Jefferson University Hospitals

Frequently Asked Questions

What is a biventricular pacer?

Symptoms of congestive heart failure develop due to a weak heart muscle. Sometimes, the heart's ability to pump is further compromised if it is not contracting in a synchronized fashion. In such cases, implantation of a biventricular pacemaker, or pacer, improves the function of the heart by re-synchronizing, or re-coordinating, contraction.

A biventricular pacer is a small electrical generator powered by a battery with special wires called "leads"; that run to the heart. The device is implanted under the skin of the chest. Computer-like circuitry inside the device transforms the energy from the battery into tiny electrical pulses that travel to the heart through the leads. Electrodes on the tips of these leads touch the heart wall. One electrode is placed in the right ventricle of the heart; the other is placed through a coronary vein that stimulates the left ventricle. Simultaneous impulses down each lead cause the right and left sides of the heart to contract simultaneously, thereby re-synchronizing contraction of the chambers, making the heart work more efficiently.

Who should get a biventricular pacer?

With each heartbeat, the left ventricle, which is the main pumping chamber of the heart, squeezes or contracts, ejecting blood to the rest of the body. If the heart is simply beating weakly, a biventricular pacer will not help. The patients who will benefit the most from this new technology are those whose heart failure stems from a lack of synchrony in the heart's contraction. This occurs when there is a delay in the electrical impulse that signals the heart muscle to contract. The delay in electrical conduction causes one wall of the heart to contract before the other. The resulting lack of coordination, or dyssynchrony, reduces the pumping function of the heart and may lead to worsening heart failure.

An electrocardiogram (ECG) monitors the heart's electrical activity and can easily determine if there is a delay in electrical conduction to the left ventricle. The results of this painless test will determine if you are a good candidate for a biventricular pacer.

How does the biventricular pacer help?

A biventricular pacemaker improves the function of the heart by re-synchronizing contraction. One pacemaker lead is placed in the right ventricle and a second over the left ventricle. The leads are attached to a pacemaker battery that then sends impulses to both leads simultaneously. The heart is re-synchronized – both sides now contract at the same time. The physician programs the pacer according to what the patient's heart requires, making whatever adjustments are necessary to the strength, duration and speed of the electronic impulse.

Implanting the biventricular pacer in appropriate patients has been shown to reduce symptoms, hospitalization and mortality, compared to other treatments for congestive heart failure. Other benefits include improved exercise performance and quality of life.

How is the pacer implanted?

The pacer is implanted through minor surgery. Sedation and local anesthesia are used – not general anesthesia.

A local anesthetic is administered to numb an area on the chest wall, near the shoulder, where the device will be placed. A surgeon makes an incision, and a pocket (about three inches by two inches) is created for the pulse generator.

The pacemaker leads are introduced into a vein near the site of the pocket and then, guided by x-ray images, advanced through the large veins leading to the heart. Once proper function is confirmed, the leads are attached to the pulse generator, which is then placed in the pocket beneath the skin.

The resulting scar will be about three inches long. In very thin individuals, the pulse generator may be noticeable underneath the skin. In heavier people, there may be no outward evidence of a pacemaker at all.

What happens after the surgery?

The patient will generally spend one night in the hospital after pacemaker implantation. For comfort, many patients will wear a sling, or "immobilizer," on the arm during that time. The surgical site may be uncomfortable for one to two weeks. Analgesics (aspirin, acetaminophen or ibuprofen) can provide relief.

Before leaving the hospital, the patient will get a wallet ID card containing details about the pacemaker in the event of an emergency. The patient's activities may be limited the first two weeks after surgery because vigorous motion of the affected arm and hand could cause the leads of the new pacemaker to move or be dislodged.

Four weeks after the procedure, the patient will visit the surgeon, who will evaluate the pacemaker to make sure it is working properly.

Are there risks associated with this procedure?

Pacemaker implantation is a safe procedure. However, there is a minor possibility (less than 1 percent) of risks such as bleeding, blood clots, infection or a punctured lung. Device malfunction is rare, but patients with pacers should call their physicians if they experience any of these signs:

  • Pain at the pacer site
  • Swelling of the arm or hand where the pacemaker was placed
  • Shortness of breath
  • Signs of infection: redness, heat, oozing
  • Reappearance of congestive heart failure symptoms that had initially disappeared

How do I know if the pacemaker is working?

Patients generally do not know if their pacemaker is working properly. Therefore, they must return to their doctors' offices for regular appointments. During these appointments, your doctor will evaluate the function of your pacemaker and be able to non-invasively adjust its function using a computerized program.

Pacer batteries generally last from six to 10 years. During regular office visits, physicians evaluate patients' pacer battery status. When your battery reaches its elected replacement time, a minor outpatient surgical procedure will be necessary to insert a new battery and remove the old one.

Are there restrictions on living with a pacemaker?

Few precautions are necessary to protect the pacer. High magnetic fields can interfere with pacer function, so patients cannot have MRI scans. Inform screeners at airports so that you do not have to linger around security detectors any longer than necessary for a walkthrough, although this security measure need not be avoided. Everyday devices such as cellular telephones and microwave ovens pose no threats. Your physician will provide instructions about any particular hazards.

Today, people are more aware than ever of the risks of having a high blood cholesterol level.

High cholesterol levels can lead to clogged arteries, heart attack or stroke. So if you have high cholesterol, you should take steps to lower it. Simple dietary and lifestyle changes can reverse your course and set you back on the path of good health. For those who have coronary artery disease, or are at unusually high risk for it, lowering your lipid levels can reduce further coronary events and the possible need for interventions such as surgery or angioplasty.

What is cholesterol?

Cholesterol is a waxy substance produced by the liver that is also found in animal foods such as red meat and whole milk dairy products, which are usually high in fat as well. (Plant sources do not contain cholesterol.) Your body uses cholesterol to build cell walls and other necessary tissues. High-fat diets stimulate the liver to produce excessive cholesterol. As a result of the amount your body manufactures normally and in response to a fat-laden diet, you can accumulate too much cholesterol in your blood. That is when trouble occurs in the form of cardiovascular disease.

Cholesterol travels through the blood in packages called lipoproteins. Low-density lipoproteins (LDL), or bad cholesterol, have a tendency to cling to the inner walls of the arteries as plaque. This plaque restricts the flow of blood to the heart or brain, which can lead to heart attack or stroke. High-density lipoproteins (HDL), or good cholesterol, whisk surplus cholesterol from the blood and arterial walls, thus lowering the odds of developing cardiovascular disease.

What do my cholesterol numbers mean?

Total blood cholesterol is the number most people are familiar with. Doctors no longer measure just the total cholesterol level in your blood, because that only provides part of the picture. Your doctor should do a complete lipid profile, which includes measuring your levels of good (HDL) and bad (LDL) cholesterol and triglycerides. (Although completely different from cholesterol, triglycerides likewise are fats found in foods and manufactured in the body. Most of the fat we eat is in the form of triglyceride.) Other lipid tests are also available, if needed, to help your doctor and you define your risk level.

Ideally, your LDL cholesterol should be below 100; a desirable HDL level is 45 of higher. The lower the LDL and the higher the HDL, the more protected you are from cardiovascular disease. Most pre-menopausal women have high levels of HDL because of the female hormone estrogen, which offers added protection against heart disease. After menopause, though, a woman's risk for heart attack jumps until she is 65, by which time it is almost as great as a man's.

Triglyceride levels above 150 mg/dl are abnormally high. A high triglyceride level often accompanies a higher total cholesterol and LDL cholesterol level, and especially a lower HDL cholesterol. The combination of high triglycerides and low HDL levels in concert with disorders such as diabetes or high blood pressure is termed "metabolic syndrome." Metabolic syndrome is strongly associated with abdominal obesity, which itself has been shown to put you at risk for coronary artery disease. Whatever your cholesterol counts, keep in mind other important risk factors as well. Age, heredity, family history, high blood pressure, diabetes, smoking and lifestyle should all be considered when evaluating your risk of cardiovascular problems.

How can I lower my cholesterol level?

You can take control of your cholesterol by making lifestyle changes. Eating a heart-healthy diet is often an effective way to bring your blood cholesterol within a normal range. Limit saturated fat to no more than 7 percent of your daily calories and trans fat to no more than 1 percent, and substitute more whole-grain and high-fiber foods.

Load up on fish, fruit, vegetables, beans, rice and other whole grains in place of meat or baked goods. Switch to low-fat or skim milk dairy products. When you must cook with fat, choose the monounsaturated varieties, such as olive or canola oils. Don't overdo your use of even these oils, however, as they are still high-fat foods. Fat in the diet stimulates the liver to raise blood cholesterol levels; it is not just eggs that elevate blood cholesterol.

Additionally, since regular exercise has been shown to increase the level of good cholesterol, get active. Because smoking reduces the level of good cholesterol, smokers should quit. Everyone should maintain a normal body weight, as above-normal weight and obesity contribute to abnormal lipid levels, as well as diabetes, high blood pressure and other disorders. The rewards of changing your habits are well worth it; for every 1 percent drop in bad cholesterol, you get a 2 percent drop in cardiovascular risk.

Are foods labeled 'Cholesterol Free' safe bets?

Don't be fooled by food labels that say "cholesterol free." Foods bursting with saturated fat are sometimes disguised with these healthier-sounding labels. Likewise, products made with hydrogenated vegetable oils may seem good for you but are actually rich in fat. Current U.S. Food and Drug Administration regulations cut down the hype surrounding terms used on food labels, such as "cholesterol free." To prevent being misled, however, read nutrition labels to learn the amount of fat in a serving. A truly low-fat product contains three grams or less of fat for every 100 calories.

Should I consider cholesterol-lowering drugs?

Drugs that can help normalize blood cholesterol may be necessary for people at higher risk who can't control their levels through diet. Dietary changes should often be tried before medication, however. Within three months of following a low-fat diet, you should notice a reduction in your cholesterol count. If this self-care method doesn't lower your cholesterol to an acceptable level, you may need to add medication to your regimen, particularly if you have other risk factors for cardiovascular disease. Since drugs that lower cholesterol can have side effects, however, you should consult your physician before deciding if medication is appropriate.

Do I need to worry about my child's cholesterol levels?

Research indicates that one out of four children and teenagers has a high cholesterol level. Clearly, it's never too early to start thinking about your child's cholesterol. Although the American Academy of Pediatrics does not recommend universal screening of all children, it's wise to test children over two years of age who have a family history of early heart attacks or elevated cholesterol. Overweight children or those with high blood pressure, diabetes or other risk factors for heart disease should also be screened. An abnormal level warrants dietary modifications, but it is best to consult your doctor in individual cases.

Eating habits are established at a young age, and regardless of whether your child has a clean bill of health, you should set an example for a healthy future by serving low-fat meals to children over two years old. Remember, though, that children need some fat in their diets to help them grow.

How can I ensure an accurate cholesterol test?

It's usually better to get tested at your doctor's office rather than at a mass screening at a mall. To obtain a correct measurement of blood cholesterol, you need to fast for 12 hours prior to an HDL/LDL/triglyceride workup for a total profile.

How often should cholesterol be checked?

A high cholesterol level produces no warning symptoms, so it makes sense to test periodically. The American Heart Association recommends a lipid profile by age 20 or earlier in some cases. If your levels are acceptable, return to your doctor every five years for subsequent checks until age 45; after that, screenings should be scheduled every three years.

Before menopause, some degree of protection is afforded to most women, but they should still be tested. After menopause, all women should have their cholesterol measured every three to five years.

Can a cholesterol level ever be too low?

Usually, a low cholesterol level is a good health indicator. In other cases, it may point to a systemic disease that needs treatment. Ask your family physician to discuss your cholesterol measurement with you.

 

What is high blood pressure?

High blood pressure, also known as hypertension, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension “the silent killer” because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their bodies is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What's a normal blood pressure?

A blood pressure reading consists of two numbers. The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

For adults, a blood pressure reading less than 120/80 mmHg, read as “120 over 80,” is considered normal blood pressure. Both numbers must be in the normal range for your blood pressure to be considered normal. Stage 1 hypertension is defined as a pressure between 140 and 159 systolic or 90 and 99 diastolic. People with Stage 2 hypertension have a systolic reading of 160 or higher or a diastolic of 100 or higher.

A new category of pre-hypertension has been recognized with blood pressure between 120 and 139 systolic or 80 and 89 diastolic. These patients need to be followed closely. Therapeutic lifestyle changes (diet, exercise) are recommended prior to antihypertensive medication.

If your doctor tells you your blood pressure is a little high, don't panic and assume this permanently places you into the category of hypertensive. Your doctor may do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. Your doctor may also ask you to measure your pressure at home as well. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated; more severe elevations may require immediate treatment, though.

How serious is high blood pressure?

High blood pressure should not be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely. When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though. Certain medical problems, such as sleep apnea and chronic kidney disease, may cause blood pressure to rise, and some medicines can raise your blood pressure.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, sodium itself does not cause hypertension. However, most Americans consume way too much salt. Excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because, in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Studies show that the DASH diet, which is low in salt, fat and cholesterol and rich in low-fat or non-fat dairy products, fish, poultry, nuts, nutrients, protein and fiber, reduces blood pressure.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume and, therefore, the pressure of your blood. Beta-blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure.

Calcium blockers, alpha blockers, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) all relax blood vessels, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers interfere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors and ARBs block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.

What is the goal of treatment?

The treatment goal for most adults is to get and keep blood pressure below 140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

Any discussion on small-vessel stents requires background information on coronary artery disease – a condition in which fatty deposits accumulate in the cells lining the wall of the artery and obstruct blood flow. The inadequate supply of blood to the heart muscle damages the heart. Untreated, patients may experience angina – chest pain that occurs when the heart isn’t receiving enough oxygen. Blocked arteries can also lead to a heart attack.

Cardiologists treat coronary artery disease by opening up these blocked blood vessels. In the past, open-heart surgery was the only way to accomplish this. Today, however, there are innovative medical strategies and technologies that do not require surgery. If symptoms of heart disease do not respond to drugs, diet and lifestyle changes, a cardiologist may recommend an angioplasty and stent. The combination of these two non-surgical procedures – the medical term for which is percutaneous coronary intervention (PCI) – has been highly successful in opening up blocked blood vessels and diminishing the chance that a blockage will recur.

What is a stent?

Balloon angioplasties have been the most common non-surgical technique for opening clogged arteries in patients since the 1980s. More recently, though, studies have shown that patients who also receive an implanted device called a stent were less likely to require additional angioplasties or bypass surgery in the future.

A coronary stent is a mesh tube the size of a spring in a ballpoint pen. The stent is placed in the artery to hold it open after the angioplasty balloon has cleared the blockage. About 70 percent of patients receiving balloon angioplasties today are now treated with stents as well to improve their odds of a successful outcome.

How does a stent help?

A stent can be used alone but is typically inserted following an angioplasty procedure. Placing a stent in a cleared vessel has been shown to cut the risk of subsequent blockages in half by keeping the arteries wide and reducing the incidence of re-closure. The device usually relieves the chest pain of angina, and the benefits are longer lasting than an angioplasty on its own.

Another significant advantage is that only a small incision is required for a stent as opposed to invasive bypass surgery. The non-surgical stenting procedure entails less pain and a shorter recovery time. While helping to restore normal blood flow, stents also keep the artery open if any damage occurs from the catheter during the angioplasty. Overall, the complication rate of angioplasty goes down too when a stent is used.

What is the advantage of the new small-vessel stent?

First introduced in the early 1990s, stent design has steadily improved to offer greater effectiveness, more variety in size and minimal trauma.

Jefferson cardiologists have pioneered the use of small-vessel stents for tiny and hard-to-reach heart vessels. These compact stents being used by top cardiologists today have the ability to reach lesions in small blood vessels which were previously difficult to access. The ultra-smooth surface of the small-vessel stents also promotes proper blood flow, thus reducing the possibility of thrombosis (blood clots), a particular risk when stenting small vessels.

How is a stent inserted?

A physician trained as an interventional cardiologist performs the procedure, which usually starts with the angioplasty. An incision the size of a pencil tip is made. Guided by X-ray images, the doctor threads a balloon-tipped catheter through the arterial system and into the obstructed coronary artery. At the end of the catheter is the stent, a small flexible tube made of plastic or mesh.

Next, the physician inflates the angioplastic balloon to force the plaque against the arterial wall; in the large majority of cases, this opens up the obstructed artery. This balloon inflation also causes the stent to expand and press against the
vessel wall.

Once the angioplasty balloon is deflated and removed, the stent stays in place permanently to hold the blood vessel open.

New cells and tissue slowly grow over the stent and eventually cover the surface.

Are there any risks or possible complications associated with stents?

Stenting is a safe procedure with a small risk of complications such as blood clots (which may cause heart damage) and scar tissue (causing restenosis, or recurrent blockage). In all, the medical risks of the angioplasty and stent are usually lower than for heart bypass surgery (which is more difficult for small arteries).

Are stents beneficial for anyone with coronary artery disease?

Stents are used to treat a wide variety of patients with narrowing or clogged arteries. The indications for using a stent can be angina (chest pain) or a heart attack. Or sometimes, stents are inserted as a temporary measure for cardiac patients who are not fit for surgery.

The size of the obstructed artery and location of the blockage will determine whether a stent is a suitable treatment and what size is required. Most, but not all, patients with blocked arteries are candidates for stents.

What should I expect after the procedure?

Most people stay in the hospital for only one night following an angioplasty and stent. Full recuperation may take several days. Patients may feel mild chest pain initially from the stretched artery. After stenting, patients also must take blood- thinning agents to help prevent re-closure of the artery. Aspirin is recommended indefinitely and an anti-platelet agent – clopidogrel (Plavix®) – is prescribed for up to one year.

Stroke is a "brain attack" cutting off vital sup-plies of blood and oxygen to the brain. It can damage brain cells that control everything we do – from thinking, to speaking, to walking to breathing. Symptoms include:

  • Sudden numbness or weakness of face, arm or leg – especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

A stroke happens when an artery leading into the brain becomes blocked or ruptures. These arteries can be blocked by blood clots formed in the heart or elsewhere in the body or by the gradual build-up of plaque and other fatty deposits such as cholesterol.

What is cholesterol?

Cholesterol is a soft, waxy, fatty material found in the bloodstream and in all of your body's cells. Your body naturally makes all the cholesterol it needs for use to form cell membranes, some hormones and vitamin D. Certain foods (such as egg yolks, liver or foods fried in animal fat or tropical oils) contain cholesterol and also saturated fats which increase blood cholesterol levels.

Cholesterol can not dissolve in the blood on its own. It has to be delivered to and from the cells by tiny particles called lipoproteins. The two main lipoproteins that have a direct effect on cholesterol levels are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

How does cholesterol affect stroke risk?

High cholesterol may indirectly increase stroke risk by increasing your risk for heart disease – an important stroke risk factor. In addition, plaque formation in the carotid arteries to the brain may also block normal blood flow and cause a stroke.

What is LDL cholesterol?

LDL cholesterol is also often referred to as "bad" cholesterol due to its artery clogging properties. LDL carries cholesterol in the blood stream to the tissues, where it can be used or stored in your body. This type of cholesterol can cause a build-up of plaque, a thick, fatty substance that can clog arteries. The plaque can eventually cause narrowing of the arteries or block them completely, causing a heart attack or stroke.

What is HDL cholesterol?

HDL has the opposite effect of LDL cholesterol. HDL transports cholesterol from the tissues to the liver, where it is expelled from the body. High levels of this type of cholesterol tend to protect against heart attack and stroke, and it is therefore known as "good" cholesterol. A low HDL level may indicate a greater risk of heart attack or stroke.

What increases blood cholesterol levels?

  • Blood cholesterol levels may be affected by a variety of factors, including:
  • Foods high in saturated fat
  • Being overweight
  • Lack of exercise
  • Inherited health traits
  • Age (Most but not all people experience gradual increases in blood cholesterol as they become older)
  • Gender – Before the age of 50, women tend to have lower cholesterol levels than men. However, once women reach menopause, their LDL "bad" cholesterol tends to rise and their HDL "good" cholesterol tends to fall. After the age of 50, women tend to have higher cholesterol levels than those of men of the same age. Throughout life, women's HDL cholesterol remains higher than that of men. This difference may help explain why women under the age of 80 usually experience lower rates of heart disease and stroke than men.

Should I be checked for high cholesterol?

According to the National Heart, Lung and Blood Institute's (NHLBI) Cholesterol Education Program, all adults 20 years of age or older should have their cholesterol levels checked at least once every five years. Your cholesterol should be checked more frequently if you are older than 45 or have a family history of high cholesterol or heart attacks. A simple blood test can determine your cholesterol levels.

What do my cholesterol levels mean?

According to the NHLBI, for people over age 18, a high cholesterol level is considered to be over 200 mg/dL for your total cholesterol, which combines both LDL and HDL levels. If the total blood cholesterol number is higher than 200, or if your HDL is lower than 45, you generally have an increased risk for heart disease and stroke. Your doctor can determine if you are at greater overall risk.

Total Blood Cholesterol Levels
Desirable: less than 200/mg/dL Borderline: 200-239 mg/dL High: 240 mg/dL or higher

HDL-Cholesterol Levels
Desirable: 45 mg/dL or higher

LDL-Cholesterol Levels
Desirable: less than 130mg/dL Borderline: 130-159 mg/dL High: 160 mg/dL or higher

If you have had a stroke or previous heart attack, your cholesterol levels may need to be even lower than as indicated here.

What can I do to lower my cholesterol levels?

A low-fat diet: A diet with 30 percent or fewer calories from total fat, and low in saturated fat is important for lowering cholesterol levels. Your diet should also include vegetables, fruits, lean meats such as chicken and fish, low-fat dairy products and a limited number of egg yolks. Adding fiber such as whole-grain bread, cereal products or dried beans to the diet may also help reduce cholesterol levels by 6 to 19 percent, according to published studies. Along with the diet, there should be a change in cooking habits, with an emphasis on baking, broiling, steaming and grilling rather than frying foods. If you do fry foods, use non-stick cookware and non-stick spray.

Exercise: Active people generally tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop the clogging of blood vessels by fatty deposits. Your doctor may recommend a program of regular exercise to help lower your cholesterol. Be sure to check with your doctor before starting any exercise program. For the best results, you should take part in some aerobic activity most days of the week, for at least 20 or 30 minutes each time. This can be achieved by a brisk walk with a friend, taking the stairs instead of the elevator or parking farther away from your destination.

Medication: Although many people can successfully control their cholesterol levels through diet and exercise alone, a number cannot. For these people, medication may be prescribed by a doctor to lower cholesterol levels. If your doctor decides you need to add medication to help control your cholesterol, be sure to TAKE IT AS DIRECTED, even on days you feel fine. You and your doctor may have to try several different medications before you find the one that's right for you. This is very common, so don't be discouraged.

Statins are a widely used class of cholesterol lowering medications that may help reduce the size of the plaque that causes hardening and clogging of the arteries. New studies have also shown that some statins may prove to be effective in reducing the risk of stroke or a transient ischemic attack (TIA) in patients who have had a heart attack, even though they have average or only slightly elevated cholesterol levels.

Several other cholesterol-lowering drugs are also available and may prove effective in certain individuals. Talk with your doctor about which medication is right for you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

This information comes from the National Stroke Association.

What is high blood pressure?

High blood pressure, also known as hyperten-sion, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension the silent killer because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their body is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What ranges of blood pressure readings are considerd high?

For adults, a blood pressure reading between 130/85 and 139/89 (read as "130 over 85" and "139 over 89") is considered high normal. Mild hypertension is defined as pressure between 140/90 and 159/99. People with moderate hypertension have a reading of 160/100 to 179/109. Severe hypertension is a blood pressure reading of 180/110 to 209/119.

What do the numbers mean?

The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

A word of caution, though: If your doctor tells you your blood pressure is a little high, don't panic and assume this automatically lumps you into the category of hypertensive. It's best that your doctor do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated.

How serious is high blood pressure?

High blood pressure shouldn't be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely.

When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, normal amounts of sodium usually do not cause hypertension. But excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Preliminary studies suggest that a diet rich in potassium and calcium may help reduce blood pressure. Eating a balanced diet that includes low-fat dairy products and more fruit and vegetables will automatically boost your intake of these nutrients.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume, and therefore the pressure, of your blood. Beta blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure. Calcium blockers, alpha blockers and ACE (angiotensin-converting-enzyme) inhibitors all keep blood vessels open, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers intefere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.

Are there alternatives to a VAD for heart failure?

For patients who are sick enough for a VAD, the only other options are chronic inotropes (intravenous medications that push the heart to work harder), transplantation and hospice. Inotropes are not good for long-term use because patients usually do not survive more than a year. Transplantation is limited by the availability of donor organs. In addition, some patients do not qualify for transplantation. Hospice is reserved for patients who cannot get any of the other therapies or who do not desire to have them.

Can my heart recover on a VAD?

While there are some people whose heart gets better after placement of an LVAD, this is not common. However, we monitor all patients on a VAD for signs of recovery. If recovery occurs, the removal of the device is a possibility.

Can I live at home on a VAD?

Our goal is to get every VAD patient home again living the life they want to live. After recovering from the VAD placement, patients are usually able to return to a fairly normal life at home. Some patients require inpatient rehab before going home. Your doctors will assess your need for this prior to discharge.

Which doctors will take care of me while I’m on the VAD?

You’ll require special care by physicians who are experts in the care of VAD patients. The physicians at Jefferson will provide care for you as long as you have your VAD. Patients on VADs also will need to be at a VAD-capable hospital for any admission or procedure requiring anesthesia.

How long does the surgery take?

The VAD surgery usually takes 4 to 8 hours.

How long will I be in the hospital after a VAD implantation procedure?

Patients are usually in the hospital for two weeks or more after implantation. Your health prior to the surgery will factor in to the length of stay.

Is it better to have a VAD or Total Artificial Heart?

VAD is almost always a better option for people who only need support of the left side of the heart. For those with severe failure of both sides of the heart, a total artificial heart or bi-ventricular assist devices are the best options. Your cardiologist and surgeon will determine which device is best for you.

If I cannot shower with a VAD, how will I stay clean?

Our team will educate you about how to stay clean with sponge baths. In addition, many VAD patients are willing to share their tips.

What will be expected of my family/support?

You should plan for someone to be with you at all times for about six weeks after you are discharged home. Most patients need support to perform sterile dressing changes of the driveline (wire coming out of the abdomen) site; to assist with filling a medication box and making changes to the pill box when needed; to accompany you to the laboratory and office visits; and to assist with monitoring symptoms and calling when needed.

How will I wear the external equipment?  

You will be provided with a vest and a bag to carry the equipment. Many patients create other alternatives and most VAD patients are eager to share tips.

Why should I exercise?

Exercise offers many health benefits to women. Aerobic exercises, such as brisk walking, swimming, jogging, and cycling, are beneficial because they give you energy and increase your cardiovascular (heart and lung) endurance. Weight-bearing exercises, such as walking or jogging, and resistive exercises, such as weight training, can help prevent the loss of bone mass (osteoporosis) common to older women. In general, exercise lessens many of the symptoms of premenstrual syndrome and menopause. Some medical studies have shown a link between regular exercise and reduced risk for certain women's cancers. And of course, any regular exercise routine will help you to lose weight or maintain your ideal weight, which makes you look better and feel better.

Can anyone begin an exercise program?

Anyone in good health can start an exercise program. Of course, if you are pregnant or under a doctor's care for any other reason, get your doctor's approval before starting any new physical activities. Likewise, see a doctor first if you have high blood pressure, smoke, are overweight or are over 40 years old and have never exercised before.

Why is exercise good for my heart? Why is that important?

Your heart is a muscle that pumps blood throughout your body. Regular aerobic activities strengthen your heart by making it work harder. At the same time, they increase your body's ability to use energy-giving oxygen. Since heart disease is the number one killer of women in this country, building cardiovascular endurance — that is, strengthening the heart, lungs, and circulatory system — should be a priority in every woman's fitness program. Aerobic exercises are the most efficient way to do this. Remember, though, that for effective conditioning, you must choose activities that elevate your heart rate and keep it elevated for a period of at least 20 minutes straight, three times a week. Stopping and starting in the middle of your exercise is not as effective. However, it's okay to start slowly and, as the days and weeks go by, progress up to at least 20 minutes. Also, every exercise session should include a proper warm-up and cool-down with stretching.

How can I tell if I'm working my heart hard enough?

In order to improve cardiovascular fitness, you must exercise hard enough to make your heart beat faster than it does at rest. How much harder will depend on your age and physical condition. To calculate this you can use this simple formula: 220 – age x 75% = your target heart rate. A general rule of thumb is, you should be able to talk, but not sing while performing your activity. If you can't talk, you're working too hard; if you can sing, you're not working hard enough.

How often should I exercise?

You should exercise at least three times a week. Aerobic exercises can be performed every day with no adverse effects. Resistive exercises, such as weight training or toning exercises, should be done every other day, to allow your muscles to recover. If you break your fitness pattern — especially if you stop exercising for more than six weeks — you will lose your conditioning benefits. You will need to begin building up your endurance all over again.

Do housework or childcare count as exercise?

Any activity is better than no activity. Certainly, heavy housework and chasing after children can increase your heart rate temporarily and give you some muscle tone. But these are no substitute for a regular fitness routine.

I've been exercising, but I'm still not losing weight.

A balanced, low-fat diet with the appropriate number of calories, combined with a sustained exercise program, is the best way to lose weight. If you exercise regularly without cutting calories or fat grams, you will lose weight more slowly. However, you should still notice a change in your body as your muscles become firmer.

As you progress in your exercise program, your body replaces fat cells with muscle, which weighs more. Thus, you may begin to look more slender even before a change shows up on the scale. As you continue to exercise, you will lose weight.

Will exercise affect my menstrual cycle?

A vigorous exercise routine can affect a woman's menstrual cycle. With excessive, intense exercise, you may find that you have less frequent menstrual periods, or you may not menstruate at all. Of course, these changes can be due to factors other than exercise. If you stop menstruating, consult your doctor to find the cause.

Other menstrual irregularities, such as bleeding or spotting between periods, and bleeding and pain after sexual intercourse, are not related to exercise. If you experience changes in your menstrual cycle, see your doctor.

I'm pregnant. Can I still exercise?

Exercising during pregnancy can help keep you both fit and comfortable as your pregnancy progresses. It will also help you get back into shape more quickly after your baby is born. Consult with your doctor about specific exercises you wish to do — your fitness level before you got pregnant and your condition during pregnancy will determine what exercise routine is acceptable for you.

You will find that the extra weight you are carrying will make you work harder as you exercise. Other changes that occur during pregnancy, such as a shift in the body's center of gravity, and the increased laxity of joint ligaments, will affect what one can do. Let your body guide you, and don't push yourself. Some healthcare institutions and fitness facilities offer special exercise classes for pregnant women.

Walking is an excellent exercise during pregnancy, particularly for women who did not exercise regularly before becoming pregnant.

OK, I'm sold. How do I begin?

Getting started is the hardest part of getting fit. Here are some tips to help get you on your way:

  • Plan time for exercise as you would a business meeting or other important engagement. Write it down in your calendar or appointment book.
  • Find a buddy to exercise with, someone who will keep tabs on you. The peer pressure might be just what you need to stay motivated.
  • Tell yourself you're only going to exercise for five minutes. Chances are, once you get started, you'll do more.
  • The number-one reason for quitting is lack of time. Choose a spot to exercise that's convenient to home or work.
  • Pick an activity that's fun for you.
  • Vary your routine.

Have a backup routine for emergencies. For instance, if you normally walk outside and it's raining, walk in a mall instead. Or exercise to videotapes.

Remember that part of being fit includes weight control, proper nutrition, stress reduction and healthy lifestyle choices. Becoming fit means saying "no" to unhealthy habits such as smoking, alcohol and drug misuse. A fit lifestyle can increase the number and quality of the years ahead of you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.