What are the warning signs of a heart attack?
It is important to remember that if you experience any of these symptoms you should seek medical attention immediately:

• Discomfort, tightness, pressure, squeezing in the center of the chest lasting more than a few minutes or that comes and goes
• Crushing chest pain
• Pressure or pain that spreads to the shoulders, neck, upper back, jaw or arms
• Dizziness or nausea
• Clammy sweats, heart flutters or paleness
• Unexplained feelings of anxiety, fatigue or weakness – especially with exertion
• Stomach or abdominal pain
• Shortness of breath and difficulty breathing

Do you offer free consultations?
We do not offer free consultations, but we are happy to bill your insurance for the office visit. If you do not have insurance, we will work with you on an individual basis to arrange payment terms.

Will you bill my insurance?
Waco Cardiology Associates is a participating Medicare and Medicaid provider and we accept most insurance company, many of which require members to pay an office copayment for each office visit. Our office will request payment of the co-pay at the time of your visit and will then file a claim with your insurance company for the balance. Because our relationships with insurance company can change from time to time, we recommend that you contact our office and your insurance company directly to verify our participation in your plan. It is important for us to have a record of your current insurance information, so we will ask for a copy of your ID card at each visit. Please contact our office if you have other questions regarding insurance coverage or billing.

Do I need a referral from my primary care physician to see a cardiologist?
You do not need a referral, unless your insurance company requires you to have a referral. If your insurance is a HMO/managed care plan and you are required to obtain a referral from your primary care physician, the referral must be obtained before you can be seen for an office visit.

We do accept self-referred patients with cardiovascular concerns. To enhance your appointment time with the cardiologist(s), we require you to obtain your past medical records and bring them to your appointment.

How can I prepare for my first appointment?

• If you are having lab work done before your appointment, fast for 12 hours (no food or drink except water) prior to your blood draw.
• Bring your completed cardiovascular clinic patient questionnaire.
• Bring results of any requested laboratory tests.
• Mail or bring any medical or personal records related to previous hospitalizations, cardiovascular risk factor values and/or treatment.
• Plan on being at the clinic for one to two hours.

What are preventative measures for heart health?

Stop smoking
If you smoke, quit. If someone in your household smokes, encourage them to quit. We know it’s tough, but it’s tougher to recover from a heart attack or stroke or to live with chronic heart disease. Commit to quit. We’re here to help if you need it.

Reduce blood cholesterol
Fat lodged in your arteries is a disaster waiting to happen. Sooner or later it could trigger a heart attack or stroke. You’ve got to reduce your intake of saturated and trans fat and get moving. If diet and exercise alone don’t get those numbers down, then medication is the key. Take it just like the doctor orders. Here’s the lowdown on where those numbers need to be:

Total cholesterol – Less than 200mg/dL

LDL (bad) Cholesterol

• Low risk for heart disease – Less than 160mg/dL
• Intermediate risk for heart disease – Less than 130mg/dL
• High risk for heart disease including those with heart disease or diabetes – Less than 100mg/dL

HDL (good) Cholesterol

• 40mg/dL or higher for men and 50mg/dL or higher for women

Triglycerides

• Less than 150mg/dL

Lower high blood pressure
It’s the single largest risk factor for stroke. Stoke is the No. 2 killer and one of the leading causes of disability in the United States. Stroke recovery is difficult at best and you could be disabled for life. Shake that salt habit, take any medication the doctor recommends exactly as prescribed and get moving. Those numbers need to get down and stay down. Your goal is less than 120/80 mmHg.

Be physically active every day
Research has shown that getting 30-60 minutes of physical activity on most days of the week can help lower blood pressure, lower cholesterol and keep your weight at a healthy level. Something is better than nothing. If you’re doing nothing now, start out slow. Studies show that people who have achieved even moderate level of fitness are much less likely to die early than those with a low fitness level.

Aim for a healthy weight
Obesity is an epidemic in the United States and a precursor to type 2 diabetes, high cholesterol, and high blood pressure – the very factors that heighten your risk of cardiovascular disease. Your BMI (Body Mass Index) will tell you if your weight is healthy. Good nutrition and physical activity are the only way to maintain a healthy weight.

-Manage diabetes

-Reduce stress

-Limit alcohol

How do I obtain prescription refill authorizations?
Contact your pharmacy and allow 72 hours to obtain the refill. Your pharmacy has all your refill information and will fax or electronically send the request to our office. Even if you have no refills remaining, your pharmacy will send us a request.

OR

Call our Prescription Refill Line at 254-399-5415. Leave your name, daytime telephone number, name of prescription, dosage, how many times a day you take it, and any other pertinent information.

Prescription Refill requests are checked throughout the day. Someone will handle your request at the earliest convenience. After hours or weekend requests will be handled the next business day.

Do I stop my medication if there are no refills?
When you are getting low on your medication and there are no refills, contact your pharmacy. The pharmacy will forward your request to our office. The medication will be refilled if you are to continue taking the medication. You will receive a call from our office if you are to discontinue the medication.

What if I utilize a mail pharmacy for my prescriptions?
Mail pharmacies require a new prescription annually. Don’t wait until you are out of your medication to request a refill. Allow two (2) weeks for the pharmacy to process and mail your prescription. Request this prescription at your visit to the provider or contact our office and leave a detailed message for the nurse (name of the medication, strength of tablet and directions for use). Many, but not all, mail pharmacies are in our electronic system which allows the cardiologist to electronically transmit your prescription to the pharmacy.

What if I am changing pharmacies?
Take your prescription bottles to the new pharmacy. The pharmacy will send us a new request.Please allow 72 hours to obtain the new refill.

What do I do if I run out of my cardiac medications over the weekend or holiday?

Contact your pharmacy. They will send a request to our office and often give you enough medication to get you through until the next business day when our clinical staff will process the refill.

What is cardiovascular or heart disease and how is it diagnosed?
The most common form of heart disease is coronary artery disease. Narrowing of the arteries that supply blood to the heart (coronary arteries) results in insufficient blood delivery to the heart muscle. This will often lead to decreased exercise capacity, symptoms such as chest discomfort, or premature death (heart attack).

The diagnosis is typically made by noninvasive stress testing or cardiac imaging such as Echocardiograms, Nuclear MRI and PET scans. However, the gold standard for diagnosis is an invasive procedure called cardiac catheterization.

How do I prepare for a Stress Test?

The following are instructions for an Exercise Treadmill Test:

Medications

Please take all medications as prescribed by your cardiologist with exception of any medications that you were asked to hold at the time of scheduling.

Meals

No caffeine or decaffeinated beverages  (i.e. coffee, tea, sodas, chocolate).

Test Schedule

If your exercise treadmill test is scheduled for the morning, do not eat breakfast.

If your exercise treadmill test is scheduled for the afternoon, do not eat for at least four (4) hours before the test. Breakfast should be light (cereal, toast, juice). Lunch should also be light (fruit, salad, juice).

What to Wear

Wear or bring appropriate clothing, rubber-soled running, flat or walking shoes are needed (no slippers, clogs or thongs). Pant legs should not be excessively long so as to get caught in the moving equipment. 

Men – Should bring or wear gym shorts, Bermuda shorts or plain loose-fitting trousers, and shirts that button in the front (no overalls). 

Women – Should bring or wear short-sleeved, loose-fitting blouses that button in the front, and shorts or loose-fitting trousers. No dresses, one-piece undergarments or panty hose should be worn.

Should you have to cancel your appointment

Please notify the scheduling department at 254-399-5400?  Please give us at least 24-hours’ notice, if you are unable to keep your appointment.

What can I expect from a Nuclear Medicine Stress Test?

A nuclear stress test shows how well blood flows through your heart and arteries while you are resting and during physical exertion. In this test, a small amount of radioactive tracer is injected into your body. This substance allows images of the heart to be recorded so that your doctor can see:

• How well the heart is pumping blood
• If a part of the heart has been damaged
• If any of the arteries that feed the heart are blocked

What happens during the test?

Two sets of images will be taken, one while you are resting and one after you have exercised or received a pharmacological agent for those who are unable to excercise. This test is usually done in a special area called a lab.

You will be asked to lie down on an examining table. An IV will be placed into a vein in your arm or hand. A radioactive substance will then be injected through the IV. You will need to lie still with your arms above your head for a few minutes to allow the substance to circulate through your body.

Your exercise test

Before the exercise party of the test, small disks called electrodes will be placed on your chest. The electrodes are connected to an electrocardiogram machine. An electrocardiogram charts your heart’s electrical activity.

You will then walk on a treadmill or received a pharmacological agent for those who are unable to exercise.

You will be asked how you are feeling. Be sure to report any symptoms you may have, such as pain or discomfort in your chest, arm or jaw, shortness of breath or dizziness.

If you are unable to exercise, you will be given a medication that causes the heart and blood vessels to react as they would during exercise. The medication may cause sensations such as shortness of breath, headache or some slight abdominal cramping. This is normal and will go away in 4-5 minutes.

Please allow one week to receive your test results.  If you don’t receive your results within a week, we ask that you call our office.

If you are signed up for the patient portal, please remember to check it for results.

Your doctor’s recommendation

Feeling uncertain about your health can be stressful for you and your family. Because you have had this test, you know that any advice about treatment is based on facts discovered during your test. You may be advised to have more tests or you may need medication or a surgical or nonsurgical treatment. Whatever your doctor’s recommendation, you can rest assured that it is based on the best possible information.

It is important to note that the radioactive tracers used in this test is safe and will not harm your body.

What is an Echocardiogram?

An echocardiogram, also known as echo, is a simple, yet very essential, non-invasive test that uses two-dimensional, Doppler, M-mode, and color flow ultrasonic imaging for the assessment of chamber size and function, valve function, physiological information (blood flow velocities, gradients and pressures) and other important disorders such as congenital defects.

The echocardiogram will show how well your heart muscle is working, if it is enlarged or thickened, if any of the valves are leaking or have calcium build up and if there is fluid around the heart.  This test is not able to evaluate whether you have “blocked arteries”.  It is similar to the test done on pregnant women to check the fetus in the womb.  There is no preparation for the test.  You should wear a two-piece outfit as you will have to undress from the waist up.  You may eat and take all your medications.

The echocardiogram will be performed in our office by a technologist and takes about 45 minutes.  A transducer coated with cool gel will be moved over your chest, this device creates sound waves that make images of your heart.  The images are digitally recorded and reviewed by the cardiologist.

What is a Holter Electrocardiogram?

Your doctor has ordered a Holter Electrocardiogram (ECG). You are probably curious to know exactly what a Holter ECG is, what the recorder is for and what you are expected to do during the test.

A Holter ECG is a relatively simple, and painless procedure. There is nothing to be afraid of or to worry about. Your doctor will arrange for a technician to connect you to a small lightweight portable recording unit that you will wear from 24 to 48 hours, depending on your doctor’s instructions. Monitoring electrodes will be put on your chest. These will pick up the signals from your heart and transfer them to the recorder, where a tape recording of the signals will be made. The recording will later be transformed into a report which your doctor will analyze.

The Holter ECG is basically a continuous electrocardiogram taken while you are performing your normal daily activities. This differs from a normal ECG in that a normal ECG records only a very small portion of your heart’s activity, less than of 1% of your daily heart beats. The normal ECG is also taken while you are at rest and, therefore, does not show how your heart will react to the stressful situations of normal daily life.

The reason for the Holter ECG is to provide your physician with a record of how your heart reacted to each stressful or unusual situation during the day as well as at rest situations.

You will be provided a diary to record the events that occur throughout the day. This diary will provide your doctor with a means of correlating the recording results with the various events that occurred during the day. He will look at the activities and symptoms you list and will see how your heart reacted during each of these events. It is extremely important that you record your daily activities and symptoms accurately.

What can I do while wearing the Holter?
The recorder you will be wearing should not interfere with your normal routine and there are only a few restrictions while you are wearing it. Obviously, you should not tamper with the recorder, electrodes or lead wires. You should not take a shower or bath or get the electrodes or recorder wet in any way. If you are wearing the recorder at night, you should not use an electric blanket, as it may interfere with the recording. If the electrodes do come loose, secure them with tape.

What is a Cardiac Event Recorder?

• First and foremost…
  The recorder is designed to document symptoms and is not an intervention device. If you feel in peril, you should follow whatever emergency precautions given to you by your cardiologist. Push the Symptom button first, then seek help.
• When to wear the recorder…
  During daytime and sleeping hours, but not during bathing or showers. When bathing, the electrodes (only) may be left on. Water will not hurt them.
• When to remove the recorder…
  Only during bathing. The purpose of the test is to capture unexpected cardiac arrhythmias that occur before the push of the button. If the recorder is not in place before the button is pushed, the data will be missed. Thus, it must be worn continuously to ensure its availability at the time of need.
• When to push the button…
  Whenever you feel the symptom your doctor is trying to document. Obviously, unrelated symptoms are not useful, but anything you feel that may be heart-related is a valid event. Push the button and call us.
• How many times should I transmit?
  The typical patient will make 5-10 transmissions during the 30-day period, but there is no limit. On some, we’ll catch the event within the first few transmissions. Others will be caught later, maybe even on the 30th day.
• When should I make the transmission?
  After every push of the button, as soon as you can reasonably get to a phone.
• What are the hours that calls can be made?
  We have an answering service available 24 hours per day, 365 days per year. Even Sundays and holidays.
• What number should I dial?
  254-399-5445
• When should I return the recorder?
  At the end of the 30-day period, or when your doctor advises. Remember, like a library book, it is your responsibility to return the recorder or the monthly service charges will continue. Loss of the recorder is also the patient’s responsibility, so please do not let it out of your possession.