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2018 Top Doctors For Las Vegas
Congratulations to Dr. Navid Kazemi, Dr. Samuel Green, and Dr. Patrick Hsu for being listed as a “Top Doctor” by Healthcare Quarterly Magazine.
Healthcare Quarterly Magazine has just announced it’s 2018 Top Doctors for Las Vegas. They have researched over 6,000 doctors, dentists and medical professionals in Southern Nevada to find the “Top Doctors” recommended by their peers. No doctor can pay to be on this list.
Heart Pacemaker Surgery: What to Expect Before, During, and After
People have a pacemaker for low heart rate, sometimes complete heart blockage where the upper chambers can no longer transmit electrical impulses to the lower chambers. A patient usually has a problem with the “wire,” if you will, that sends the signals.
What Can I Expect When Having A Pacemaker Surgery?
Pacemaker implantation is usually minor surgery that takes about an hour. Sometimes, it’s quicker or slower. If your family members are in the waiting room, they may think it takes two hours or longer because there’s a lot of paperwork beforehand and after. Like most surgeries, you won’t have anything to eat or drink after midnight the day before; we might have you hold off taking specific blood thinner medications. Usually, we have people on Plavix, aspirin, or other anti-platelet agents to continue those medications.
Before the surgery, the anesthesiologist will make you sleepy with a lighter sleep called conscious sedation. It will be moderate or deeper than that. If we sense that you are starting to feel pain, we will adjust the sedation. We make an incision to form a pocket to place the pacemaker, usually on the left side of your chest, the traditional placement area for your pacemaker. We will then connect leads into the heart. We put it all under the skin. You will be given some numbing medicine around the incision so you won’t feel any pain. You can almost always expect to spend the night in the hospital for a new device and will most likely go home the next day unless we see an issue. You will get pain medicine overnight and antibiotics before and after the surgery. The device will be checked the next day to ensure the leads are in place and that the heart has not rejected any leads. There is a follow-up visit to check the surgical wound and optimize the device for your particular needs.
What Are The Risks of Pacemaker Placement Surgery?
We generally tell people with any surgery or procedure, there is a risk of stroke, heart attack, and death. There is always surgical risk (like if you had your gallbladder or appendix out or even a colonoscopy). The main risks include:
- Collapsed lung. We work with needles around the lungs, so there’s a one percent chance of a lung perforation, and that’s treated with a chest tube.
- Perforation of the heart. Again, there is generally one percent or less risk of that happening. When we put leads into the heart, there is a slight chance that one may perforate. If that happens, it’s generally treated with a chest tube under the breast bone to drain the blood away from the heart. Depending on the situation, it can require open heart surgery to fix the hole.
- The risk of infection is about one percent, maybe higher. If that happens, it must be removed and replaced when the infection is eliminated. You can even have an infection much later. This would be a severe infection that involves the bloodstream – one of those once-in-a-lifetime type infections. Again, an infection can seed that device just like an artificial hip or heart valve.
- Lead dislodgement is about one percent. If it happens to you, we must return and fix the lead in the heart. There are some restrictions on lifting your arm. Usually, we ask you not to lift your arm between 4 and 6 weeks after your surgery. You should not raise your arm more than 90 degrees. If you lift your arm higher than that, you’ll pull leads out of the heart and have to go back in with repeat surgery.
If you have more questions about having a pacemaker, speak to one of our caring cardiologists about pacemaker surgery. New patients are always welcome. Start by calling 702-475-5115 or using our online form here.
What is Atrial Fibrillation or AFib?
Atrial fibrillation is the most common sustained heart rhythm in the United States, affecting about 3 million Americans. Instead of beating normally, the upper chambers quiver or fibrillate. The upper chambers no longer fill the lower chambers with blood, and heart output can be reduced by 20-40%. During atrial fibrillation, the upper chambers send about 600 impulses a minute down to the lower chambers. While the lower chambers do not beat 600 times a minute, they can still beat very fast and irregularly. Over time, this can cause the important lower pumping chambers to fail. Possibly the worst complication of atrial fibrillation is stroke. When the upper chambers stop contracting, blood can stagnate and form a clot. This clot can break off and go anywhere in the body, including the brain. 75% of strokes associated with atrial fibrillation leave a patient in a nursing home or are fatal.
What Beta Blockers are Approved for Heart Failure?
There are two beta blockers approved for heart failure in the United States.
The first is metoprolol succinate (also called Toprol XL, Toprol, metoprolol ER or metoprolol ER succinate). This long-acting formulation should not be confused with short-acting metoprolol (metoprolol, metoprolol tartrate or Lopressor) which is NOT an approved drug for heart failure.
The second beta blocker approved for the treatment of heart failure is carvedilol (also called Coreg or Coreg CR).
Drugs that are NOT approved for heart failure include atenolol and Bystolic. These are approved to treat hypertension.
NOT APPROVED: metoprolol tartrate, Lopressor, atenolol, Bystolic
APPROVED: metoprolol succinate, Toprol XL, Toprol, metoprolol ER, metoprolol ER succinate, carvedilol, Coreg, Coreg CR
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Three Components of Treating Heart Failure
There are three components to keeping heart failure under control:
- Daily weights
- Diuretics
- Fluid restriction/salt restriction
Daily weights are critical for heart failure patients.
Weights should be done the first thing every morning on the same reliable home scale before eating or drinking anything. Establish a DRY WEIGHT with your physician.
Think of ALL WEIGHT GAIN as an INCREASE IN FLUID, not as getting fatter.
Should I Use Aspirin?
Aspirin acts on the platelets, which are the blood clotting cells of the body. It makes them less “sticky” – less likely to form a blood clot.
If a cholesterol plaque inside a blood vessel ruptures, the body’s natural reaction is to form a clot in that area. This can lead to heart attacks (a total blockage of blood flow down a coronary artery) or stroke.
The U.S. Preventive Services Task Force (USPSTF) recommends men with no history of heart disease or stroke who are 45 to 79 years old use aspirin to prevent a heart attack.
Angiogram vs. Angioplasty (and stents)
An angiogram of the heart is a direct visualization of the coronary arteries and is the gold standard test to diagnose blockages in the arteries.
During an angiogram, light anesthesia is used to provide relaxation and a numbing medicine is administered in the groin over the femoral artery. A special IV (or sheath) is then placed in the artery. Through this IV, a catheter is advanced to the heart, and the coronary arteries are engaged. X-ray contrast is injected into the arteries, and pictures are taken.
If a significant blockage is found (60-70% or greater) and this can be safely fixed, then an angioplasty will be done. A balloon is advanced to the site of the blockage and expanded to push the blockage to the sides of the artery. When the balloon is removed, blood can get through more easily. Most of the time, a stent is also placed. A stent is a wire mesh tube that helps keep the artery open. Before stents were developed, about 2/3 of blockages came back. With bare metal stents, only 1/3 of the blockages come back. With new drug eluting stents, less than 10% of the blockages come back.
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Results of a Cardiac Catheterization
Several results are possible after undergoing cardiac catheterization (angiogram of the blood vessels of the heart).
The best result is that there are no critical blockages detected by the test. The chest pain and/or abnormal test results are not related to significant blockages in the arteries supplying blood to the heart. One of the most serious causes of the clinical findings has been ruled out with essentially 100% certainty. It would be like a cancer doctor telling you the good news that you do not have cancer.
An Introduction to Chest Pain
“Chest pain” is a general term used in the medical profession to describe ANY SYMPTOM IN THE CHEST. It may be a sign that the heart is not getting enough blood and should be evaluated in a timely manner. Pain in the chest may be described as a tightness, burning, squeezing, or sharp pain. It is important to remember that every person is unique, and symptoms may not necessarily come out of a textbook.
The location of chest pain is not necessarily critical in determining how serious it is. A heart attack or angina can present with right-sided chest pain even though the heart is located primarily in the center and left part of the chest. The nerves inside the body (unlike the nerves on our skin) are very vague and may not exactly correlate with the location of the problem.