All About Telehealth for Atrial Fibrillation Telehealth allows doctors to care for people virtually over a phone call, text message, or most commonly, video chat. Although some situations require an in-person visit, telehealth is a great option when you can't get to the doctor's office for your atrial fibrillation (afib). If you're new to telehealth, here's what you need to know. Medicare will cover telehealth visits just like in-person visits, but state Medicaid programs and private insurers vary, so confirm your coverage in advance. With telehealth, even though you're not in the doctor's office, your private health information is still covered by HIPAA, so it will remain confidential and secure. Although your cardiologist can't give you a physical exam via telehealth, they can write prescriptions and offer quality care, especially if you prepare in advance. Before your telehealth appointment:- List any afib symptoms (including dates and severity), like palpitations, fatigue, dizziness, shortness of breath, or chest pain - Note any side effects from your afib medications or treatments, such as nausea, dizziness, or fatigue - Some blood thinners can cause dangerous bleeding, so your doctor may order regular blood tests if you take it - Keep a food diary, and document any new stresses in your life - Compile a list of your health conditions and all medications - Gather any recent lab results - Record your vital signs if you own a heart rate monitor, blood pressure monitor, pulse oximeter, or another device - Write down any questions you have for your cardiologist - Charge your computer or phone - Make sure your internet is reliable - Download any telehealth apps your specific provider may require - Find a quiet, private space to conduct the call - Be prepared with pen and paper or a note-taking app Turn to Healthgrades to connect with the right cardiologist to treat atrial fibrillation via telehealth. And share this video to spread the word!

Coronary artery disease is when cholesterol plaque builds up within the arteries. Cholesterol plays a role in coronary artery disease in that it collects in the arterial walls. This can result in a narrowing of the artery over time, or it can also result in a plaque rupturing into the artery, which causes a heart attack. There is a connection between coronary artery disease and diabetes. Patients with diabetes are more susceptible to developing the cholesterol plaque inside your arteries. And when they do develop these plaques inside of the arteries, they tend to develop in a very diffuse nature, affecting many of the blood vessels supplying blood flow to the heart. There are several signs and symptoms of coronary artery disease. One, this can cause a stiffening of the arteries. It can cause angina, or cardiac chest pain, or it can result in a heart attack, or weakening of the heart muscle over time. At times, it's associated with discomfort radiating to the neck, jaw, arm, or to the back, oftentimes associated with sweating, perhaps nausea. There's several contributing factors that lead to the development of coronary artery disease. Risk factors include the presence of diabetes, hypertension, high cholesterol, whether you smoke or not, how active a lifestyle you lead, and your family history. If someone's having symptoms of coronary artery disease or angina, those symptoms can be treated with beta blockers, nitrates, or other medications that dilate the blood vessels to the heart. If patients continue to have symptoms despite being on adequate medical therapy, that's when we consider revascularization. The message for hope for patients with coronary artery disease is that we currently have many treatments available that decrease your risk of having a heart attack or stroke and extend your life. My name is David Halpin and I'm an interventional cardiologist.

In the normal heart, the heart is composed of four different chambers, two bottom ones that are the ventricles and two top ones that are the atria. With normal rhythm at resting state, people have a heart rate of about 60 to 100 beats per minute, which starts in the right, in the top right chamber, which is the right atrium. And then it goes down to the bottom. With atrial fibrillation, there's a problem that actually overtakes that normal rate and instead of going at 60 to 100 beats per minute in the top chambers, it goes to 300 and 350 and 400 beats per minute. There is more than one way that afib negatively affects the heart. First of all, you lose your normal atrial function. And that is, that adds about maybe 15, 20% of your heart efficiency or the pumping efficiency of the heart. And then the second thing is with a heart rate that is fast, you could actually affect the function in the bottom part of the heart. Ejection fraction is what we call it, which is the amount of blood that the heart pumps each beat. It goes from a normal of about 65 or 70% down to maybe 40, 30, 20% sometimes. It actually causes heart failure. On the very basic level to get afib, your heart probably has some abnormality. Most of the time that involves some scarring in the heart. An enlarged left atrium for any reason could cause afib so things like high blood pressure that's not treated, valvular heart disease, heart valves that are diseased, that are not treated. Things like thyroid disease, lung disease could cause afib. Some medications if they're taken in excess or if they're not monitored well can cause afib. A lot of things can cause afib. Atrial fibrillation, unfortunately is like I said, a burdensome disease that at this point is a chronic condition and it's not curable. However, even though we can't say that we can cure it today, we can absolutely manage it. It is a very manageable disease and with a good relationship with your cardiologist, as well as a good healthy lifestyle as far as your diet, your exercise regimen, weight management and treatment of other conditions that could actually be contributing to afib like diabetes, high blood pressure, obstructive sleep apnea, then you can live a very normal life. My name is Layth Saleh and I'm a cardiac electrophysiologist.

Pulmonary embolism is a blockage in the pulmonary artery, which is most commonly caused by a blood clot. Pulmonary embolism can be really fatal. In different reports, the fatality is reported to be different, anywhere between 5% to 30%. Pulmonary artery is a big vessel that connects the right side of the heart to the lungs. Pulmonary embolism obviously directly can affect the lung. It will cause blockage in the pulmonary artery, which is providing blood flow to the lungs. That section of the lung that doesn't see the blood flow will eventually die. Symptoms can vary. The most common symptom of a pulmonary emboli is shortness of breath. They might also have chest pain. Chest pain can be sharp, stabbing pain. There are also--a variety of different cardiac symptoms are common. Most common ones are tachycardia, which means the patients are feeling their hearts beating fast. In more severe cases, we see patients coming in with shock and, unfortunately, sudden cardiac arrest. If someone is exhibiting these symptoms, the best thing to do is to go to the emergency room. There are different factors that raise the risk for having pulmonary embolism. These are including: advanced age--Anyone over the age of 65 is going to be at more risk; Obesity; If you have clotting issues in the family or if you have clotting issues in the past, that will put you at more risk. Recent surgery is another risk factor; smoking; if you are inactive or nonmobile for a period of time. Treatment options vary. The majority of the time, we use blood thinners as a first step. In more severe cases, we use very strong clot busters called thrombolytics. Also, we have interventions that we do that we actually go with catheters, we go after the clot, and we can basically mechanically extract the clot. In some also rare cases, they'll need surgery to remove the clot. The good news is that with timely and effective treatment, we expect patients to have a full recovery and really go back to their normal life in a few months. I'm Nima Aghili. I'm an interventional cardiologist.

Coronary Artery Disease 101 Coronary artery disease (CAD) affects 16.5 million Americans. If you're one of them, here's what you need to know. Your coronary arteries are vessels that send blood to your heart muscle so it can pump it to the rest of your body. CAD develops when cholesterol and fatty deposits called plaques build up, blocking and narrowing your coronary arteries. As a result, your heart doesn't get enough blood and nutrients it needs. You might feel shortness of breath and chest pain called angina. If blood flow is completely blocked, or your heart muscle weakens, this can cause a heart attack. Lower your risk of CAD by:- Exercising regularly- Eating less fat and salt- Managing stress levels Medications for CAD include blood thinners, cholesterol drugs, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs. In severe cases, you may need a stent to keep your artery open, or a bypass that allows blood to flow around blocked arteries. If you're concerned about your heart health, turn to Healthgrades to connect with the right cardiologist for diagnosis and treatment of coronary artery disease. And share this video to help spread the word!

Pulmonary Embolism 101 Your pulmonary artery carries blood from your heart to your lung tissue. Sometimes, a blood clot forms in the veins of the leg or arm and travels up through the pulmonary artery to your lungs. If the blood clot blocks the pulmonary artery, it's called a pulmonary embolism (PE). This makes it harder for your lungs to send oxygen to the rest of your body. If untreated, PE can be life-threatening. PE symptoms include:- Sudden shortness of breath- Pain in the chest, neck, jaw, arm, or shoulder- Coughing up blood- Lightheadedness and dizziness- Sweating and fever- Leg pain or swelling- Blue-ish, clammy skin Certain factors can raise your risk of PE, like:- Some cancers and chemotherapy- Being sedentary for too long- Recent surgery- Heart disease- Taking estrogen supplements- Being overweight- Pregnancy- Smoking Sitting in one position, like on a long plane ride, can increase your risk of PE because blood flow in your legs slows down and can pool, leading to blood clots. If you're diagnosed with PE, your doctor may prescribe a blood thinner (anticoagulant), or in more severe cases, a clot dissolver (thrombolytic) or even surgery. Lifestyle changes can help prevent PE, like:- Compression stockings to prevent blood pooling- Taking a blood thinner per doctor's instructions- Regular exercise- Quitting smoking Turn to Healthgrades to connect with the right pulmonologist for diagnosis and treatment of pulmonary embolism. And share this video to help spread the word!

5 Things You Didn't Know About Atrial Fibrillation 1. Atrial fibrillation (afib) begins in the upper chambers of the heart (the atria) and involves a rapid, irregular heartbeat, also known as fibrillation. 2. Afib often causes symptoms like weakness, chest pain, fatigue, shortness of breath, and heart palpitations, although some people experience no symptoms at all. 3. In some cases, afib goes away on its own, or comes and goes over time, but many people require treatment to prevent serious complications. 4. People with untreated afib are five times more likely to have a stroke. 5. Treating afib can greatly reduce your risk of heart disease-related death and stroke. Turn to Healthgrades to connect with the right cardiologist for diagnosis and treatment of atrial fibrillation. And share this video to help spread the word!

Dr. Lee Marcus: How did you know you were having a heart attack? Beth: I didn't. Beth: I was at work. I was nauseous, dizzy, and my pain was majority in my back. Juan: I felt a sharp pain in my chest. I broke out into a sweat. Peter: I felt like I was going to pass out. Some pain kind of radiating up through my neck. Kevin: I was out on a bike ride. I started having severe chest pain. Spread to my shoulder, my left arm, my left jaw. Sharon: I had lower back pain and I equated it to being back spasms. Juan: Then the EMT arrived. And they were like, "You know, mister, I don't think this is a heart attack." Well, if it's not a heart attack, then I'll wait it out. The next morning, the burning is still very intense in my heart. Kevin: So I drove myself to the emergency room. And when you walk into the emergency room and you say chest pains and shortness of breath, you go to the front of the line. Juan: The nurse behind the desk was like, "Are you crazy? You're lucky you're alive." Kevin: They run all the tests, EKG. They draw blood. They said, "You're not going home today. You're actually having a heart attack now." Sharon: It completely blew my mind. I couldn't understand how I had a heart attack. A person who goes to the gym and that eats healthy. Kevin: 90 minutes after I left the house that morning, I'm in the cardiac catheter lab with my hero, my cardiologist, who did find a torn artery. Peter: One of my major arteries was blocked, so I needed a stent. Kevin: There was a lot of mental wrestling with what exactly was going on. Did my body betray me? How do I deal with this? Juan: You need to realize that your body may feel strong, like your arms and legs, but your heart took a major hit. Beth: I did cardiac rehab for six months, and it was the best exercise and informative program that I've ever done in my life and I learned so much from it. Dr. Lee Marcus: The value of cardiac rehab is equivalent to the effect of medications, lowering risk 25 to 30% of having a second heart attack. Beth: That's what I've heard. Kevin: When you go to cardiac rehab, they have classes, and they're teaching you proper nutrition, exercise. They're trying to get you to change all these behaviors that may have led to your heart attack. Peter: That was really the beginning of a change in my lifestyle. I exercise. I watch my diet. I take my medicine, my medications diligently. Sharon: Knowing what I can and cannot do is extremely important. Juan: It gave me a sense of where the limit is. When I would work out on my own, I had a sense of when I was pushing too much. Peter: I started to feel much better, stronger. I don't feel any fear. Sharon: Because I know the signs of a heart attack, I can act quicker. Juan: And I'm not wasting time. In a weird way, this heart attack has been like a new beginning for me. Kevin: We can't really change what just happened. What we can do is learn from it and adapt and move forward.

Dr. Williams: What other factors have changed in your life since your heart attack? Mariana: My diet. But I still have a little ways to go. Dr. Williams: Dietary management is all about balance. Something that encompasses whole grains, lean protein, vegetables, but definitely no saturated fats and the sugars. Mike: A lot of the food I am eating is better. The number of calories I eat over the course of the day is slightly less, but it's better quality food. Dr. Jones: People are becoming a lot more aware of fat. They're like, "Oh, fat. We don't want fat." But there are good fats and bad fats. You get cholesterol in your body mostly from saturated fat in food, and saturated fat only comes really from animals. So mostly from beef, and in our country, dairy or cheese. The good fats, which are the poly and the monounsaturates, those come essentially from vegetables. Dr. Williams: You have to be a student of the labels. Anytime you buy foods, I would recommend that you look on the back- Mariana: And see the saturated fat. Dr. Williams: ... and you read not only just the saturated fat, but all the components. Mariana: Right. Dr. Williams: That's how you can educate yourself, and that's how you can make sure that you're eating the foods that you need to eat. Dr. Jones: What are you doing as far as non-medical things? Do you exercise? Rina: Exercise, yeah. Dr. Jones: How much are you doing? Rina: I've gone back to yoga, slowly. I actually try to go a couple of times a week to yoga, and that's all the exercise that I do. Dr. Jones: People just limit their activity and don't realize it. Rina: I mean, I could walk up and down the stairs in my house. Dr. Jones: You could. Dr. Williams: Are you still doing intervals? Mariana: You know, I'm still running, but I don't push myself the way I used to. Dr. Williams: Have you had a discussion with your cardiologist about what your limits are? Mariana: When I see my heart rate go to 120, that's about all I ... then I start to slow down. Dr. Jones: Listen to your body. That's always my first thing. I'm not a real fan of very high intensity. I'm much more about consistent, steady exercise. I would rather have you go for a power walk every day for 30 minutes, than do a crazy intensity workout once a week. Rina: Right. Dr. Jones: But for the cardiac effect, I think you do need to raise that heart rate a little bit.

New Speaker: Has your doctor gone over with you the types of medications you're taking and the importance of these medications? Mariana: Yes. New Speaker: I'm sure you're on a beta blocker. Mariana: Yes. Dr. Williams: Okay, and probably an ACE inhibitor medication. Mariana: Yes. Dr. Williams: Mm-hmm, now these are two medications that are blood pressure medications. However, in the instance of a patient who's had a heart attack, their role is not necessarily to control blood pressure. Mariana: Right. I get that. They do other things. Dr. Williams: Mm-hmm. Mike: The meds, it hasn't been overly intrusive. It's really one or two additional medications. Dr. Jones: One of the big things when people have heart attacks is actually, it's not just a plaque buildup, but it's a blood clot and so being on an anti-platelet agent is really important because the platelets get sticky and stick together. In addition, you didn't get them, but if people have stents placed in the arteries with a heart attack, they are then on two anti-platelet agents for at least six months and even a year in order to keep the stent from forming clots also. Dr. Jones: Did you know your cholesterol was high? Rina: I did. Dr. Jones: So that was probably- Rina: Not horribly high and my ratio was good. Dr. Jones: Yeah. This is a lifelong process for you, as you see. Rina: Yeah. Dr. Jones: I'm going to assume, I shouldn't assume, but let me assume you are on something to lower your cholesterol. Rina: True. Dr. Jones: A statin. Rina: True. Dr. Jones: One of the statin medicines. Rina: Mm-hmm. Dr. Jones: Do you know your cholesterol numbers? Rina: I don't. Dr. Jones: Okay, you should. We should know just to know. Rina: Well they're low thanks to taking the statin. Dr. Jones: Good. Dr. Williams: I'm certain one of those medications is aspirin. Mariana: Yes. Yes, baby aspirin. Dr. Williams: Okay. Mariana: Absolutely. Dr. Williams: So baby aspirin is essential in patients who have had heart attacks to continue. Mariana: Right. Dr. Williams: What it does is prevent clotting inside the arteries of the heart. Mariana: Which is what the blood thinners do too, right? Dr. Williams: That is correct. There's other types of blood thinning medications. Works in a similar manner on similar cells within the blood as aspirin, but a different mechanism, but the two of them together work in conjunction to reduce your risk of having a second heart attack.

Dr. Marcus: Essentially, heart failure is when the heart is unable to pump enough blood to meet the needs of the body. Dr. Grayver: The heart really is nothing but a pump. It's supposed to pump in one direction, and in one direction only. Dr. Green: When the heart isn't pumping efficiently, the body adjusts and tries to compensate. The main way that the body adjusts is to accumulate fluid. Dr. Grayver: It starts to back up. It goes into the lungs, it goes into the liver. Beth Warren: That means their body is holding on to a lot of fluid. Dr. Marcus: The main causes of heart failure are related to coronary artery disease or heart attacks. Dr. Green: Long-standing high blood pressure. Dr. Grayver: Congenital heart disease. Dr. Marcus: People can get heart failure after pregnancies. Dr. Green: There are a variety of medicines and lifestyle modifications that patients can make to improve their quality of life and long -term prognosis, their length of life, with heart failure. Beth Warren: I look to make things practical and simple. Small changes carry over in the long run a lot more effectively than these huge changes. Dorothy H.: Stress management is key. The meditation, prayer, exercise ... That absolutely is a game changer. Beth Warren: Be physically active, but with their doctor's guidance. Dr. Green: Good healthy muscles can accommodate a little bit better and make the overall body healthy. Dr. Marcus: Heart failure patients also should be on a low-sodium diet. Beth Warren: We could eat foods that damage the heart, and you could eat foods that improve the heart. Dr. Grayver: We start off by a water medication. Dr. Green: Usually with diuretics so patients urinate that extra fluid out. Dr. Grayver: And then there's a slew of drug classes. There's a beta blocker, there's an ACE inhibitor, there's an ARB inhibitor. And when the drugs do not work, that's when we have to go through more of a mechanical support for those patients. Dr. Marcus: We've found out that putting something called a pacemaker defibrillator in people can improve mortality up to 50%. Don't let yourself get down and depressed about the diagnosis. There are so many treatment options. Dorothy H.: Your body is miracle machine. If you give it the least amount of help, it will find the resources to heal your disease. Dr. Marcus: Cardiologists that treat heart failure really are "never-say-die" cardiologists. We never like to give up. Dr. Green: It represents a transition to a new outlook on life, but this does not mean that their life is coming to an end by any stretch of the imagination.