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3650 W. Wheatland Rd. Suite C, Dallas, TX 75237
Phone: 214-774-9771
Fax: 214-774-9762
Russell M. Canham
, MD, MCS
Cardiovascular Conditions
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ATRIAL FIBRILLATION and FLUTTER
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Atrial fibrillation (also called AFib or AF) is one of the more common arrhythmias, and causes an irregular heartbeats. This occurs from a quivering or irregular heartbeat from the top atrial chamber of the heart that is less effective at moving blood to bottom ventricle.
This can lead to blood clots, stroke, heart failure and other heart-related complications. It is associated with a 5-fold increased risk for stroke, and about 15–20 percent of people who have strokes have this heart arrhythmia. This clot risk is why patients with this condition are put on blood thinners, which is critical at preventing stoke. Treatment can include rate control or rhythm control with medications, cardioversions and ablation procedures.
Atrial flutter also occurs when rapidly firing electrical signals cause the muscles in the heart’s upper chambers (atria) to contract quickly. Flutter can be from a reentrant circuit and also increases risk of clot formation at stoke. This leads to a steady, but overly fast, heartbeat. Someone with atrial fibrillation can also have atrial flutter. But it’s also possible to have atrial flutter without another arrhythmia.
In addition to anti-coagulation (blood thinners), treatment options can include rate control or rhythm control with certain medications, cardioversions and ablation procedures can be very successful.
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ARRHYTHMIAS
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The heart muscle is responsible for circulating blood throughout the body. When the heart does not operate as it is supposed to and develops an irregular or abnormal rhythm that is a change from the normal sequence of electrical impulses that conduct through the heart, the condition is known as an arrhythmia.
An arrhythmia is any variation from the heartbeat's normal rhythm. The heart rate at rest is usually between 60 and 99 beats per minute. These electrical impulses may cause the heart to beat too fast, called tachycardia, or too slowly called bradycardia, or erratically with an irregular arrhythmia. Much lower rates may be normal in young adults, particularly those who are physically fit. Variations in heart rate are normal. When the heart rate is too fast or too slow, or when the electrical impulses travel in abnormal pathways, the heartbeat is considered abnormal. Such rhythms may be regular or irregular.
When the heart doesn't beat properly, it can't pump blood as effectively. Arrhythmias can originate from the top of the heart (atria) or from the bottom (ventricle). They may be completely harmless or life-threatening. Symptoms can included palpitations or a fluttering feeling that can lead to dizziness or syncope (passing out).
Monitoring devices can be used to identify the rhythm include a holter, telemetry or MCOT monitors or much longer lasting and very small implantable loop recorders which can connect to your phone and our office for instant evaluation and monitoring.
Treatment options include medications to control rate and/or rhythm, ablation procedures and sometimes ICDs or defibrillators or LifeVest.
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CORONARY ARTERY DISEASE
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Atherosclerosis is the process that causes the artery wall to get thick and stiff and leads to coronary artery disease. It can lead to complete blockage of the artery, which can cause a heart attack. Coronary heart disease is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. The plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. This is also called ischemia. It may be a chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle, or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot. A myocardial infarction or heart attack can lead to significant damage to the muscle and heart failure, valve disease and even sudden cardiac death.
The traditional risk factors for coronary artery disease include elevated lipids and cholesterol, high blood pressure, family history of CAD and genetics, diabetes, smoking, being post-menopausal for women and being older than 45 for men, age, sedentary life style and obesity, and high stress.
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A proper work-up can be done to assess for ischemia with proper stress testing done with a cardiologist, or other imaging modalities like calcium scoring or CT of the coronary vessels. A left heart catheterization may be needed if these are abnormal. Treatment includes proven and safe medications, modifying risk factors, and possible revascularization with stenting or coronary bypass surgery if needed.
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GENETIC and OTHER CARDIAC SYNDROMES
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There are many genetic or inherited cardiac syndromes. They include structural problems and electrical ones. The cardiac channelopathies are a group of heritable disorders that are associated with arrhythmias and sudden cardiac death
Genetic arrhythmias can be broken down into two main causes. Primary electrical disease are arrhythmias in the absence of structural heart disease. Secondary arrhythmia syndromes are arrhythmias in the presence of structural heart disease. When the condition is genetic and passed down through families, it is known as a familial arrhythmia. Types of familial arrhythmias or structural ones that can cause arrhymias can include ones like Hypertrophic cardiomyopathy, Brugada syndrome, Catecholaminergic polymorphic ventricular tachycardia, Long QT syndrome, Short QT syndrome, Timothy syndrome, Wolff-Parkinson-White syndrome, Arrhythmogenic right ventricular dysplasia, Idiopathic ventricular fibrillation.
Some of these can be identified on ECG, echocardiogram or cardiac MRI. Genetic studies have helped identify many of these as well. Treatments can include medications and sometimes ICD or defibrillator placement.
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HEART FAILURE
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The term heart failure means that the heart isn’t pumping as well as it should be and has become weaker. Congestive heart failure is a type of heart failure that requires seeking timely medical attention, although sometimes the two terms are used interchangeably.
Your body depends on the heart’s pumping action to deliver oxygen and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.
The heart stretches to contract more strongly and keep up with the demand to pump more blood with heart failure. Over time this causes the heart to become enlarged and weaker. The heart may try to pump faster to help increase the heart’s output. The body tries to compensate with pumping faster and diverts blood away from other tissues and organs like the kidneys, the heart and brain. Heart failure continues and worsens until these compensating processes no longer work.
Eventually the heart and body just can’t keep up, and the person experiences the fatigue, shortness of breath, trouble lying flat, weight gain from fluid build-up, coughing and swelling in the legs. Heart failure usually falls in a few main categories including ischemic (from underlying coronary disease and blockages) or non-ischemic, of which there are several sub-types that occur from other causes including hypertension, valve disease, viral causes, thyroid disorders, prolonged faster rates, post pregnancy, and stress.
Treatment options include proven medications, life style changes and risk factor modification, ICD or defibrillator sometimes with CRT therapy, LifeVest (a temporary life-saving external wearable monitor and defibrillator), possible surgery or for end stage options LVAD (left ventricular assist device) or heart transplant.
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We specialize in heart failure workup, therapy and treatment options, and ICD and CRT placement to prevent risk of sudden cardiac death.
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HIGH CHOLESTEROL
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High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke.
Cholesterol is not all bad, as your body needs it to build cells. But too much cholesterol can pose a problem. Some foods are high in saturated and trans-fats. Those fats cause your liver to make more cholesterol than it otherwise would.
There are two main types of cholesterol: LDL cholesterol, which is bad, and HDL, which is good. Too much of the bad kind, or not enough of the good kind, increases the risk that cholesterol will slowly build up in the inner walls of the arteries that feed the heart and brain.
Cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. This can narrow the arteries and make them less flexible – a condition known as atherosclerosis. If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.
LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This condition narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease, or PAD.
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HDL cholesterol can be thought of as the “good” cholesterol and are protective, so, higher levels are actually better. A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show that low levels of HDL cholesterol increase the risk of heart disease.
Triglycerides
Triglycerides are the most common type of fat in the body. They store excess energy from your diet. A high triglyceride level combined with high LDL (bad) cholesterol or low HDL (good) cholesterol is linked with fatty buildups within the artery walls, which increases the risk of heart attack and stroke.
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HYPERTENSION
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Hypertension is another name for high blood pressure. Untreated hypertension may lead to serious health problems including stroke, heart attack or heart disease, peripheral vascular disease, kidney disease/failure, complications during pregnancy, eye damage, vascular dementia, aneurysms, and even death.
Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, and heart failure. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions. It is often referred to as the silent killers, as High blood pressure usually doesn’t cause symptoms at first, until too much damage has been done.
Management and treatment includes lifestyle adjustments are important with regular physical exercise including activities like walking, jogging, cycling, or swimming. Eat healthy foods that are low in salt and fat. Try to reach and maintain your best body weight. Stress reduction and avoiding or learning to manage stress can help a person control blood pressure. Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues. Medication are very important to treat hypertension. Often, people with hypertension will need to combine two or more drugs to manage their blood pressure.
It is important to check your own blood pressure regularly with a home blood pressure monitor. These electronic monitors are available at most pharmacies or online.
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PERIPHERAL ARTERIAL DISEASE​
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Peripheral artery disease (or PAD) happens when fatty deposits build up in arteries outside the heart, usually the arteries supplying fresh oxygen and blood to the arms, legs and feet.
PAD may be the first warning sign of atherosclerosis or chronic fatty deposit build-ups throughout your arteries. The whole circulatory system, including your heart and brain, are at risk when arteries are blocked and narrowed. Fatty deposits also increase the risk for vascular inflammation and blood clots that can block the blood supply and cause tissue death.
PAD is potentially a life-threatening condition that can be managed or even reversed with proper care. PAD is dangerous because these blockages can restrict circulation to the limbs, organs and brain. Without adequate blood flow, vital organs, legs, arms and feet, and your brain, suffer damage. Left untreated, the tissue can become infected or die, a condition called gangrene and lead to amputation.
Treatment for peripheral artery disease focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms.
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SUPRAVENTRICULAR TACHYCARDIA​
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Supraventricular tachycardia (SVT), also called paroxysmal supraventricular tachycardia, is defined as an abnormally fast heartbeat. It's a broad term that includes many forms of heart rhythm problems (heart arrhythmias) that originate above the ventricles (supraventricular) in the atria or AV node.
Supraventricular tachycardia include many types of arrhythmias including atrial tachycardia, and atrioventricular nodal reentry tachycardia (AVNRT). Symptoms include palpitations, dizziness, sweating, and can start and stop suddenly. Symptoms may last anywhere from a few minutes to a few days, and some people have no symptoms at all.
Supraventricular tachycardia becomes a problem when it occurs frequently and is ongoing, particularly if you have heart damage or other coexisting medical problems.
Treatment options are medications, avoiding stimulants like caffeine and catheter ablation procedures to destroy the tissue or pathway causing the arrhythmia.
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SUDDEN CARDIAC DEATH​
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Cardiac arrest or sudden cardiac death, is caused when the heart’s electrical system malfunctions. The heart stops beating properly with severe ventricular arrhythmias (bottom chamber). The heart’s pumping function is “arrested,” or stopped and can't pump and circulate blood and oxygen.
This can be caused by a heart attack which is caused by a blockage that stops blood flow to the heart. It can also occur from underlying heart failure, or rare cases, a genetic cardiac syndrome.
Cardiac arrest may be caused by irregular heart rhythms called arrhythmias. A common arrhythmia associated with cardiac arrest is ventricular fibrillation and ventricular tachycardia. In ventricular fibrillation, the heart’s lower chambers suddenly start beating chaotically and don’t pump blood.
In cardiac arrest, death can result quickly if proper steps aren’t taken immediately. Cardiac arrest may be reversed if CPR is performed and a defibrillator shocks the heart and restores a normal heart rhythm within a few minutes. Treatment includes medications, sometimes revascularization, and a wearable cardiac defibrillator (LifeVest) or ICD or implantable defibrillator. We specialize in treatment to get the heart stronger, and ICD placement.
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VALVULAR HEART DISEASE​
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Heart valve disease is more common among older people. As we age, our heart valves can become lined with calcium deposits that cause the valve flaps to thicken and become stiffer.
People who have had rheumatic fever or a case of infective endocarditis are at greater risk for heart valve problems. Heart problems like a heart attack, heart failure, arrhythmia, or previous heart valve conditions from birth (called congenital heart defects) can also increase the likelihood for developing valve problems. Additionally, survivors of cancer who had radiation to the chest for their cancer have an increased prevalence of heart valve disease later in life.
People who have been diagnosed with a heart murmur, a defect like a bicuspid aortic valve, mitral valve prolapse or a mild form of valve disease should maintain regular check-ins with a healthcare provider and should be aware of possible symptoms should they start or become worse.
Treatment can include surgery if needed to repair or replace a valve that is more invasive or often minimally invasive, or even with a catheter like Transcatheter Aortic Valve Replacement (TAVR).
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VASCULAR DISEASE​
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Vascular disease is any abnormal condition of the blood vessels or the arteries and veins. The heart pumps blood through the body using blood vessels to circulate to our systems. Problems along this network can cause severe disability, strokes and death.
Vascular diseases outside the heart can present anywhere. The most common vascular diseases are stroke, peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), carotid artery disease (CAD), arteriovenous malformation (AVM), critical limb-threatening ischemia (CLTI), pulmonary embolism (blood clots), deep vein thrombosis (DVT), chronic venous insufficiency (CVI), and varicose veins.
Evaluation for these states can involve ABI’s ultrasounds, CT scans and angiograms to visualize blockages or clots. Treatment includes proven medications, and can include stenting or surgery.