What is a heart attack?   A heart attack occurs when plaque and blood clots block an artery and stop blood flow to areas of the heart muscle. The heart muscle then becomes deprived of oxygen. This can cause permanent damage to the muscle.

What are the symptoms of a heart attack?  

• Uncomfortable pressure, squeezing or pain in the center of the chest lasting more than two minutes.
• Pain spreading from the chest down the left arm or into the left side of the neck.
• Heavy sweating, shortness of breath and fatigue, sometimes accompanied by fainting, lightheadedness or nausea

You should also be alert if the following occur individually or together with or without chest pain:

• Indigestion. Bloated or full feeling, sometimes accompanied by a dull ache, a burning sensation or a feeling of nausea. Though sometimes difficult to distinguish from normal digestion, be careful. Feelings of indigestion may indicate a particular form of a heart attack occurring on the back wall of the heart because of blockage in the right coronary artery.
• Pain in the lower jaw.
• Pain in the arm or shoulder. It may be difficult to pinpoint a place where the pain is localized.
• Shortness of breath. Gulping for breath after only routine exertion, which does not subside with rest and resumes with minor activity.
• Tired feeling. Like fatigue, the feeling sweeps over the entire body.

Are all types of heart disease hereditary?   No. Some forms of heart problems are congenital, which means you were born with it. Other heart problems are a result of viral infections, toxic medications or alcohol related. Frequently though, heart problems can have a base in family history that may predispose an individual to developing heart disease. There are also lifestyle factors such as smoking, cocaine use and an unhealthy diet that can increase the risk of heart disease.

Does high blood pressure mean I will have a heart attack or a stroke?   High blood pressure (or hypertension), increases your risk for developing heart disease and experiencing a heart attack as well as increasing your risk of stroke. This is why treatment for hypertension by a medical professional is important. Maintaining control of your blood pressure through diet, regular exercise and a reduced stress level are key to keeping blood pressure at a healthy level.

I have a pacemaker that was implanted by another doctor. How do I switch my device follow-up to Sanger?   Contact the Pacemaker Clinic at 704-444-4150 to arrange an appointment with a Sanger Clinic cardiologist. Bring your ICD, Pacemaker or ILR card to the first visit.

I had a heart catheter. When can I go back to my usual activities, i.e. golf, swimming, walking with no restrictions?   If it was a diagnostic heart catheter and no intervention was done, you may return to your normal activities without restrictions after three days.

I had a heart catheter and a stent was placed. When can I go back to my usual activities with no restrictions?   You may go back to your normal routine after one week.

I had a heart attack. When may I go back to my usual routine without restrictions?   Your individual cardiologist will determine the answer. It is important to check before resuming activities. In most cases you may return to normal activities with no restrictions after completing a monitored rehabilitation program in about four to six weeks.

I had a stent placed in my heart. Do I need an antibiotic before I go to the dentist?   No. You do not need antibiotics for coronary stent implants, coronary artery bypass grafts or heart attacks. Your cardiologist may ask you to wait for dental cleaning and procedures for one month if you have had a heart attack.

I had a stent placed in my heart. Can I have an MRI?   Yes, you may have any kind of MRI ordered after eight weeks from implant date.

I have a pacemaker or ICD. Can I have an MRI?   No.

Are you in network?   Click here for the list of accepted insurance policies.

What is a D.O degree?   There are two types of complete physicians in the United States. A Doctor of Osteopathy is a complete physician licensed to perform surgery and prescribe medicine in all 50 states. The main difference is that osteopathic medical schools emphasize training students to be primary care physicians with a focus on preventive healthcare. D.O.s receive extra training in the musculoskeletal system, providing an understanding of the ways that an injury or illness in one part of the body can affect another.
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How should I prepare for my visit?   Please plan to arrive 15 minutes before your appointment time. This allows time for parking, obtaining wheelchair assistance if needed, and updating your records at our front desk. You should bring a current medication list with you to every visit.

If this is the first time you are being seen in our Pacemaker Department and a physician other than Sanger Clinic implanted your device, you should bring your device identification card. You should also arrange for your medical records to be sent to Sanger by the cardiologist who has been following your device. Device records may be faxed to 704-374-1367, Attention: Pacemaker Nurse

How long will my visits last?   It usually takes between 20-40 minutes to check a pacemaker, ICD or ILR. Please allow extra time for your visit if you are experiencing any problems or you have received therapy from your ICD. If you are being seen for a check of your incision, please allow between 15-30 minutes.

Do I need to bring my pacemaker telephone transmitter for my office visit?   No, this equipment is used for transtelephonic follow-up.

Will I see a physician during my visit?   It is not necessary to see a physician at every device follow-up visit. Unless you have a pre-arranged appointment with your physician, you will see the pacemaker/ICD nurse. If problems are identified during the course of your visit, the nurse will consult with the physician and appropriate follow-up will be arranged. If you are experiencing non-device related problems, you should contact your physician for follow-up. If you are experiencing non-cardiac problems, contact your primary care physician.

Is it safe to use a microwave oven?   Microwave ovens are safe around pacemakers. Most household appliances and home/office equipment such as personal computers, printers and fax machines are safe and shouldn't affect your pacemaker, ICD, or ILR.

How often will my pacemaker need to be checked?   Depending on the type of pacemaker you have, it should be checked in the office every 3-12 months. You will be scheduled for transtelephonic monitoring between visits. As pacemakers age, they will need to be followed more frequently.

How long do pacemakers last?   Pacemakers typically last between 6-8 years depending upon the frequency they pace and how they are programmed. Regular pacemaker follow-up ensures optimal programming.
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What is an ICD?   An Implantable Cardioverter Defibrillator is a small, metal encased electronic device usually implanted below the skin just below the collar bone which like a pacemaker is used to treat arrhythmias (abnormal heart rhythms). Unlike a pacemaker, which treats slow arrhythmias, the ICD treats both fast and slow heart rates. The fast heart rates primarily treated with ICDs are those that originate from the ventricles, or bottom chambers of the heart and are life threatening, ventricular tachycardia (VT) and ventricular fibrillation (VF). Special lead wires that "connect" the ICD to the heart are used to both monitor the heart and deliver the necessary therapies. Some ICDs are also being implanted for patients who are at high risk of developing ventricular arrhythmias. Some patients who have had a heart attack and have weakened heart muscles are at risk for developing these arrhythmias.

Why would a doctor recommend one instead of the other?   The type of device selected for a patient is very individualized and based on the type of heart rhythm problem, which has been diagnosed, as well as other heart conditions such as heart failure or atrial fibrillation.

How often will my ICD need to be checked?   Every three months. Follow-up frequency increases as the devices age. If the ICD delivers therapy, you will need to have the device evaluated in the office.

How long will it take for my ICD to be checked?   Routine checks take between 20-40 minutes

How long do ICDs last?   Typically 3-5 years depending on the frequency they deliver therapy and pace, as well as how they are programmed. Regular ICD follow-up ensures optimal programming.

Can ICDs be checked by telephone like pacemakers?   At this time most ICDs cannot be checked by telephone. However, there are some newer devices that may be checked remotely using telephone lines, the Internet and/or cellular and satellite technology. These are new and emerging technologies and The Sanger Clinic hopes to make them available to our patients when possible.
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What is an ILR?   An ILR is an Insertable Loop Recorder. An ILR may be used to help diagnose the cause of recurrent fainting spells or other transient symptoms such as unexplained recurrent palpitations, light-headedness, or dizziness. ILRs monitor the rate and rhythm of the heart on a continuous basis for up to 14 months. Using a small, pager size, "activator" device the patient stores the heart's electrogram (ECG) by placing the activator over the device and pressing a button. This is done at the time the patient is having symptoms or after waking from a fainting spell. Family members or friends can also place the Activator over the patient's device to save the information. Arrangements are then made for the Pacemaker Nurse to interrogate the stored data have the physician analyze the findings. The ECG information will be used to determine whether or not the fainting event or other symptoms were the result of an abnormal heart rhythm (arrhythmia). Once the etiology of the fainting or other symptoms is discovered, the device is removed and either treatment is begun or the patient is referred to other specialists.

How is the ILR implanted?   The ILR, slightly smaller than a pack of gum, is inserted in the chest, right under the skin. The procedure takes about 15-30 minutes and is usually done under a local anesthetic.

How is it different from a pacemaker?   ILRs are diagnostic tools and do not provide therapy.

How long will it take for my ILR to be checked?   Routine checks take between 20-40 minutes

How often will my ILR need to be checked?   One week after they are implanted, and monthly for the life of the device. Patients with ILR devices should be checked after making heart rhythm recordings.

How long do ILRs last?   14 months, after which they need to be removed.
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What can I expect to happen at the time of the appointment?   You will be asked for a brief family and patient history. Usually, blood pressure, height, weight, pulse oximetry, and an EKG are performed. The physician then performs a physical examination directed toward identifying cardiovascular abnormalities. As needed, additional tests will be performed which may include an echocardiogram that can be completed in the office the same day. Normally the results will be discussed as soon as the evaluation is complete.

What do I need to bring to the appointment?   All patients should bring:

• A list of all currently prescribed medications with the instructions.
• The insurance/Medicaid card(s).
• The name, phone number and address of your primary care or referring physician.
• A completed patient demographic and family history forms
• Any prior cardiac evaluation reports should be forwarded to our office before your appointment.
• For infants, a pacifier, a bottle of juice, formula or breast milk is very helpful for performing tests.

Note: Examining the hearts of infants and children requires a quiet atmosphere. Other children in the room may be distracting and make it more difficult to examine the patient. Noise and distractions also impact our ability to discuss the problem with you, the parent. We recommend that if at all possible you come without other children. Pediatric Cardiology does provide a waiting room separate from other waiting areas stocked with children's videos, books and a small table for children to sit and read and write.

Does my child have to stop taking their medicine before the appointment?    missing copy

Can they eat before they come?:   Patients should continue their medications and diet as normal.
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How long will the appointment last?   Approximately one hour. If an emergency or delay occurs, you will be notified and given the option to reschedule. To avoid delays and/or provide slots for other patients - it is important that you keep the appointed time given or call our office in advance to reschedule.

How long does the test take?  

• Regular echo: 30-45 minutes
• Transesophageal echo: 1 hour
• Dobutamine stress echo: 1 hour
• Stress echo: 1 hour

May I eat before the test?  

• Regular echo: yes
• Transesophageal echo: no, nothing after midnight the night before
• Dobutamine stress echo: if test is before lunch, no; if test is in afternoon then a light breakfast is ok
• Stress echo: May eat breakfast.

Will I be able to drive after the test?  

• Regular echo: yes
• Transesophageal echo: no, not for the entire day of the test
• Dobutamine stress echo: yes
• Stress echo: yes

Should I take my medicines before the test?  

• Regular echo: yes
• Transesophageal echo: no, wait until after the test
• Dobutamine stress echo: yes, but please check with your physician. There are certain medicines that your physician may have you hold until after the test.
• Stress echo: yes, but please check with your physician. There are certain medicines that your physician may have you hold until after the test.

What are the risks of this test?  

• Regular echo: none
• Transesophageal echo: throat may be slightly sore, patient may be drowsy
• Dobutamine stress echo: medicine can cause nausea, tingling sensation in face, head and extremities. Patient may "feel tired" after the test.
• Stress echo: fatigue

When will I know the results of the test?   Results are sent to Sanger physicians within 24 hours, other physicians receive results within 3-5 business days.

What is an echo with contrast study?    An IV must be started in an arm vein. Saline or a contrast agent will be injected into the IV, and then ultrasound images of the heart are obtained while watching the saline/contrast flow through the heart. There are usually no side effects.
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What are the benefits of treatment?   For many patients, EECP® can reduce the frequency and intensity of chest pain or eliminate it altogether, decrease the need for medication, and greatly improve functional capacity with the ability to participate in activities of everyday life. After receiving EECP® treatment, patients often are able to enjoy moderate exercise for the first time since they developed angina.

How will I feel after treatment?   You may feel a little tired, but you are unlikely to experience any unpleasant aftereffects.

How soon can I expect to feel an improvement in my condition?   Experience has shown that some patients report improvement about halfway through their course of treatment.

Are there any drawbacks to the procedure?   The length of treatment (usually 7 weeks) may be a consideration. During that time, patients must visit an outpatient clinic and receive treatment for one hour per day. Some patients may require more than one course of therapy to achieve optimal relief.

What are the risks of EECP® treatment?   EECP can be associated with some risks and patients need to be carefully selected. Some patients have experienced minor skin irritation or bleeding within the muscle due to the pressure of the cuffs. Patient with peripheral vascular disease and phlebitis may be at risk of thromboembolus. Recent cardiac catheterization may increase risk of bleeding. Some patients with weak heart muscle may have exacerbation of dyspnea due to increased venous return to the heart by inflations. Patient with significant aneurysms are not candidate due to risk of rupture during increased pressures from cuff inflations. Your risk for potential complications will be evaluated prior to initiating therapy.

What are the advantages of EECP® treatment over other angina treatments?   EECP® is administered outpatient, and does not involve any post-treatment recuperation, unlike bypass surgery and balloon angioplasty.

Can I eat or drink before my procedure?   Not for an hour and a half before the treatment.

Can I take medication before my procedure?   Yes.
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Do Sanger's cardiac surgeons use the most advanced surgical procedures?   Yes. In addition to open heart surgery for coronary artery bypass surgery and valve replacement, our cardiac surgeons are skilled in performing minimally invasive bypass surgery such as MIDCAB and Port Access Surgery without opening the patient's chest. In addition, off-pump bypass surgery is offered, which allows the heart to keep beating during surgery, thus reducing or eliminating many complications associated with traditional bypass surgery. For coronary bypass surgery, Endoscopic Vein Harvesting (EVH) is utilized. This minimally invasive procedure involves a small incision at the knee, rather than the traditional harvesting that requires a long incision down the entire leg to remove the blood vessel. In addition to avoiding a scar, patients undergoing EVH are less likely to experience complications and usually have a shorter recovery time.

Will my insurance cover my heart surgery?   The majority of medical insurance plans will cover cardiac surgery. Our office will get the surgery approved by your insurance carrier before your surgery date to minimize any problems. You will be contacted prior to your surgery if there are any problems with getting approval from your insurance carrier.

Do I need to quit smoking before surgery?   If you smoke, quit. Smoking makes you more prone to developing pneumonia and pulmonary complications after surgery. It also makes your heart work harder. You should quit smoking at least three weeks prior to surgery.

How will my family members be kept informed on the day of surgery?   Your family will be directed to the waiting room in the Carolinas Heart Institute. The surgeon will speak with your family following the operation to inform them of your condition and to answer questions.

How long will I be in the hospital?   The length of hospitalization varies with the patient and the type of surgery. Most of our patients undergoing open-heart surgery go home in about 4 - 6 days.

When will I return to the surgeon's office after surgery?   Your follow-up visit should typically occur three weeks following your discharge from the hospital. If you are not given a specific appointment time upon discharge, you will be instructed to call the office to make an appointment.

What are the signs of incisional infections after surgery?   Wound infections following open-heart surgery are associated with elevated temperature, a redness and soreness around the site of the incision. If these conditions arise, please contact our office for guidance.

When will I be able to drive?   Typically one month following the date of surgery.

When can I return to work?   Your surgeon will determine this at the time of your follow-up visit.
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What is the United Network for Organ Sharing?   his nationwide organization manages the national transplant waiting list, matching donors to recipients 24 hours a day, 365 days a year. UNOS monitors every organ match to ensure UNOS policies are followed. UNOS maintains the database that contains all organ transplant data. These data are used to improve transplantation, develop organ sharing policies, support in the care of patients and help patients make informed healthcare decisions.

How are patients added to the UNOS waiting list?   When a patient's physician determines that an organ transplant may be necessary, the patient is referred to a transplant center for evaluation. The medical team at the transplant center considers the patient's past and present medical condition as well as his or her ability to follow prior medical instructions and the emotional support from the patient's family or friends.

What criteria must patients meet to be placed on the waiting list?   Historically, each transplant center uses its own criteria to evaluate and list patients. To maintain uniform standards, UNOS committees, consisting of transplant professionals, recipients and donor family members, have developed uniform guidelines to determine the minimum listing criteria a candidate must meet.

How are donated organs matched to patients awaiting transplant?   When a patient is added to the transplant waiting list, his or her medical information is entered in the UNOS computer. The patient's name is added to a "pool" of patient names. When an organ donor becomes available, all patient information is compared to that particular donor's. The computer then generates a list of patients who match the donated organ. These matches are based on many things which may include the level of illness, urgency of the transplant candidate, time spent on the waiting list, biological similarities between the donor and the recipient (such as organ size, blood type and genetic makeup) and the candidates availability to be transplanted immediately. Generally, donated organs are also distributed in certain geographic order.

How long does it take to receive an organ?   Patients added to the UNOS waiting list may receive an organ that day, or they may wait years. Factors affecting waiting time include how well the donor and recipient "match," how ill the patient is, and the availability of donors compared to the number of patients waiting. UNOS publishes waiting time statistics in an annual report.

Am I a candidate for living donation?   UNOS has no policy or guidelines for living donation. Living donation is handled by the transplant centers. Living donors have historically been a close relative (spouse, sibling, parent, etc.) of the recipient. Living stranger-to-stranger donation is quite new.

Can a patient from another country receive a transplant in the U.S.?   Yes. Patients may travel from other countries to the U.S. to receive transplants. Once accepted by a transplant center, international patients receive organs based on the same policies as those that apply to U.S. citizens. These types of transplants are limited in number.

How can I receive UNOS data on organ transplantation and donation?   Call toll-free 888-894-6361 or visit www.transplantliving.org
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Who can become a donor?   Anyone can and should consider themselves a potential organ donor. Medical conditions at the time of death will determine what organs and tissues can be donated.

What organs and tissues can I donate?   Organs include the heart, kidneys, pancreas, lungs, liver and intestines. Tissues include corneas, skin, bone, ligaments, heart valves, tendons and blood vessels.

Will my decision to become and organ and tissue donor affect the quality of my medical care?   No. organ and tissue recovery takes place only after all efforts to save your life have been exhausted and death has been declared. The doctors working to save your life are entirely separate from the medical team involved in recovering organs and tissues.

Will donation disfigure my body?   No. Donation neither disfigures the body nor changes how it looks in a casket.

Does it cost anything to donate organs and tissues?   No.

Is there an age limit for donating organs?   No set age limit exists for organ donation. At the time of death, the potential donor's organs are evaluated to determine their suitability for donation. Therefore, people of any age wishing to become organ donors should complete a donor card and inform their family that they wish to donate.

What medical conditions exclude a person from donating organs?   HIV and actively spreading cancer normally exclude people from donating organs. Otherwise, the organs are evaluated at the time of death.

Does my religion approve of donation?   All of the major religious denominations in the U.S. approve of organ donation and consider it a gift-an act of charity. If you have any questions, consult your religious advisor.

What will happen to my donated organs and tissues?   A national system ensures the fair distribution of organs in the United States. The patients who will receive your organs and tissues will be identified based upon such factors as blood type, length of time on the waiting list, severity of illness and other medical criteria. Factors such as race, age, gender, income or celebrity status are not considered when determining who receives an organ. Buying and selling organs is illegal.

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