The Heart

Q: After heart surgery, when can I drive again?

A: After coronary artery bypass surgery or open heart surgery when the sternum has to be cut and then resewn together, most surgeons recommend 8 weeks after the surgery. This is the minimum time required for bone to heal. Some surgeons are more conservative. You should consult your own cardiac surgeon before resuming driving. Also, with my patients, I ask that they not drive if they feel weak, dizziness or lightheaded, any visual problems like blurred vision, double vision, you cannot walk, having chest pain or shortness of breath. In fact, if you are experiencing any of these symptoms after open heart surgery, you need to seek out your Cardiologist or primary physician as soon as possible.


Q: I had a stress test just last month. My Doctor said it was fine. Can I consider myself safe from a heart attack?

A: No. A heart attack is rarely caused from a stable plaque within the coronary artery. It is when the stable plaque becomes unstable that the heart attack results. Dr. Ambrose found in his study during the 1980s of heart attack victims, that the cause of the heart attack was not the high-grade blockages but the less than 50% blockages which became unstable and ruptured. Once the plaques ruptures, the contents of the plaque, lipid rich cholesterol becomes exposed to blood. The blood recognizes this as foreign substance and initiates the clotting cascade. This results in a clot within the coronary artery resulting in total occlusion of the artery. The heart no longer gets blood to that distribution and if not reopened within 15 minute, irreversible damage results. Up to 30-50% of victims of heart attack never make it to the hospital alive. This is what happened to Tim Russert.

Mr. Russert had a stress test in April 2008 and was told he did fine. However, he died suddenly while at work on June 13, 2008.


Q: So why bother with a stress test if it is not predictive of future events?

A: Stress tests are critical in allowing us to detect significant coronary blockages and prognosticating cardiac risk. There are four basic types of stress tests:

1. EKG stress test alone

2. EKG stress test with nuclear imaging before and after exercise.

3. EKG stress test with Echocardiogram imaging before and after exercise.

4. EKG test with pharmacologic or drug induced ischemia.

Of all the above testing types, the most sensitive is nuclear imaging performed in conjunction with EKG exercise stress test. The least sensitive to detect a significant blockage is the EKG exercise stress test alone.

 

There are other factors that make stress testing less sensitive:

1. the patient didn’t walk long enough or get his/her heart rate high enough.

2. the patient’s EKG is nondiagnostic or uninterpretable for detection of changes that Doctors need to diagnose a significant blockage.

If you already have coronary artery disease an exercise stress test with nuclear or Echocardiogram imaging is recommended. This allows your Doctor to obtain risk assessment over time.

If you don’t have coronary disease, but have multiple heart attack risk factors like strong family history of heart disease, smoking cigarettes, recent chest pains, abnormal EKG or elevated cholesterol or lipids, an exercise stress test performed with adequate exercise (you walked as long and as hard as you possible can), can provide crucial information about the presence or absence of a significant coronary blockage.

 

Stress tests alone aren’t good enough to prognosticate heart attack risk. There are other tests which can be done which will allow or enhance your Doctors ability to determine if you are at higher risk for a heart attack in the next 6 months to one year (see: What’s New in Heart Treatment). The Doctors’s own clinical judgement must be allowed to integrate all of these tests into a meaningful prognosis of your heart attack risk. Doctors are Scientists first. As such, physicians all like to have a formula we can plug certain numbers in and get a clear answer: Yes or No. But Medicine is rarely ever so black and white. Sometimes, it comes down to the suspicion of the Doctor who takes all of these tests into consideration and makes a final judgement.

 

The other major tip I have as a practicing Cardiologist can give you: if you have anything like chest pain, heart burn, shoulder pain (not directly attributable to trauma or athletic strain), jaw pain or tooth pain: directly seek out Medical attention. DO NOT WAIT.

If it is going on right now: CALL 911 and let the paramedics get some baseline information that they can then fax directly to the Emergency Dept. Doctor (see my section on the 411 on calling 911).

 

I tell my patients, I would rather have them wait 5-8 hours at the Emergency room, rather than lose the rest of the years, days, hours and minutes of your life.

About Dr. Nanavati

Dr. Vimal Nanavati is an Interventional Invasive Cardiologist residing in San Diego, California.  He was recruited to Northern California from Ohio in 1997 to initiate a quality Cardiology Program for the people living on the Northern Coast of California.  Dr. Nanavati inaugurated the Arcata Heart Care Program and was the director of their first Cardiac Catheterization Lab at Mad River Hospital from June of 1998 to March 1999.  

In 1999, Dr Nanavati relocated to Redding in order to provide his patients with more comprehensive cardiology services.  Since 2005, Dr. Nanavati has been in San Diego providing Cardiology Services.

Dr. Nanavati performs cardiac catheterizations, angioplasty, coronary Stent deployment, intracoronary ultrasound, and Doppler Pressure measurements in the coronary artery.  He also provides the complete array of non-invasive diagnostic tests such as echocardiography, stress testing, pacemaker follow-up, and EKG testing.  Since March 2002, Dr. Nanavati has added EECP (Enhanced External Counterpulsation), the only noninvasive therapy for angina not amenable to intervention or bypass surgery.

Dr. Nanavati received his medical training in Chicago, Illinois, where he grew up.  After finishing his fellowship training at the University of Illinois in 1993, he traveled to Ohio where he was in practice until 1997.  Dr. Nanavati is Board Certified in Cardiovascular Diseases and Internal Medicine.  He is a member of American College of Cardiology, Society of Angiography, and Interventions, American College of Physicians, California Medical Association, and San Diego County Medical Society.

Dr. Nanavati's Philosophy of Patient Care in his own words: 

"Treat every patient as if they were your own family member."

"If I cannot provide the most advanced therapy, I will find someone eminently qualified who will."

"The smile on a patient's face is my greatest reward." 

"If you don't need the procedure, I'm not going to order it." 

"The best patient is the informed patient."

Dr. Nanavati feels it a singular honor and privilege to serve the heart care needs of all patients and family members who use this site. This website is dedicated to them.

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Critical Care Cardiology

Dr. Vimal Nanavati is an Interventional Invasive Cardiologist residing in San Diego, California.  He was recruited to Northern California from Ohio in 1997 to initiate a quality Cardiology Program for the people living on the Northern Coast of California.  Dr. Nanavati inaugurated the Arcata Heart Care Program and was the director of their first Cardiac Catheterization Lab at Mad River Hospital from June of 1998 to March 1999.  

In 1999, Dr Nanavati relocated to Redding in order to provide his patients with more comprehensive cardiology services.  Since 2005, Dr. Nanavati has been in San Diego providing Cardiology Services.

Dr. Nanavati performs cardiac catheterizations, angioplasty, coronary Stent deployment, intracoronary ultrasound, and Doppler Pressure measurements in the coronary artery.  He also provides the complete array of non-invasive diagnostic tests such as echocardiography, stress testing, pacemaker follow-up, and EKG testing.  Since March 2002, Dr. Nanavati has added EECP (Enhanced External Counterpulsation), the only noninvasive therapy for angina not amenable to intervention or bypass surgery.

Dr. Nanavati received his medical training in Chicago, Illinois, where he grew up.  After finishing his fellowship training at the University of Illinois in 1993, he traveled to Ohio where he was in practice until 1997.  Dr. Nanavati is Board Certified in Cardiovascular Diseases and Internal Medicine.  He is a member of American College of Cardiology, Society of Angiography, and Interventions, American College of Physicians, California Medical Association, and San Diego County Medical Society.

Dr. Nanavati's Philosophy of Patient Care in his own words: 

"Treat every patient as if they were your own family member."

"If I cannot provide the most advanced therapy, I will find someone eminently qualified who will."

"The smile on a patient's face is my greatest reward." 

"If you don't need the procedure, I'm not going to order it." 

"The best patient is the informed patient."

Dr. Nanavati feels it a singular honor and privilege to serve the heart care needs of all patients and family members who use this site. This website is dedicated to them.


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Heart Attack Symptoms and Information

If you are experiencing these symptoms, dial 911 immediately!

  • Chest discomfort

  • Shortness of breath

  • Arm pain

  • Dizziness

  • Jaw pain

Every year, tens of thousands of Americans survive heart attack, go back to work and enjoy a normal life. You have every reason to be confident of a full recovery. Your heart is healing and with each passing day you’ll get stronger and more active.

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If you do not currently have medical insurance, no problem. If you have a diagnosis of heart disease or you think you may have heart disease, feel free to set up an introductory meeting. We have several heart care packages that allow you to receive continued Heart care with our Board Certified Cardiologist. After an initial evaluation, we can determine which package works best for your specific needs. Call us now. Don't wait for a heart attack!

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