of training and preparation necessary to optimize an individual’s likelihood of completing a marathon. Unfortunately, to train for a marathon is to expose oneself to a high risk of injury. For example, the yearly incidence rate for running injuries varies between 37 and 56%, and may be as high as 90% in individuals training for a marathon.1 About 50% to 75% of injuries are attributable to overuse, and 20% to 70% of individuals who experience an initial running-related injury encounter a recurrence. …

Cardiology patient page. Screening for critical congenital heart disease in newborns.

We have come a long way in our ability to treat critical congenital heart conditions, which affect about 3 of every 1000 live births and account for 30% of all infant fatalities in the United States annually.1 Prenatal sonograms can often identify structural heart disease; however, the sensitivity of congenital heart disease (CHD) detection is highly variable, depending on operator expertise, gestational age, fetal position, and the type of cardiac defect. As a result, prenatal sonography will miss some patients with critical CHD and is known to miss many newborns with simple CHD. Newborns who might benefit from early treatment can often be identified in their first days of life through pulse oximetry screening—a painless, readily available noninvasive examination that is easy to incorporate into newborn assessments. This noninvasive test measures the percentage of hemoglobin in the blood that is saturated with oxygen and pulse rate. The addition of pulse oximetry to fetal ultrasound and physical examination as a screening tool can reduce the chance of overlooking critical congenital heart disease (CCHD) in newborns.2 Oxygen breathed in through the lungs attaches to the red blood cell protein hemoglobin. The newly oxygenated blood then circulates to the tissues. Arterial hemoglobin saturated with oxygen is bright red, and venous hemoglobin with less oxygen is darker. Pulse oximetry uses the principles of spectrophotometry and …

Dual antiplatelet therapy for heart disease.

Within the body, the heart pumps blood through paths called vessels so that all of the body’s organs get the oxygen and nutrients they need to function properly. The blood itself contains many components in addition to oxygen and nutrients, including tiny plate-shaped cell fragments fittingly called platelets. These platelets are useful because when they are needed, for example, when someone cuts a finger, the platelets can change their shape and stick together to help form clots to stop the bleeding. Platelets also form clots inside the body in the vessels that carry blood. Sometimes these internal clots are helpful, but at other times, a blocked heart vessel results in decreased blood flow, reduced oxygen supply, and ultimately injury to the heart. Antiplatelet therapy is a term used to describe the use of medications to block platelets and therefore to help prevent the dangerous type of clotting. Dual antiplatelet therapy (DAPT) refers to treatment regimens in which 2 different medications that block platelets are given at the same time. DAPT is usually prescribed after a heart attack or stent placement to keep the vessels open and to prevent future heart attacks. This Cardiology Patient Page explains how this works and why DAPT is useful. The heart is responsible for pumping blood to the body, providing organs with the oxygen and nutrients necessary for normal function. The heart requires its own steady supply of oxygen and nutrients to pump effectively. To meet this need, there are vessels, called coronary arteries, that supply the heart with blood, ensuring that …

Device Interventions for Stroke Prevention in Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder, with an estimated prevalence of 0.4% to 1% in the general population. In addition, AF is responsible for approximately 15% to 20% of ischemic strokes. Device interventions to prevent strokes in patients with AF are nonsurgical procedures to block blood clots (thrombus) from forming and traveling out of the heart. The “quivering” rather than normal contractions of the upper chambers of the heart (atria) from disorganized electric activity (AF) leads to blood stasis and thrombus formation. A small cul-de-sac called the left atrial appendage (LAA) is especially prone to thrombus formation (Figure 1). In AF patients without valvular heart disease, almost all thrombus originates from the LAA. The thrombus travels to and block major vessels in the body. Blocking blood vessels to the brain leads to strokes and transient ischemic attacks (mini-strokes). Figure 1. Transesophageal echocardiogram image of a thrombus in the left atrial appendage (dotted line). Patients with the following risk factors have a higher stroke risk: heart failure, hypertension, age of 75 years or greater, diabetes mellitus, and prior history of strokes or mini-strokes. These are often combined to form the CHADS2 score. The more risk factors you have, the higher your CHADS2 score and risk of stroke are. Blood-thinning medications (anticoagulants) such as warfarin, dabigatran, rivaroxaban, and apixaban are effective stroke prevention therapies. The risks of bleeding associated with long-term anticoagulation led to the development of permanent treatment options like surgery. Closures by sutures (ligation) and removal (amputation) of the LAA …

Genetic Testing for Inherited Heart Disease

Medical conditions that run in a family are inherited or genetic, meaning they are caused by changes in genes that are passed from generation to generation. Many different types of heart disease can be inherited. Some conditions like high blood pressure or coronary artery disease (blockages in the arteries that supply the heart with blood) run in families but probably result from a number of different genetic changes that individually have a subtle effect but work collectively in a complex manner to cause disease. In these situations, genetic testing is not yet available. There are other less common inherited heart diseases that are caused by just 1 or very few genetic changes that have a very strong effect in causing disease. These are called monogenic conditions. In this Cardiology Patient Page, we describe our approach to monogenic inherited heart conditions and genetic testing. Examples include conditions that affect the heart muscle, called inherited cardiomyopathies, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. There are also inherited heart conditions that affect the electric system of the heart, causing abnormal heart rhythms called arrhythmias. Examples of inherited arrhythmias include the long-QT syndrome and Brugada syndrome. Some of these conditions may require changes in lifestyle or medical therapy. All inherited heart diseases require special attention not only for the individual patient but also for their family to see if other relatives are in need of medical care. Genes are the basic units of inheritance and are made up of chemicals called DNA. Genes provide instructions for cells to make proteins that carry out all body functions and form our physical characteristics. We each have more than 20 000 genes, and each gene is present in 2 copies. One copy is inherited from your mother and 1 copy is inherited from your …

Managing Your Angina Symptoms With Nitroglycerin

You have been diagnosed with angina pectoris, commonly referred to as angina. This condition may be associated with discomfort in the chest or adjacent areas. Other symptoms of angina may include shortness of breath, fatigue, or nausea. The symptoms you feel are usually the result of a temporary lack of blood flow to your heart muscle, often caused by a blockage in the blood vessels that feed your heart. It is especially noticeable when there is an increased demand on your heart to pump blood such as during exercise or periods of emotional stress. There are 2 types of angina. If you have discomfort that usually arises on increased physical activity or stress, it is called stable angina. If your discomfort occurs with minimal activity or at rest or is increasing in frequency or intensity, it is called unstable angina. Angina is common in patients with coronary artery disease (CAD; blocked heart arteries usually caused by cholesterol and other risk factors such as high blood pressure, diabetes mellitus, and cigarette smoking) and occurs in both men and women across all age groups. Generally, patients with chronic stable angina have reduced quality of life and are less likely to participate in regular physical activity programs. Nitroglycerin, also referred to as “nitro,” has been used with success for more than a century to treat angina. Nitroglycerin is a useful medication to help patients with CAD “reintroduce” physical activity into their lives. Nitroglycerin may alleviate the discomfort of both stable and unstable angina. Most patients with CAD can reduce their risk of future heart problems if they make changes to their lives that help improve their health. One of the important lifestyle changes is participating in regular exercise. Research shows that routine exercise not only improves quality of life but also reduces the …

Peripartum Cardiomyopathy

Peripartum Cardiomyopathy

Radiation From Cardiac Imaging Tests

Many patients are referred by their physicians for noninvasive cardiac tests. Among these tests are cardiac imaging tests, which take pictures of the heart’s structure or function. There are different types of cardiac imaging tests, which were explained in a recent Cardiology Patient Page,1 and these tests are performed more than 20 million times per year in the United States. One concern shared by many patients referred for cardiac imaging tests is their exposure to radiation. If an imaging test is performed for a good reason and using good technique, the expected benefits provided by the test will far outweigh the risks related to radiation. Radiation is referred to as a weak carcinogen, which means that it is very rare for radiation to cause cancer. Moreover, it generally takes at least a decade for someone to develop cancer related to radiation exposure. However, an imaging test can provide very valuable information about your heart that can immediately affect treatment, prevention, and ultimately health outcomes. The right imaging test undoubtedly has the potential to save a life. Nevertheless, it is very understandable that patients referred for cardiac imaging are concerned about risks from radiation, because any unnecessary risk is too much of a risk. Unfortunately, there is no “Good Housekeeping Seal of Approval” for imaging tests, so it is hard for patients to know whether their imaging test will be performed for a good reason and with good technique. First, know what type of test is being ordered. An echocardiogram, which uses sound waves, or a magnetic resonance imaging (MRI) test, which uses magnetic fields, does not involve the type of radiation (ionizing radiation) that leads to DNA mutations that may cause cancer. This is not to say that these tests are always harmless, but radiation-related cancer should not be …

Warfarin Management

Until recently, most patients taking warfarin (brand name Coumadin) had to visit a laboratory and/or clinic every few weeks for an international normalized ratio (INR) blood test and adjustment of their warfarin dose. It is now possible for a patient to measure his/her INR (self-testing) with a finger-stick drop of blood with use of a small, portable, battery-powered device. Some self-testing patients adjust their dose of warfarin (self-dosing) based on a set of instructions. Even more recently, online systems have been developed to facilitate and improve self-testing and self-dosing. Patients who use self-testing have described it as life changing. A video on the ease and benefits of self-testing by a physician-patient named Dr Michael Schwartz can be viewed on ClotCare at www.clotcare.org/inrselftestingvideo.aspx. Yes. The additional benefits are why Medicare and other insurance companies started paying for self-testing for most patients in March 2008. To understand the other potential benefits, however, one needs some background information. Warfarin is used to prevent blood clots that cause strokes, heart attacks, or other life-threatening conditions. If the dose of warfarin is too small, the INR will be low, and a patient may get a blood clot. If the dose is too large, the INR will be high, and a patient …