Frequently Asked Questions

If there is an acute emergency, the best thing to do is immediately contact 911. If you think you may be having a heart attack, also immediately call 911. When the paramedics arrive, or you are seen in the emergency room, you should notify them who your cardiologist is so they can directly notify our physicians.

Yes. We have physicians available 24 hours a day for acute care needs. A physician from our group is also always available to perform an emergency procedure for an acute heart attack. Please let the paramedics or emergency room staff know who your cardiologist is so they can notify the physician on call.

Yes. Physicians are available every weekend and holiday to care for all your inpatient needs. This may not be your primary cardiologist; however, he has informed the on-call physician about your current in-hospital stay, and outpatient records are always available if needed.

Yes. After every visit, a letter is dictated and sent to your primary care physician. We are also in frequent telephone contact with them. Our physicians also work closely with your primary care physician in the hospital setting if you are hospitalized. Your cardiologist can recommend one if you do not have a primary care physician. If you switch primary physicians, please notify our staff so we can arrange to have further evaluations sent correctly.

We offer a complete blood lab in our office. If we cannot accommodate a specific lab test for you, our front office staff will happily arrange it.

If you need a refill of your heart medicines, please contact our medical assistants or log on to your account through the Patient Portal (here). They will then notify your physician, who can authorize refills for you. When you see your physician in the office, bringing your medications with you is always best. Our medical assistants will update your chart and notify the doctor if drugs must be reordered.

No. While we work closely with many primary care physicians in the community, you do not need a referral to have an evaluation with our physicians.

We strive to be as accessible as possible to our patients. In addition to participating in most insurance plans in our area, we offer flexible payment plans and accept MasterCard, Visa, American Express, and Discover.

If you have any questions about our participation in a particular plan or network, call us at 770-962-0399.

If this is the case, please get in touch with our business department. They can often assist you with a payment program tailored to your needs.

Unfortunately, it can be confusing for a patient when experiencing chest pain, especially if it's on the left side. The concern is whether it's related to the heart. While we know the typical description of heart chest pain, it doesn't always conform to textbook explanations. It can feel like indigestion, with burning sensations, not necessarily on the left side but also behind the breastbone or on the right side. Heart pain due to lack of blood supply doesn't usually last for a few seconds; it often occurs during physical exertion.

There are different characteristics and precipitating factors that we, as physicians, ask the patients when trying to determine whether the chest pain is truly due to a lack of blood to the heart. There are multiple other causes of chest pain. Concerning the heart, one can also experience chest pain secondary to inflammation of the outer sac of the heart, called pericarditis. This pain is typically worse when one lies down and better when sitting up. The most common cause is a viral syndrome. Therefore, it is usually preceded by a fever, cold, or flu-like symptoms.

Chest discomfort post-meal or lying down is often from indigestion or heartburn—a burning sensation behind the breastbone that may extend to the jaw. Gallbladder pain, especially after fatty meals, is typically on the right side and may spread to the shoulder blade, often with nausea. Pain below the breastbone or left side of the upper abdomen that eases with eating is likely stomach inflammation or an ulcer. Chest pain worsening with deep breaths or coughing may stem from a lung issue like pleurisy, often caused by a viral infection. Superficial chest wall pain from muscle, bone, or nerve injury can occur. In females, chest pain from the breasts can mimic heart-related pain.

An EKG is a snapshot of the electric patterns in your heart that make it beat. It is a routine test in any cardiac evaluation. You can expect one during an initial assessment and any time symptoms change. It is also used to monitor the effects of certain medications. A medical assistant or nurse in the office administers the test. It allows us to look for irregularities in the electrical rhythm of your heart and gives us clues to structural abnormalities of the heart.

Heart failure occurs when the heart cannot pump efficiently to circulate oxygen-rich blood to different body organs. Simply put, the heart cannot keep up with its workload.

- Shortness of breath

- Easy fatigue

- Coughing, particularly when lying down

- Swelling in the ankles

- Weight gain

- Loss of appetite

- Rapid heartbeat

- Difficulty tolerating exercise

Common causes of heart failure include:

- Heart muscle weakness (Cardiomyopathy)

- Stiffness of the heart

- Valvular abnormalities such as leaky or narrowed valves

- Issues with the heart's electrical system (Arrhythmias)

- Arterial blockages and heart attacks

- Hypertension

- Congenital heart defects

- Infections

- Obesity

- Nutritional deficiencies

Treatment for heart failure varies based on the cause and symptoms. Lifestyle changes can reduce signs, sometimes even reversing heart failure causes. Medications such as ACE inhibitors, beta-blockers, angiotensin receptor blockers, diuretics, and antiarrhythmics are common. Implanting devices like pacemakers, defibrillators, or an artificial heart (LVAD) may be necessary for severe cases. In refractory instances, a heart transplant could be considered for certain patients.

Preventing heart failure hospitalizations involves key steps:

- Adhering to prescribed medications consistently.

- Monitoring weight regularly for any sudden gain exceeding 2 pounds daily.

- Notifying your doctor of increased shortness of breath, lower limb swelling, or notable weight gain.

- Adopting a low-salt diet.

- Manage blood pressure and blood sugar levels and address underlying issues like sleep apnea.

To prevent heart failure, consider these steps: Embrace dietary adjustments such as opting for a low-salt diet. Avoid smoking and alcohol abuse, and prioritize physical activity—address underlying conditions like high blood pressure, diabetes, sleep apnea, and arrhythmias. Manage stress effectively, as it can elevate blood pressure and heighten the risk of heart attacks.

The outlook for individuals with heart failure can vary significantly based on factors such as the cause, risk factor management, lifestyle adjustments, and adherence to prescribed medications. If left untreated or if underlying issues are unaddressed, heart failure can deteriorate over time, potentially leading to a fatal outcome. It is crucial to consult your healthcare provider to explore tailored treatment options.

Various heart diseases can increase the risk of sudden cardiac arrest. A cardiac arrest typically occurs due to an electrical storm in the ventricles, the heart's main pumping chambers. When this occurs, the heart essentially stops beating, and if left uninterrupted, it results in almost immediate death. An implantable defibrillator (or ICD) can protect you.

Implantation closely resembles pacemaker insertion. The ICD is usually placed under the skin via a small incision beneath the collarbone. A lead is then guided through a vein to the heart, making contact with its lining. This lead enables the defibrillator to monitor the heartbeat. Upon detecting any cardiac electrical irregularities, the defibrillator can charge and deliver a shock to reset the heart, akin to having a paramedic ready. The procedure is performed under sedation and local anesthesia. You may be discharged on the same day or require an overnight stay, depending on the circumstances.

After the implantation, you may experience minimal pain and slight swelling at the site. Pain medication will be provided if needed. Expect to wear a sling for a few days, avoid lifting more than 10 pounds, and keep your elbow below shoulder level for 3 weeks. Steer clear of strenuous activities like a full golf swing for several months. Follow-up appointments are typically scheduled in the next couple of weeks, with regular check-ins at our device clinic once or twice a year. Home monitoring can complement these office visits.

Pacemakers are used to prevent a slow heartbeat. A slow heartbeat is caused either by the natural pacemaker of your heart, the sinus node, firing too slowly or because those electrical impulses don't make it reliably from the upper chambers, the atria, the lower chambers, and the ventricles.

A pacemaker is typically implanted beneath the skin through a small incision below the collarbone. Pacemaker leads are then threaded through a vein to the heart, where they touch the heart's lining. These wires allow the pacemaker to sense the heartbeat and stimulate the heart to beat if it is too slow. The procedure is done with sedation and local anesthetic. Depending on the situation, you may be able to go home the same day or may need to stay overnight.

After implantation, the site usually has minimal pain and mild swelling. Pain medication will be provided if needed. A sling is worn for a few days. For three weeks, avoid lifting over 10 lbs. and keep the elbow below shoulder level. Refrain from vigorous activity like a full golf swing for a few months. Follow-up appointments are typically scheduled within a couple of weeks. Pacemakers are usually monitored in our device clinic once or twice a year, with the option of home monitoring for additional checks.

The main pumping chamber of the heart is the left ventricle. However, the effectiveness of that pump is compromised if the sides of the left ventricle don't squeeze simultaneously. This lack of synchronization affects the heart's output and can lead to progressive weakening and enlargement of the heart. When that lack of synchronization is caused by a delay in the electrical signal directing the heartbeat, it can be corrected by a special pacemaker known as a biventricular pacemaker. This is also referred to as cardiac resynchronization therapy. This pacing technique can be applied to both pacemakers and implantable defibrillators.

During either pacemaker or defibrillator implantation, an extra “third wire,” also known as a left ventricular lead, is placed. This is threaded to the heart the same way as other pacemaker or defibrillator leads, except it is then further threaded from the right atrium into another vein that leads to the surface of the left ventricle. Getting that third wire in place is trickier but achievable in about 95% of cases. Otherwise, the rest of the procedures are the same as a standard pacemaker or defibrillator implantation. Please see the descriptions of those procedures.

Please see the details for the defibrillator or pacemaker implantation. However, unique to biventricular pacing, the left ventricular lead passes very close to a nerve that runs along the surface of the heart from the spine down to the diaphragm. This is called the phrenic nerve. If the left ventricular leave stimulates it, it can cause a twitch of the left side of the diaphragm with every heartbeat. This is not dangerous but can be quite aggravating. It can usually be corrected by reprogramming the pacemaker or defibrillator in the office. We frequently watch people overnight because of the potential for phrenic nerve stimulation.

Heart disease is the primary cause of death in the United States, accounting for 1 in 4 female deaths. The number of women and men succumbing to heart disease each year is equal. Surprisingly, two-thirds of women who passed away suddenly from heart disease had no prior symptoms. Approximately 6% of white women, 8% of African-American women, and 6% of Mexican American women are affected by coronary artery disease.

More women present with atypical symptoms than men, and some women have no symptoms of heart disease. Common Heart attack symptoms in women can be pressure in the chest, shortness of breath, jaw pain, throat pain, and pain in the upper abdomen or back. Pain can be sharp, dull, burning, or indigestion-like. These episodes can occur during rest or physical activity or can be triggered by mental stress.

Hypertension. High cholesterol. Smoking. Diabetes. Excessive alcohol use. Physical inactivity. Overweight and obesity. Poor diet.

Women usually develop heart disease a decade later than men. Microvascular disease, impacting the heart's small arteries, is more common in women. Mitral valve prolapse is also more frequent in women. Additionally, women are more prone to conditions like broken heart syndrome, where extreme stress can cause heart muscle failure and palpitations. By modifying risk factors, changing lifestyles, using medical treatments, and considering surgeries, women can decrease heart disease mortality risk and improve symptoms like men. Early prevention, accurate diagnosis, and timely treatment are crucial for better survival rates.

Yes. All our physicians have staff privileges at the Gwinnett Medical Center. Depending on your diagnosis, you may see one of the other partners in conjunction with your primary cardiologist.

We recommend letting the physician at this facility know who your primary cardiologist is. That physician will then notify us regarding your current illness. If necessary, can we arrange to transfer you to continue your care?

If an urgent need does not require evaluation in a hospital setting, we can often make accommodations for you. Please call our front office so we can assist you with an appointment. You will then be seen by either our physician assistant or the physician available that day in our office. However, if you think there is an emergency, it is best to call 911, and our staff will see you urgently in the emergency room

Cardiac catheterization diagnoses and treats cardiovascular conditions. A thin tube is inserted into the patient’s artery in the groin, neck, or arm, passing through blood vessels to the heart. This procedure helps assess heart and blood vessel health, diagnosing issues like chest pain, abnormal stress tests, heart valve conditions, high blood pressure, lung blood clots, and an enlarged heart.

Your doctor could order a cardiac catheterization for several reasons.

 

1) To determine whether there are blockages in the arteries that feed the heart

2) To measure the pressures in the heart and the lungs

3) To measure pressure differences across the valves of the heart

The procedure is performed in a hospital setting, and while it only takes about 30-60 minutes, the preparation and recovery time can take several additional hours. Sometimes, the patient may have to spend the night in the hospital before or after the procedure. After cardiac catheterization, the doctor should have an informed idea of what is causing the problem and will be able to determine the best treatment plan for the patient. Full recovery time is usually a week or less, depending on where the catheter was inserted; the patient must keep the insertion area clean during recovery.

The procedure is performed with conscious sedation. This means that you will get medications to help relax you and to help with pain. In addition, a local anesthetic will be administered to the area of access, either the groin or the wrist. Many people don't remember much of the procedure afterward because of the sedation that is administered.

The risk of complications for patients undergoing cardiac catheterization electively is low. The most common complications include bleeding or discomfort at the site of access, either in the groin or the wrist. Rarely do these bleeding complications require a blood transfusion or surgery to fix the artery. Less common, though more dangerous, complications can occur, including stroke, heart attack, or even death. You should talk to your doctor about these risks.

Most procedures are done to determine whether there are significant blockages in the arteries that feed your heart. If your doctor finds a severe bottleneck, he or she may open that blockage with a balloon and stent, a small metal tube inserted to keep the artery open. If your doctor finds several severe blockages, he or she may suggest you have coronary bypass surgery.

After a cardiac catheterization, most patients spend a couple of hours in the recovery unit. If the procedure involved the large artery in the groin, a device or stitch may have been inserted to seal the hole, requiring the patient to lay flat for a couple of hours. If a tube were pulled from the groin, the patient would need to lay flat for around 4 hours post-procedure. Avoid driving or lifting heavy objects for a few days afterward. A band is used to apply pressure on the artery for procedures via the small wrist artery. Discomfort at the access site and some bruising may occur in the days following the process. Notify your doctor if a lump forms or if there is significant bleeding, in which case immediate medical attention is necessary.

A stress test, also known as an exercise stress test, is a diagnostic tool to evaluate how well your heart functions during physical activity. Nuclear stress tests, a type of stress test, are specifically ordered to identify blocked arteries in the heart by assessing blood flow to the heart muscle. This non-invasive procedure involves injecting a small amount of radioactive substance to help create detailed images of the heart's blood flow.

You need to arrive fasting and wearing comfortable clothes. Part of the heart is behind the stomach, so food in the stomach will result in poor images and possibly inaccurate results. You should avoid any liquids except a minimal amount of water.

You should continue taking your regular medications on the day of the test. There are two exceptions to this rule:

If you are fasting, please refrain from taking your diabetic medications. However, ensure you bring them with you to the test as there will be a designated time for you to consume food, and you will require the diabetic medication then.
For a treadmill stress test to yield accurate results, we must elevate your heart rate. Therefore, you are advised to omit your beta-blocker medication (such as metoprolol, atenolol, coreg) the evening before and the morning of the test.

In a stress test, the doctor compares symptoms, your ECG, and images of your heart at rest and after exercising. The heart can be exercised via a treadmill or, if unable to use a treadmill, use chemicals to simulate exercise. You should expect to be present for 2-3 hours. You will need to lay flat, preferably with your arms above your head, for a set of resting images and a second set of images after stress.

Within a day or 2 after completing the test, you should be contacted with your results. If you are not, please call for your results.

An EKG is a snapshot of the electric patterns in your heart that make it beat. It is a routine test in any cardiac evaluation. You can expect one during an initial evaluation and any time symptoms change. It is also used to monitor the effects of certain medications. A medical assistant or nurse in the office administers the test. It allows us to look for irregularities in the electrical rhythm of your heart and gives us clues to structural abnormalities of the heart.

We perform several types of stress tests. Some involve getting on a treadmill, while others injecting medicine into a vein. We examine your heart using techniques, including ECGs, ultrasounds, or nuclear images during the stress test.

Different types of stress tests last different amounts of time and can vary from 30 minutes to over 3 hours.

Please wear comfortable clothes and shoes that you are able to walk and run in.

In adult cardiology, structural heart disease usually pertains to disorders of the valves of the heart or to holes in the heart that should have closed either during gestation or shortly after birth.

The most common forms of structural heart disease seen in adults in the United States are disorders of the aortic and mitral valves. Less commonly treated structural heart disorders include patent foramen ovale is and atrial septal defects.

The aortic valve is between the heart's pumping chamber and the aorta, the main blood vessel that brings blood to the entire body. Its function keep blood from flowing back into the heart as the heart's pumping chamber relaxes.

The most common aortic valve disorder is aortic stenosis, in which the leaflets of the aortic valve become calcified over time and don't allow the valve to open appropriately. Less common, though just as important, is aortic regurgitation, in which the valve is leaky and allows blood to flow backward from the aorta back into the heart.

The most common symptoms of aortic stenosis are chest pain with exertion, shortness of breath with exertion, dizziness or passing out, particularly during or immediately after exertion, and fatigue.

Aortic stenosis is usually diagnosed because the patient has symptoms, as noted above, or because your doctor hears a heart murmur. In these cases, your cardiologist will likely order an echocardiogram or an ultrasound of the heart.

No known medications slow the progression of aortic stenosis. If you have mild aortic stenosis, your cardiologist will monitor it with regular heart ultrasounds. Once symptoms appear or are severe on ultrasound, treatments include aortic valve surgery or transcatheter aortic valve replacement.

Because transcatheter aortic valve replacement is a relatively new technique, and because the very long-term outcomes of this form of valve replacement are somewhat unknown, surgical aortic valve replacement remains the standard of care for patients at low risk for surgery based on things like age and other medical conditions the patient might have. Patients at intermediate or high risk for surgery are candidates for transcatheter aortic valve replacement.

Because transcatheter aortic valve replacement is a new technique, a cardiac surgeon is always present during valve placement. In most centers, the procedure is performed by one interventional cardiologist and one cardiac surgeon.

Talk to your treating cardiologist and cardiac surgeon about whether you are a candidate for transcatheter aortic valve replacement. Currently, patients who are at low risk for surgery should undergo surgical aortic valve replacement. However, clinical trials are ongoing to evaluate whether low-risk patients should be offered transcatheter aortic valve replacement.

The mitral valve is the valve located between the pumping chamber of the heart and the left atrium, which is the chamber of the heart that collects blood from the lungs and holds it until the pumping chamber is ready to accept it. The mitral valve is important because it keeps blood from being forced back into the lungs when the heart's pumping chamber pumps.

The most common mitral valve disorder in the United States is mitral regurgitation, in which the valve is leaky and allows blood to flow backward into the lungs when the main pumping chamber pumps. Mitral stenosis, where the valve is narrowed, is becoming increasingly rare.

Most people with severe mitral regurgitation complain of shortness of breath, palpitations, or a fluttering feeling in the chest due to an arrhythmia or fatigue.

Mitral regurgitation is often diagnosed because of the symptoms noted above or because your doctor hears a heart murmur. Your cardiologist will likely order an ultrasound of the heart cold and echocardiogram, which can definitively diagnose mitral regurgitation.

Medication doesn't slow mitral regurgitation down. Your cardiologist will monitor it with echocardiograms to see if it's mild or moderate. For severe cases, open heart surgery may be necessary. Repairing the valve is common, but sometimes, it needs replacement. Discuss options with your surgeon, including minimally invasive techniques. A non-surgical alternative is MitraClip, a procedure for those unsuitable for surgery. It involves placing a clip in the valve through a vein in the groin.

A PFO is present in everyone at the time of birth. When you are a fetus, there is no need for blood to be sent to the lungs because you get all your oxygen from your mother's blood. A flap between two heart chambers allows blood to be diverted as it returns to the heart to be sent back to the body. At the time of birth, the pressures in the heart change rapidly, and this flap normally closes and scars over. In about 20% of people, however, the flap remains open. This is called a patent foramen ovale.

PFOs are not dangerous in most people and are usually detected when someone undergoes a heart ultrasound for another reason. However, in a very small subset of people with a PFO, a blood clot that forms in the leg can cross over this flap and cause a stroke. Closure of the PFO is currently recommended in people for whom a stroke is thought to have occurred because of a PFO.

Nearly everyone with a PFO is asymptomatic. As noted above, a small subset of people with PFO can develop strokes.

PFO closure should only really be performed in people who have a stroke thought to be related to the PFO in whom an extensive search for other causes of stroke has not revealed any other potential source of the stroke.

PFO closure is performed in the hospital. The devices are implanted via the large vein in the groin, and an ultrasound camera in the other large vein in the groin provides guidance. Most people go home the same day, and the procedure is usually very well tolerated. It is done under sedation. Patients will need to be on aspirin and a second blood thinner for at least a month and then on aspirin indefinitely.

As opposed to PFOs, ASDs are quite rare. They are never normal and occur due to problems with the development of the heart, in which the wall between the atria does not fully form.

Most people with ASD are asymptomatic until later in life. Sometimes, patients will develop shortness of breath.

ASDs are usually seen by echocardiogram. If you are diagnosed with ASD, your cardiologist will most likely order a transesophageal echocardiogram. This is done in the hospital under sedation and gives a much better view of the ASD and the wall between the atria.

Not every ASD needs to be closed. If the ASD is quite small, most people can be followed with routine echocardiograms to evaluate for worsening heart problems. If blood flow through the ASD appears to be affecting the right side of the heart, patients should have their ASD closed.

ASD closure is performed either through severe open-heart surgery or through the large vein in the groin. Many patients can be treated without having open heart surgery, but the approach depends largely on the shape and size of the ASD as well as its location in the wall between the atria. You should talk to your cardiologist about whether surgery or procedure suits you.

A catheter ablation, also known as cardiac ablation, is a procedure used to treat cardiac arrhythmias such as atrial fibrillation, atrial flutter, and Wolff-Parkinson-White syndrome. It is performed by guiding a thin tube to the heart that uses energy to create tiny scars in the heart. This is done to block abnormal electrical signals and restore a normal heart rhythm. The procedure can take two to four hours, and the patient is given medication to relax. Whether or not the patient is conscious during the process depends on the individual case.

Like any procedure, catheter ablation can have risks. However, they are extremely rare. Medical professionals perform catheter ablation in a hospital setting, and the patient is heavily supervised the entire time; the patient's safety is a top priority. Cardiac ablations target only abnormal heart tissue. There is no significant impact on heart function.

Rapid electrical impulses from the pulmonary veins usually trigger atrial fibrillation or AFib. These are veins coming from the lungs that drain into the left atrium. Heart muscle-type cells in those veins with different properties than the rest of the heart allow such rapid electrical activity. When we ablate atrial fibrillation, we either burn or freeze around the openings of those pulmonary veins to make a firewall that keeps those impulses from irritating the heart. In many situations, that is all that is required. However, ablation may be needed in more advanced atrial fibrillation in other areas.

AFib ablation is usually done with general anesthesia. Simple pulmonary vein isolation typically takes about two hours but can take significantly longer if additional ablation is required.

In general, you can expect an 85% reduction in atrial fibrillation. This may be a complete elimination or just a drop in atrial fibrillation. Recurrences can be due to triggers from outside the pulmonary veins or to reconnection of the pulmonary vein muscle fibers to the left atrium. Depending on the severity of the recurrence, a repeat ablation procedure may be required.

Major complications are rare but can be serious. The most concerning are stroke, atrial esophageal fistula, and death. Blood clots usually cause strokes in the heart, and therefore, we prescribe anticoagulants around the time of ablation. A risk peculiar to atrial fibrillation ablation is damage to the esophagus, which passes directly behind the left atrium. In rare cases, a hole can form between the atrium and the esophagus, which can be lethal. We, therefore, monitor the esophageal temperature during ablation and prescribe acid blockers afterward to protect the esophagus.

Plan to stay overnight. You'll rest for three hours after the ablation. You can move around afterward but avoid heavy exertion for a week. Ablation aims to prevent atrial fibrillation, yet it may irritate, leading to irregular heartbeat. Depending on risk assessment, we may prescribe an antiarrhythmic drug. Expect mild chest discomfort for 2-3 days, managed with anti-inflammatory meds. Antacid therapy is provided for a month to protect the esophagus. Bruising at the puncture sites is common, usually local, but can extend down to the knee occasionally. Progressive pain or swelling at the sites may indicate continued bleeding. Immediate attention is needed for late-onset chest pain or pain on swallowing to prevent atrial esophageal fistula.