Heart and Vascular Center

At Manatee Cardiovascular Wellness Institute, we provide state-of-the-art medical technologies and comprehensive cardiovascular care to our patients, their families and the community, within a compassionate and service-oriented environment.

Please see a list of conditions we treat at Manatee Cardiovascular Wellness Institute.

Click on each topic to see a detailed explanation of the condition or service our Heat & Vascular Center provides.

Assure Yourself.
Get A 2nd Opinion


What is an aneurysm?

An aortic aneurysm is a blood vessel disease which usually occurs in older adults. The disease weakens the main blood vessel in the chest (thoracic cavity) or belly (abdomen). Although it cannot be seen from the outside, an ultrasound, x-ray, CT or MR scan will reveal an aneurysm, which is a weak area of the blood vessel that appears as a bulge. Most of the time, an aneurysm occurs only in the abdominal aorta. These are called abdominal aortic aneurysms (AAA). Less often, the aneurysm is located in the chest. This is called a thoracic aneurysm (TAA). Aneurysms can occur in both the chest and abdomen at the same time.

Abdominal Aortic Aneurysms

After filling up with oxygen in the lungs, blood is pumped from the heart and into a very large blood vessel known as the aorta. The aorta is shaped like a candy cane, passing upward from the heart, then curving back downward through the chest and into the abdomen. This very important blood vessel sends fresh blood to every part of the body through blood vessels called arteries. These arteries supply the head, arms, spinal cord, intestines, liver, kidneys and legs.

The different parts of the aorta include the ascending aorta (the section that leaves the heart and passes upwards), the aortic arch (where the aorta turns downwards), the thoracic aorta (where it passes the lungs in the chest), and the abdominal aorta (the portion where the aorta passes down through the abdomen).

Most of the time an aneurysm does not cause any pain or discomfort. Blood is pumped through these blood vessels under pressure, and as the wall becomes weaker, the aneurysm becomes larger. If the wall becomes weak enough, the blood vessel can tear or rupture. If this happens, a lot of blood can be lost very quickly and the likelihood of survival is low. For this reason, it is important that large aneurysms are treated promptly when they are found. Of the 200,000 people diagnosed each year with AAA, almost 15,000 are in danger of rupture and death if they are not treated.

aortic-stenosisAortic Stenosis

The aorta is the main artery that carries blood out of the heart to the rest of the body. Blood flows out of the heart and into the aorta through the aortic valve. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart.

Does aortic stenosis always produce symptoms?

No, not always. It’s important to note that many people with AS do not experience noticeable symptoms until the amount of restricted blood flow becomes significantly reduced.

Symptoms of aortic stenosis may include:

  • Breathlessness
  • Chest pain (angina), pressure or tightness
  • Fainting, also called syncope
  • Palpitations or a feeling of heavy, pounding, or noticeable heartbeats
  • Decline in activity level or reduced ability to do normal activities requiring mild exertion
  • Heart murmur

Arrhythmias/Heart Rhythm Disorders

The heart beats because of electrical signals that flow through its natural electrical system and through the individual heart muscle cells. The term “arrhythmia” refers to any change from the normal sequence of electrical impulses in the heart, resulting in a disruption of the normal heart rhythm.

This can cause the heart to pump less effectively. Some arrhythmias are so brief that the overall heart rate or rhythm isn’t greatly affected. But if arrhythmias continue, they can cause the heart rate to be too slow or too fast or the heart rhythm to be erratic.

Tachycardia (Fast Heart Rate)

Tachycardia refers to a fast heart rate (more than 100 beats per minute). Symptoms include palpitations, rapid heartbeat, dizziness, lightheadedness and fainting. Ventricular tachycardia is an arrhythmia that starts in the bottom chambers of the heart, known as the ventricles, and it usually is life-threatening. Ventricular tachycardia is most often detected in damaged hearts that have scar tissue, such as after a heart attack. If treated in time, ventricular tachycardia can be stopped with an electrical shock. Medication also can be used to prevent ventricular tachycardia. Placement of an implantable cardioverter defibrillator often is required to provide additional rhythm correction within seconds of an abnormal electrical signal occurring in the heart. Catheter ablation is another treatment that may also be necessary to block or ablate the short circuit in the heart.

Bradycardia (Slow Heart Rate)

A heart rate that’s too slow (less than 60 beats per minute) is called bradycardia. Although a slow pulse can be a sign of good health and cardiovascular fitness, a particularly slow pulse at rest and with exercise can be very uncomfortable or even life-threatening. Symptoms related to a slow pulse include fatigue, dizziness, lightheadedness and, in the worst case, fainting. These symptoms can be easily corrected by implanting an electronic pacemaker under the skin to monitor and speed up the heart rhythm as needed.

Atrial Septal Defect

atrial-septal-defect-2An atrial septal defect is a hole in the septum separating the upper chambers of the heart. Typically this condition is detected in childhood. The hole can increase the pressure of the blood supply to the lungs causing damage to the lungs and lead to pulmonary hypertension. Other conditions can include heart failure, arrhythmias and stroke.

In adults, signs or symptoms usually begin by age 30, but in some cases signs and symptoms may not occur until decades later.

Atrial septal defect signs and symptoms may include:

  • Shortness of breath, especially when exercising
  • Fatigue
  • Swelling of legs, feet or abdomen
  • Heart palpitations or skipped beats
  • Frequent lung infections
  • Stroke
  • Heart murmur, a whooshing sound that can be heard through a stethoscope

When to see a doctor

Contact your doctor if you or your child has any of these signs or symptoms:

  • Shortness of breath
  • Tiring easily, especially after activity
  • Swelling of legs, feet or abdomen
  • Heart palpitations or skipped beats

These could be signs or symptoms of heart failure or another complication of congenital heart disease.

Atrial Fibrillation

An arrhythmia is a problem with the speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The cause is a disorder in the heart’s electrical system.

Often, people who have AF may not even feel symptoms. But you may feel:

  • Palpitations an abnormal rapid heartbeat
  • Shortness of breath
  • Weakness or difficulty exercising
  • Chest pain
  • Dizziness or fainting
  • Fatigue
  • Confusion

AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure.

Doctors diagnose AF using family and medical history, a physical exam, and a test called an electrocardiogram (EKG), which looks at the electrical waves your heart makes. Treatments include medicines and procedures to restore normal rhythm.

Atrial Flutter

atrial-flutterThe electrical system of the heart is the power source that makes the heart beat. Electrical impulses travel along a pathway in the heart and make the upper and lower chambers of the heart (atria and the ventricles) work together to pump blood through the heart.

A normal heartbeat begins as a single electrical impulse that comes from the sinoatrial (SA) node, a small bundle of tissue located in the right atrium. The impulse sends out an electrical pulse that causes the atria to contract (squeeze) and move blood into the lower ventricles. The electrical current passes through the atrioventricular (AV) node (the electrical bridge between the upper and lower chambers of the heart), causing the ventricles to squeeze and release in a steady, rhythmic sequence. As the chambers squeeze and release, they draw blood into the heart and push it back out to the rest of the body. This is what causes the pulse we feel on our wrist or neck.

With AFL, the electrical signal travels along a pathway within the right atrium. It moves in an organized circular motion, or “circuit,” causing the atria to beat faster than the ventricles of your heart.

AFL is a heart rhythm disorder that is similar to the more common AFib. In AFib, the heart beats fast and in no regular pattern or rhythm. With AFL, the heart beats fast, but in a regular pattern. The fast, but regular pattern of AFL is what makes it special. AFL makes a very distinct “sawtooth” pattern on an electrocardiogram (ECG), a test used to diagnose abnormal heart rhythms.

Risk Factors for Atrial Flutter

Some medical conditions increase the risk for developing AFL. These medical conditions include:

  • Heart failure
  • Previous heart attack
  • Valve abnormalities or congenital defects
  • High Blood Pressure
  • Recent surgery
  • Thyroid dysfunction
  • Alcoholism (especially binge drinking)
  • Chronic lung disease
  • Acute (serious) illness
  • Diabetes

Symptoms of Atrial Flutter

The electrical signal that causes AFL circulates in an organized, predictable pattern. This means that people with AFL usually continue to have a steady heartbeat, even though it is faster than normal. It is possible that people with AFL may feel no symptoms at all. Others do experience symptoms, which may include:

  • Heart palpitations (feeling like your heart is racing, pounding, or fluttering)
  • Fast, steady pulse
  • Shortness of breath
  • Trouble with everyday exercises or activities
  • Pain, pressure, tightness, or discomfort in your chest
  • Dizziness, lightheadedness, or Fainting

Complications of Atrial Flutter

AFL itself is not life threatening. If left untreated, the side effects of AFL can be potentially life threatening. AFL makes it harder for the heart to pump blood effectively. With the blood moving more slowly, it is more likely to form clots. If the clot is pumped out of the heart, it could travel to the brain and lead to a stroke or heart attack.

Without treatment, AFL can also cause a fast pulse rate for long periods of time. This means that the ventricles are beating too fast. When the ventricles beat too fast for long periods of time, the heart muscle can become weak. This condition is called cardiomyopathy. This can lead to heart failure and long-term disability.

Without treatment, AFL can also cause another type of arrhythmia called atrial fibrillation. Atrial fibrillation (AFib) is the most common type of abnormal heart rhythm.


Having bradycardia (say “bray-dee-KAR-dee-uh”) means that your heart beats very slowly. For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If your heart beats less than 60 times a minute, it is slower than normal.

A slow heart rate can be normal and healthy. Or it could be a sign of a problem with the heart’s electrical system .

For some people, a slow heart rate does not cause any problems. It can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.

In other people, bradycardia is a sign of a problem with the heart’s electrical system. It means that the heart’s natural pacemaker isn’t working right or that the electrical pathways of the heart are disrupted. In severe forms of bradycardia, the heart beats so slowly that it doesn’t pump enough blood to meet the body’s needs. This can cause symptoms and can be life-threatening.

Men and women age 65 and older are most likely to develop a slow heart rate that needs treatment. As a person ages, the electrical system of the heart often doesn’t function normally.

What causes bradycardia?

Bradycardia can be caused by:

  • Changes in the heart that are the result of aging.
  • Diseases that damage the heart’s electrical system. These include coronary artery disease, heart attack, and infections such asendocarditis and myocarditis.
  • Conditions that can slow electrical impulses through the heart. Examples include having a low thyroid level (hypothyroidism) or anelectrolyte imbalance, such as too much potassium in the blood.
  • Some medicines for treating heart problems or high blood pressure, such as beta-blockers, antiarrhythmics, and digoxin.

What are the symptoms?

A very slow heart rate may cause you to:

  • Feel dizzy or lightheaded.
  • Feel short of breath and find it harder to exercise.
  • Feel tired.
  • Have chest pain or a feeling that your heart is pounding or fluttering (palpitations).
  • Feel confused or have trouble concentrating.
  • Faint, if a slow heart rate causes a drop in blood pressure.

Some people don’t have symptoms, or their symptoms are so mild that they think they are just part of getting older.

You can find out how fast your heart is beating by taking your pulse . If your heartbeat is slow or uneven, talk to your doctor.

How is bradycardia diagnosed?

Your doctor may take your pulse to diagnose bradycardia. Your doctor might also do a physical exam, ask questions about your past health, and do an electrocardiogram (EKG or ECG). An EKG measures the electrical signals that control heart rhythm.

Bradycardia often comes and goes, so a standard EKG done in the doctor’s office may not find it. An EKG can identify bradycardia only if you are actually having it during the test.

You may need to use a portable (ambulatory) electrocardiogram. This lightweight device is also called a Holter monitor or a cardiac event monitor. You wear the monitor for a day or more, and it records your heart rhythm while you go about your daily routine.

You may also have blood tests to find out if another problem is causing your slow heart rate.

How is it treated?

How bradycardia is treated depends on what is causing it. Treatment also depends on the symptoms. If bradycardia doesn’t cause symptoms, it usually isn’t treated.

  • If damage to the heart’s electrical system causes your heart to beat too slowly, you will probably need to have a pacemaker. A pacemaker is a device placed under your skin that helps correct the slow heart rate. People older than 65 are most likely to have a type of bradycardia that requires a pacemaker.
  • If another medical problem, such as hypothyroidism or an electrolyte imbalance, is causing a slow heart rate, treating that problem may cure the bradycardia.
  • If a medicine is causing your heart to beat too slowly, your doctor may adjust the dose or prescribe a different medicine. If you cannot stop taking that medicine, you may need a pacemaker.

The goal of treatment is to raise your heart rate so your body gets the blood it needs. If severe bradycardia isn’t treated, it can lead to serious problems. These may include fainting and injuries from fainting, as well as seizures or even death.

What can you do at home for bradycardia?

Bradycardia is often the result of another heart condition, so taking steps to live a heart-healthy lifestyle will usually improve your overall health. The steps include:

  • Having a heart-healthy eating plan that includes a lot of fruits, vegetables, whole grains, fish, and low-fat or nonfat dairy foods.
  • Being active on most, if not all, days of the week. Your doctor can tell you what level of exercise is safe for you.
  • Losing weight if you need to, and staying at a healthy weight.
  • Not smoking.
  • Managing other health problems, such as high blood pressure or high cholesterol.

Get emergency help if you fainted or if you have symptoms of a heart attack or have severe shortness of breath. Call your doctor right away if your heart rate is slower than usual, you feel like you might pass out, or you notice increased shortness of breath.


Most people who get pacemakers lead normal, active lives. You will need to avoid things that have strong magnetic and electrical fields. These can keep your device from working right. But most electronic equipment and appliances are safe to use.

Your doctor will check your pacemaker regularly. Call your doctor right away if you have symptoms that could mean your device isn’t working right, such as:

  • Your heartbeat is very fast or slow, skipping, or fluttering.
  • You feel dizzy, lightheaded, or like you might faint.
  • You have shortness of breath that is new or getting worse.

Cardiac Clearance

At Manatee Cardiovascular, our providers are here to assist with cardiac clearances that are necessary for patients to obtain to have many other kinds of surgeries. Ensuring that you, your loved one, or your patient is able to obtain an optimal cardiac clearance provides you with the peace of mind that a successful surgery and/or procedure is on the way.

Cardiovascular Genetics

At Manatee Cardiovascular, our providers help evaluate and treat patients and family members with known or suspected inherited cardiovascular disease. Our team utilizes leading genetic technology to provide the most comprehensive medical diagnoses and care.

What is Cardiovascular Genetics?

Cardiovascular genetics involves the study of family genetics to offer a comprehensive evaluation, diagnosis and disease management solution for people who are at risk for or have inherited a cardiac disorder. Heritable factors underlie a number of cardiovascular diseases including diseases of the heart’s muscle, electrical system and vasculature. These inherited heart conditions, sometimes referred to as cardiovascular genetic disorders, may go undiagnosed for years before being recognized or causing symptoms. Our heart team can evaluate a patient’s symptoms, physical examination, family history and genetic testing in order to provide a risk assessment to help establish a personalized diagnosis and proper preventative.

What is a Cardiovascular Genetic Evaluation?

Our patients receive a comprehensive evaluation for suspected or diagnosed disorders, including the following:

  • Inherited arrhythmias, including:
    • Long QT syndrome
    • Brugada syndrome
    • Catecholaminergic polymorphic ventricular tachycardia (CPVT)
    • Familial sudden death
  • Inherited cardiomyopathies, including:
    • Hypertrophic Cardiomyopathy (HCM)
    • Dilated cardiomyopathy (DCM)
    • Arrhythmogenic cardiomyopathy, also called Arrhythmogenic right ventricular cardiomyopathy)
  • Premature coronary artery disease and myocardial infarction
  • Inherited cholesterol disorders

DNA Testing

If appropriate, we can offer a precise DNA test, that aids our team in identifying and understanding the specific factors that put patients at risk for certain cardiac diseases or disorders. The test analyzes multiple genes known to underlie cardiovascular conditions. The test uses rapid and sensitive gene-sequencing technology to check dozens of heart disease genes simultaneously to identify the likely genetic cause. At Manatee Cardiovascular, these complex results are evaluated by our team to help patients and families formulate a comprehensive care plan. The test is able to report on as many as 80 genes.

Among many benefits to genetic testing is the ability to offer cascade testing in relatives who have potentially inherited the risk for disease. Through this testing, at-risk family members may be tested for the same inherited factor that contributes to the development of the disease in the family to see if they carry the genetic mutation and if they need to be monitored.

Cardiovascular Second Opinion

The Second Opinion Program at Manatee Cardio’s Heart & Vascular Center is necessary for anyone who is aiming assurance regarding their health or the health of a loved one. Our providers spend the time to help you understand your options and to customize a care plan specifically for you. A second opinion can ease your mind, possibly prevent an unnecessary procedure, or provide you with an alternative option to consider.

Do You Need a Second Opinion?

The Second Opinion Program was created for patients diagnosed with any heart condition, or for patients who have been told they need a heart-related surgical procedure.

Some patients have already had heart surgery and are now experiencing new symptoms. Others want to know if their medication regimen is the best for them. We also see patients who feel like they aren’t being taken seriously, or patients who want to explore every option and seek the latest advancements in surgical and medical treatment. These are all legitimate reasons to seek a second opinion.

Some of the diagnoses or procedures we typically provide second opinions for include:

  • Peripheral Vascular Disease
  • Atrial fibrillation
  • Heart failure
  • Cardiac catheterization
  • Ablation
  • Mitral or aortic valve repair or replacement
  • Minimally invasive heart surgery
  • Transmyocardial revascularization
  • Left Ventricular Assist Device (LVAD)
  • Aneurysm
  • Arrhythmia
  • Stents
  • Cardiomyopathy
  • Hypertrophic cardiomyopathy (HCM)
  • Other cardiovascular disease

What Do We Need? Your Medical Records

Before we can offer a second opinion, we must first review your medical records. We will provide you a list of the records that are needed from your physician. You can request the records yourself or we can help get them for you. If you would like our help, we will email, fax or mail you a medical release form to sign and return to that authorizes us to contact your physician for your medical records.

Cardiac Imaging and Diagnostics

The first step in any successful treatment is fast, accurate and complete diagnosis. Manatee cardiovascular specializes in advanced cardiovascular imaging and diagnostic services. Our clinicians take a collaborative approach with referring physicians, radiologists, and surgeons to assess each patient’s situation and develop the best course of treatment.

The Manatee Cardio’s Heart & Vascular Center has the most sophisticated imaging equipment available and the experience and expertise to apply it and interpret results.


Cardiomyopathy is a heart disease. The damaged heart does not pump blood correctly. The disease usually progresses, and patients develop life-threatening heart failure. People with cardiomyopathy are also more likely to have irregular heartbeats or arrhythmias.

There are two categories of cardiomyopathy: ischemic and non-ischemic. Ischemic cardiomyopathy is most common. It occurs when the heart is damaged from heart attacks due to coronary artery disease. Non-ischemic cardiomyopathy is less common. It includes types of cardiomyopathy that are not related to coronary artery disease.

There are three main types of non-ischemic cardiomyopathy:

  • Dilated—Damaged heart muscles lead to an enlarged, floppy heart. The heart stretches as it tries to make up for a weakened ability to pump.
  • Hypertrophic—Heart muscle fibers enlarge abnormally. The heart does not relax correctly between beats. The heart wall thickens, leaving less space for blood to fill the chambers, so less blood is pumped from the heart.
  • Restrictive—Parts of the heart wall stiffen. Thickening often occurs due to abnormal tissue invading the heart.
  • Normal Heart and Heart With Hypertrophic Cardiomyopathy



In many cases, the exact cause is not known. Possible causes include:


The cause of the initial damage is often not found, but may include:

  • Ischemic heart disease with decreased blood flow to your heart
  • Infections, usually viral
  • Chronic exposure to toxins, including alcohol and some chemotherapy drugs
  • A rare complication of pregnancy or childbirth (probably immune-related)
  • Rarely, other illnesses, including rheumatoid arthritis , diabetes, or thyroid disease


Causes may include:

  • Inherited—sometimes present at birth but often developing in teens
  • Aging, associated with hypertension


Causes are usually related to another condition, such as:

  • Amyloidosis —Protein fibers collect in the heart
  • Sarcoidosis —Small inflammatory masses (granulomas) form in many organs
  • Hemochromatosis —Too much iron in the body

Risk Factors

Factors that increase your chance of getting cardiomyopathy include:

  • Family members with cardiomyopathy
  • Alcoholism
  • Obesity
  • Diabetes
  • Hypertension
  • Coronary artery disease
  • Certain drugs


Symptoms vary, depending on the type of cardiomyopathy and its severity.

Cardiomyopathy leads to heart failure and the following symptoms:

  • Fatigue
  • Weakness
  • Shortness of breath, often worse when lying down or with activity
  • Cough
  • Swelling in feet or legs
  • Chest pain
  • Irregular heart rhythm


You will be asked about your symptoms and medical history. A physical exam will be done. A stethoscope will be used to listen to your heart. Cardiomyopathies often produce heart murmurs and other abnormal sounds.

Images of your chest may be needed. This can be done with:

Tests may be done to determine how your heart functions. These can be done with:

Your bodily fluids and tissue may need to be tested. This can be done with:

  • Blood tests
  • Heart biopsy


Heart failure may be due to blockages in the arteries. Treatments to relieve these blockages include angioplasty, stent placement, and coronary artery bypass surgery. These may lead to improved heart function and symptoms. For certain genetic causes, other treatments may also improve heart function. For many patients, however, treatment is aimed at relieving symptoms and preventing further damage.

Lifestyle Modification

  • Changes to eliminate anything that adds to the disease or worsens symptoms:
  • Avoid alcohol.
  • If you are overweight, talk to your doctor about ways to help you lose weight.
  • Eat a low-fat diet to reduce the risk and extent of coronary artery disease.
  • Limit salt intake to reduce fluid retention.
  • Follow your doctor’s advice about exercise. You may need to limit physical activity.


Medications may include:

  • Diuretics—To remove extra fluid
  • Angiotensin-converting enzyme (ACE) inhibitors—To relax blood vessels, lower blood pressure, and decrease the heart’s workload
  • Angiotensin receptor blockers—Similar to ACE inhibitors
  • Hydralazine and isosorbide dinitrate—May be used with ACE inhibitors
  • Digitalis—To slow and regulate heart rate, and slightly increase its force of contractions
  • Beta-blockers—To slow the heart and limit disease progression
  • Spironolactone—To improve the outcome in people with dilated cardiomyopathy and advanced symptoms


Surgical options include:

  • A pacemaker may be implanted to improve heart rate and pattern.
  • For people with hypertrophic disease, doctors may remove part of the thickened wall that separates the heart’s chambers. Surgery may be needed to replace a heart valve. Another option is alcohol septal ablation. This procedure reduces symptoms and improves how the heart functions.
  • For those with life-threatening, irregular heart rhythms, a cardioverter defibrillator may need to be implanted.
  • A heart transplant may be possible for otherwise healthy patients who do not respond to medical treatment. Candidates often wait a long time for a new heart. Those waiting may temporarily receive a ventricular assist device. This is a mechanical pump that takes over some or most of the heart’s pumping function.


Actively treat hypertension, coronary artery diseases, and their risk factors. This is the best way to prevent most cases of cardiomyopathy. However, other less common causes are not preventable. If you have a family history of the disease, ask your doctor about screening tests. Do this especially before starting an intense exercise program.

Carotid Artery Disease

What is it and what causes it?

Carotid artery stenosis occurs when the carotid arteries narrow. The carotid arteries are major arteries found on each side of the neck. They supply blood from the heart to the brain.

This condition is a major risk factor for ischemic stroke . Ischemic stroke is when blood flow to the brain is blocked due to blood clots.

Blood Supply to the Brain

Blood Supply to the Brain

Carotid artery stenosis is caused by the build-up of plaque along the lining of the arteries. This build-up is known as atherosclerosis . Plaque is made up of cholesterol, fat, and other substances


Carotid artery stenosis is more common in men aged 75 or younger and women aged 75 or older. Risk factors include:

  • Family history of atherosclerosis
  • Coronary artery disease
  • Peripheral artery disease (PAD)—disease of the arteries (usually in the legs) caused by fatty build-up
  • Smoking
  • High blood pressure
  • Diabetes
  • High cholesterol
  • Obesity


There are usually no symptoms. Tell your doctor if you have symptoms of a stroke or a transient ischemic attack (TIA or mini-stroke). This is a warning sign that you may have carotid artery stenosis. Symptoms may include:

  • Blindness, blurry or dim vision
  • Weakness, numbness, or tingling of the face, arm, leg, or one side of the body
  • Difficulty speaking or understanding words
  • Lightheadedness, unsteadiness of gait, or falling
  • Trouble with balance or coordination
  • Loss of consciousness
  • Nausea or vomiting
  • Sudden confusion or loss of memory


You will be asked about your symptoms and medical history. A physical exam will be done.

Images may be needed of your internal structures. This can be done with:

  • Carotid ultrasonography
  • Computer tomography angiography (CTA)
  • Magnetic resonance angiography (MRA)


The goal of treatment is to prevent carotid artery stenosis from causing inadequate blood flow to the brain or causing a stroke. Treatment will depend on:

  • The severity of your condition
  • Your symptoms

Talk with your doctor about the best treatment plan for you. Treatment options include:

Medication and Lifestyle Changes

If there are no symptoms and if plaque build-up is not severe, medications like aspirin may be given to help prevent a stroke from occurring. Lifestyle changes are also an important part of treatment. Some actions you can take to reduce your risk of stroke include:

  • Eat a  healthy diet.
  • Exercise regularly.
  • If you  smoke, talk to your doctor about ways to quit.
  • If you have diabetes, get proper treatment.
  • If you have high cholesterol, work with your doctor to lower the levels.
  • If you have high blood pressure, work to get it under control.


Surgery may be needed if the arteries have severe plaque build-up. One kind of surgery is called  carotid endarterectomy . This involves opening the artery and cleaning the plaque from it. Another surgery that may be done is carotid angioplasty and stenting. In this surgery, a balloon is inserted into the artery to widen it. Then a metal mesh, called a stent, is inserted to keep the artery open so that blood can flow freely.


To help reduce your chance of getting carotid artery stenosis, you will need to decrease the risk factors that you can control. For example, you can reduce your cholesterol, blood pressure, and weight. Here are some steps to decrease these risk factors:

  • Exercise regularly.
  • Eat more fruits and vegetables. Limit dietary salt and fat.
  • If you smoke, talk to your doctor about ways to quit.
  • If you drink alcohol, do so only in moderation. This means having no more than 2 drinks per day if you are a man, and no more than 1 drink per day if you are woman.
  • Maintain a healthy weight.
  • Keep your blood pressure in a safe range. Follow your doctor’s recommendations if you have high blood pressure.
  • Keep other conditions under control. This includes high cholesterol and diabetes.

Chest Pain (Angina)

chest-painAngina, or angina pectoris, is a medical term for the symptoms caused by the heart not getting enough oxygen from the arteries that supply the heart with blood. When these arteries become narrowed or blocked over time, it is called coronary artery disease (CAD), and it can cause angina. Most commonly, people describe their symptoms of angina as chest discomfort or pain.

Angina can be stable or unstable. When angina becomes unstable, it is commonly associated with a heart attack, which is a medical emergency. Stable angina is not usually an emergency, but it can be painful and frightening. We invite you to use the article in this center to learn more about angina and how you and your healthcare team can work together on a treatment plan that is right for you.

Cholesterol Management (High Cholesterol)

Cholesterol is a type of lipid in the blood. High cholesterol is an abnormally high level of cholesterol in the blood.

There are different types of cholesterol in your blood including:

  • Low density lipoproteins (LDL)—causes build up of cholesterol and other fats in the blood vessels. Known as bad cholesterol because high levels can cause disease in the arteries and heart disease.
  • High density lipoproteins (HDL)—can remove cholesterol and other fats from the blood. Known as good cholesterol because it may protect against heart disease.

Causes of high cholesterol include:

  • Genetics
  • High-fat diet
  • Overweight
  • Sedentary lifestyle

Risk Factors

The risk of high cholesterol increases with age. It is more common in men. It is also more common in women after menopause.

Factors that may increase your risk of high cholesterol include:

  • Family members with high cholesterol
  • High-fat diet
  • Obesity, overweight
  • Sedentary lifestyle


It is rare for high cholesterol to cause symptoms. However, high cholesterol can increase your risk of atherosclerosis . This is a dangerous hardening of the arteries. It can block the flow of blood. Some complications of atherosclerosis include:

  • Angina
  • Heart attack
  • Stroke
  • Peripheral artery disease
  • Other serious complications

Some people with high cholesterol may also have cholesterol deposits in tendons, under the eyes, or in the eye.




You will be asked about your symptoms and medical history. A physical exam will be done. You will be asked about factors that may increase your risk of heart disease or stroke.

A blood test will also be done. Blood will be sent to a lab to measure lipid levels in your blood. Tests may include:

  • Total cholesterol
  • HDL cholesterol
  • LDL cholesterol
  • Triglycerides

Other tests may be done to look for other conditions that can be associated with high cholesterol levels.

Treatment & Prevention

Talk to your doctor about the best treatment plan for you. Treatment is aimed at decreasing your LDL cholesterol levels and decreasing your risk for heart disease and stroke. Options include:

Nutritional Changes

Talk to your doctor about the best meal plan for you. Consider the following changes:

  • Balance the amount of calories you are eating with the amount of calories you use through physical activity and basic body functions. This will help you reach or maintain a healthy weight.
  • Eat a diet that is high in fruits and vegetables.
  • Include foods that are whole grain and high in fiber.
  • Eat fish at least twice per week.
  • Limit foods with saturated fats, trans fats, or cholesterol.
  • Avoid processed and refined sugars and starches. This includes white bread, white potatoes, white rice, and simple sugars like soda.
  • Choose and prepare foods with little or no salt.
  • Consider drinking green or black tea, which have been shown to help reduce cholesterol.
  • If you drink alcohol, drink in moderation.

Lifestyle Changes

  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, talk to your doctor about ways to quit.
  • If you are overweight, talk to your doctor about ways to lose weight.
  • Make sure other medical conditions, such as high blood pressure and diabetes, are being treated and controlled.

Cholesterol-Lowering Medication

You may be prescribed statins to help lower your cholesterol. Statins have been shown to reduce mortality, heart attacks, and stroke.

These medications are best used as additions to diet and exercise. They should not be use in place of healthy lifestyle changes.


Claudication is pain caused by too little blood flow, usually during exercise. Sometimes called intermittent claudication, this condition generally affects the blood vessels in the legs, but claudication can affect the arms, too.

At first, you’ll probably notice the pain only when you’re exercising, but as claudication worsens, the pain may affect you even when you’re at rest.

Although it’s sometimes considered a disease, claudication is technically a symptom of a disease. Most often, claudication is a symptom of peripheral artery disease, a potentially serious but treatable circulation problem in which the vessels that supply blood flow to your legs or arms are narrowed.

Fortunately, with treatment, you may be able to maintain an active lifestyle without pain.

Claudication symptoms include:

  • Pain when exercising. You may feel pain or discomfort in your feet, calves, thighs, hips or buttocks, depending on where you might have artery narrowing or damage. Claudication can also occur in your arms, although this is less common.
  • Intermittent pain. Your pain may come and go as you do less-strenuous activities.
  • Pain when at rest. As your condition progresses, you may feel pain in your legs even when you’re sitting or lying down.
  • Discolored skin or ulcerations. If blood flow is severely reduced, your toes or fingers may look bluish or feel cold to the touch. You may also develop sores on your lower legs, feet, toes, arms or fingers.

Other possible symptoms include:

  • An aching or burning feeling
  • Weakness

When to see a doctor

Talk to your doctor if you have pain in your legs or arms when you exercise. If left untreated, claudication and peripheral artery disease can reduce the quality of your life and lead to potentially life-threatening complications. Claudication may limit your ability to participate in social and leisure activities, interfere with work, and make exercise intolerable.

Claudication is most often a symptom of peripheral artery disease. In peripheral artery disease, the arteries that supply blood to your limbs are damaged, usually as a result of atherosclerosis. Atherosclerosis can develop in any of your arteries, especially those in your heart. When atherosclerosis affects your arms and legs, it’s called peripheral artery disease.

Atherosclerosis narrows the arteries and makes them stiffer and harder. That’s because the arteries get clogged with clumps of fat, cholesterol and other material, called atherosclerotic plaques. These plaques can make arteries so narrow that less blood can flow through them. You feel pain because your leg muscles are not getting enough oxygenated blood. Oxygen is the fuel that muscles need to contract.

Atherosclerosis isn’t the only possible cause of your symptoms of claudication. Other conditions associated with similar symptoms that need to be considered include spinal stenosis, peripheral neuropathy, certain musculoskeletal conditions and deep venous thrombosis.

The risk factors for claudication are the same as those for developing atherosclerosis, including:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Obesity (a body mass index over 30)
  • Diabetes
  • Age older than 70 years
  • Age older than 50 years if you also smoke or have diabetes
  • A family history of atherosclerosis, peripheral artery disease or claudication

Coronary Artery Disease

Nearly 16 million Americans suffer from coronary artery disease—the number one killer of both men and women in the U.S. This condition occurs when the small blood vessels that bring blood and oxygen to the heart narrow, reducing blood supply. Our providers specialize in diagnosing and treating coronary artery disease, giving our patients the best chance of a successful recovery and healthy life.

Understanding Coronary Artery Disease

Coronary artery disease is caused by the accumulation of fatty deposits along the inside of the coronary arteries. These deposits, called atherosclerosis, decrease the amount of room available for blood to flow through. Since coronary arteries deliver blood to the heart muscle, any decrease in blood flow can have serious consequences. If left untreated, coronary artery disease can lead to chest pain (angina), shortness of breath, heart attack and possibly death.

Several factors can increase your chance of coronary artery disease, including:

  • high LDL cholesterol, high triglycerides levels and reduced HDL cholesterol
  • high blood pressure (hypertension)
  • physical inactivity
  • smoking
  • obesity
  • diabetes
  • genetic predisposition

Symptoms vary in each person, with some patients having no noticeable symptoms. Typically, as less and less oxygenated blood reaches the heart, chest pain results. If the blood supply is completely cut off, the heart muscle begins to die and a heart attack occurs.

Other symptoms of coronary artery disease may include shortness of breath, weakness, fatigue and pain radiating in the arms, shoulders, jaw, neck, and/or back.

Complications from Coronary Artery Disease

Coronary artery disease can lead to myocardial infarctions, or heart attacks. A heart attack occurs when a coronary artery becomes partially or completely blocked by a blood clot. This blockage causes portions of the heart muscle being supplied with blood by that artery to become infarcted (to die).

A STEMI (segment elevated myocardial infarction) is a type of heart attack in which the artery is completely blocked by the blood clot. When a patient experiences a STEMI, all of the heart muscle areas being supplied by the blocked artery start to die. This can lead to a condition known as heart failure, where the heart does not pump blood adequately, leading to shortness of breath and fatigue.

Coronary Artery Disease Treatment

While successful and long-term treatment of coronary artery disease includes a modification of risk factors and adoption of a healthier lifestyle (See our Wellness Programs), there are several medical and surgical treatments available as well.

Click here to see our Services & Treatments

Congenital Heart Disease

Congenital heart disease (congenital heart defect) is an abnormality in your heart’s structure that you’re born with. Although congenital heart disease is often considered a childhood condition, advances in surgical treatment mean most babies who once died of congenital heart disease survive well into adulthood.

While medical advances have improved, many adults with congenital heart disease may not be getting proper follow-up care. If you had a congenital heart defect repaired as an infant, you likely still need care as an adult.

Find out if and when you should check with your doctor, if you’re likely to have complications, or if you’re at greater risk of other heart problems as an adult.

Symptoms or signs of congenital heart disease may not show up until later in life. They may recur years after you’ve had treatment for a heart defect. Some common congenital heart disease symptoms you may have as an adult include:

  • Abnormal heart rhythms (arrhythmias)
  • A bluish tint to the skin (cyanosis)
  • Shortness of breath
  • Tiring quickly upon exertion
  • Dizziness or fainting
  • Swelling of body tissue or organs (edema)



Headshot senior man with vertigo suffering from dizzinessWhen you’re dizzy, you may feel lightheaded or lose your balance. If you feel that the room is spinning, you have vertigo.

A sudden drop in blood pressure or being dehydrated can make you dizzy. Many people feel lightheaded if they get up too quickly from sitting or lying down.

Dizziness usually gets better by itself or is easily treated. However, it can be a symptom of other disorders. Medicines may cause dizziness, or problems with your ear. Motion sickness can also make you dizzy. There are many other causes.

If you are dizzy often, you should see your health care provider to find the cause.


Edema is the medical term for swelling. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, infections, pregnancy, and many other medical problems can cause edema.

Edema happens when your small blood vessels become “leaky” and release fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell.

Causes of Edema

Things like a twisted ankle, a bee sting, or a skin infection will cause edema. In some cases, like an infection, this may be helpful. More fluid from your blood vessels puts more infection-fighting white blood cells in the swollen area.

Edema can also come from other conditions or from when the balance of substances in your blood is off. For example:

Low albumin: Your doctor may call this hypoalbuminemia. Albumin and other proteins in the blood act like sponges to keep fluid in your blood vessels. Low albumin may contribute to edema, but it’s not usually the only cause.

Allergic reactions: Edema is a part of most allergic reactions. In response to the allergen, nearby blood vessels leak fluid into the affected area.

Obstruction of flow: If drainage of fluid from a part of your body is blocked, fluid can back up. A blood clot in the deep veins of your leg can cause leg edema. A tumor blocking the flow of blood or another fluid called lymph can cause edema.

Critical illness: Burns, life-threatening infections, or other critical illnesses can cause a reaction that allows fluid to leak into tissues almost everywhere. This can cause edema all over your body.

Heart disease ( congestive heart failure ): When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs quickly, fluid in the lungs, known as pulmonary edema, can develop. If your heart failure is on the right side of your heart, edema can develop in the abdomen, as well.

Liver disease: Severe liver disease (such as cirrhosis) causes you to retain fluid. Cirrhosis also leads to low levels of albumin and other proteins in your blood. Fluid leaks into the abdomen and can also cause leg edema.

Kidney disease : A kidneycondition called nephrotic syndrome can result in severe leg edema and sometimes whole-body edema.

Pregnancy: Mild leg edema is common during pregnancy. But serious complications of pregnancy like deep vein thrombosis and preeclampsia can also cause edema.

Cerebral edema ( brain edema ): Head trauma, low blood sodium (called hyponatremia), high altitudes, brain tumors, and a block in fluid drainage (known as hydrocephalus) can cause edema. Headaches, confusion, unconsciousness, and coma can be symptoms of cerebral edema.

Medications : Many medicines can cause edema, including:

  • NSAIDs (such as ibuprofen and naproxen)
  • Calcium channel blockers
  • Corticosteroids (like prednisone and methylprednisolone)
  • Pioglitazone and rosiglitazone
  • Pramipexole

When they cause swelling, usually it’s mild leg edema.

Symptoms of Edema

Your symptoms will depend on the amount of edema you have and where you have it.

Edema in a small area from infection or inflammation (like a mosquito bite) may cause no symptoms at all. On the other hand, a large allergic reaction (such as from a bee sting) may cause edema on your entire arm that can bring tense skin, pain, and limited movement.

Food allergies may cause tongue or throat edema. This can be life-threatening if it interferes with your breathing.

Leg edema can make the legs feel heavy. This can affect walking. In edema and heart disease, for example, the legs may easily weigh an extra 5 or 10 pounds each. Severe leg edema can interfere with blood flow, leading to ulcers on the skin.

Pulmonary edema causes shortness of breath and sometimes low oxygen levels in the blood. Some people with pulmonary edema may have a cough.

Treatment of Edema

To treat edema, you often must treat its underlying cause. For example, you might take allergy medications to treat swelling from allergies.

Edema from a block in fluid drainage can sometimes be treated by getting the drainage flowing again. A blood clot in the leg is treated with blood thinners. They break down the clot and get drainage back to normal. A tumor that blocks blood or lymph can sometimes be shrunk or removed with surgery, chemotherapy, or radiation.

Leg edema related to congestive heart failure or liver disease can be treated with a diuretic (sometimes called a “water pill”) like furosemide(Lasix). When you can pee more, fluid from the legs can flow back into the blood. Limiting how much sodium you eat can also help.

Enlarged Heart

An enlarged heart (cardiomegaly) isn’t a disease, but rather a symptom of another condition.
The term “cardiomegaly” most commonly refers to an enlarged heart seen on a chest X­ray. Other tests are then needed to diagnose the condition causing your enlarged heart.

You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.

An enlarged heart may be treatable by correcting the cause. Treatment for an enlarged heart can include medications, medical procedures or surgery. In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:

  • Shortness of breath
  • Abnormal heart rhythm (arrhythmia)
  • Swelling (edema)

First Opinions, Second Opinions, New Options for Patients with Complex Heart Problems

consultative-cardiology-page-photoOur Consultative Cardiology Program provides an integrative approach to the diagnostic evaluation of the cardiovascular system and to the formulation of short- and long-term therapeutic strategies for cardiac patients. Our program offers all patients with cardiovascular disease or suspected cardiovascular disease access to the highest level of specialization and medical expertise.

Our cardiologists and their support staff provide individualized coordinated care plans that evaluate our patients’ needs to enable us to adjust current plans or suggest alternative therapeutic approaches when indicated. Our team routinely confers not only with patients and their families but also our patients’ primary-care physicians and cardiologists, in order to coordinate an optimal and seamless approach to care.

Our cardiologists address the full range of cardiovascular conditions and symptoms including:

  • Abnormal heart rhythms
  • Angina (chest pain)
  • Coronary artery disease
  • Heart failure
  • Valvular Heart Disease
  • Heart disease with unique characteristics including those that are related to race, gender, ethnicity, age and co-existing conditions.
  • Arrhythmia
  • PAD
Bradenton Heart Center routinely accepts referrals of patients from other medical centers to its cardiology team for consultation and assessment. We welcome patients seeking second opinions or who have questions about diagnosis or treatment plans prescribed by their current physicians experiencing difficulties or failing to improve as hoped.

Heart Disease Prevention

Heart disease is the leading cause of death in the United States, and a major cause of disability. Nearly 2,500 Americans die of cardiovascular disease each day, which is an average of one death ever 35 seconds.

American’s risk of death due to heart disease or stroke continues to grow:

  • 7 out of 1,000 men will experience their first major cardiovascular event between the age of 35 and 44.
  • Over 152,000 Americans who are killed by heart disease or stroke are under the age of 65.
  • Heart disease kills more Americans than the next four leading causes of death combined, which are cancer, chronic lower respiratory diseases, accidents, and diabetes.
  • Within a year of having a stroke up to a quarter of patients will die.
  • Over 4.5 million visits to emergency departments are due to cardiovascular disease.

Fortunately, there are many ways to prevent getting heart disease. We are dedicated to promoting heart-healthy lifestyle choices, prevention and screening tools and research to help decrease the prevalence of heart disease.

Learn more about how to prevent heart disease >

Heart Failure

Heart failure is a serious condition in which the heart does not pump well enough to meet the body’s demand for oxygen. Heart failure can result from a damaged or weakened left ventricle (known as systolic dysfunction) or a stiff ventricle (known as diastolic dysfunction).

Conditions that could lead to the development of heart failure include:

  • coronary artery disease
  • high blood pressure (hypertension)
  • heart attack
  • cardiomyopathy
  • valvular heart disease (i.e., valvular stenosis or valvular regurgitation)
  • infection in the heart valves (valvular endocarditis) or of the heart muscle (myocarditis)
  • congenital heart disease
  • severe lung disease (i.e., pulmonary hypertension)
  • persistent tachycardia and arrhythmias

Symptoms of Heart Failure

Signs and symptoms of heart failure develop when the vital organs of the body do not receive adequate blood supply. If left untreated, blood starts to back up into the veins leading to the heart. This causes fluid buildup in the lungs and other parts of the body, causing increased shortness of breath with limited exertion or while lying flat.

Other advanced symptoms include:

  • persistent coughing or wheezing  (especially when lying down)
  • fatigue, weakness
  • feeling of suffocation while sleeping
  • shortness of breath
  • increased heart rate
  • fluid buildup (edema), especially in the legs, ankles and feet
  • sudden weight gain
  • nausea, abdominal swelling, tenderness or pain

Diagnosing Heart Failure

Once heart failure is suspected, the diagnosis is confirmed with a careful history and examination. Imaging tests are necessary to evaluate heart function, determine the underlying cause of heart dysfunction and develop a treatment plan.

Tests and procedures used to diagnose heart failure may include:

  • echocardiogram (ultrasound test of the heart)
  • magnetic resonance imaging (MRI)
  • stress testing (echocardiogram or nuclear imaging)
  • cardiac catheterization

Heart Murmur

A heart murmur isn’t a disease. It’s an extra or unusual sound heard during the heartbeat. Thus, murmurs themselves don’t require treatment. However, if an underlying condition is causing a heart murmur, your doctor may recommend treatment for that condition.

Heart murmurs are sounds during your heartbeat cycle — such as whooshing or swishing — made by turbulent blood in or near your heart. These sounds can be heard with a stethoscope. A normal heartbeat makes two sounds like “lubb-dupp” (sometimes described as “lub-DUP”), which are the sounds of your heart valves closing.

Heart murmurs can be present at birth (congenital) or develop later in life. A heart murmur isn’t a disease — but murmurs may indicate an underlying heart problem.

Often, heart murmurs are harmless (innocent) and don’t need treatment. Some heart murmurs may require follow-up tests to be sure the murmur isn’t caused by a serious underlying heart condition. Treatment, if needed, is directed at the cause of your heart murmur.

There are two types of heart murmurs: innocent murmurs and abnormal murmurs. A person with an innocent murmur has a normal heart. This type of heart murmur is common in newborns and children.

An abnormal heart murmur is more serious. In children, abnormal murmurs are usually caused by congenital heart disease. In adults, abnormal murmurs are most often due to acquired heart valve problems.

Innocent heart murmurs

An innocent murmur can occur when blood flows more rapidly than normal through the heart. Conditions that may cause rapid blood flow through your heart, resulting in an innocent heart murmur, include:

  • Physical activity or exercise
  • Pregnancy
  • Fever
  • Not having enough healthy red blood cells to carry adequate oxygen to your body tissues (anemia)
  • An excessive amount of thyroid hormone in your body (hyperthyroidism)
  • Phases of rapid growth, such as adolescence

Innocent heart murmurs may disappear over time, or they may last your entire life without ever causing further health problems.

Abnormal heart murmurs

The most common cause of abnormal murmurs in children is when babies are born with structural problems of the heart (congenital heart defects).

Common congenital defects that cause heart murmurs include:

  • Holes in the heart or cardiac shunts. Known as septal defects, holes in the heart may or may not be serious, depending on the size of the hole and its location.Cardiac shunts occur when there’s an abnormal blood flow between the heart chambers or blood vessels, which may lead to a heart murmur.
  • Heart valve abnormalities. Congenital heart valve abnormalities are present at birth, but sometimes aren’t discovered until much later in life. Examples include valves that don’t allow enough blood through them (stenosis) or those that don’t close properly and leak (regurgitation), such as mitral valve prolapse.

Other causes of abnormal heart murmurs include infections and conditions that damage the structures of the heart and are more common in older children or adults. For example:


  • Valve calcification. This hardening or thickening of valves, as in mitral stenosis or aortic valve stenosis, can occur as you age. Valves may become narrowed (stenotic), making it harder for blood to flow through your heart, resulting in murmurs.
  • Endocarditis. This infection of the inner lining of your heart and valves typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and lodge in your heart.Left untreated, endocarditis can damage or destroy your heart valves. This condition usually occurs in people who already have heart valve abnormalities.
  • Rheumatic fever. Although now rare in the United States, rheumatic fever is a serious condition that can occur when you don’t receive prompt or complete treatment for a strep throat infection. It can permanently affect the heart valves and interfere with normal blood flow through your heart.


There are risk factors that increase your chances of developing a heart murmur, including:

  • Family history of a heart defect. If blood relatives have had a heart defect, that increases the likelihood you or your child may also have a heart defect and heart murmur.
  • Certain medical conditions, including uncontrolled high blood pressure (hypertension), hyperthyroidism, an infection of the lining of the heart (endocarditis), high blood pressure in the lungs (pulmonary hypertension), carcinoid syndrome, hypereosinophilic syndrome, systemic lupus erythematosus, rheumatoid arthritis, a weakened heart muscle or a history of rheumatic fever, can increase your risk of a heart murmur later in life.

Factors that increase your baby’s risk of developing a heart murmur include:

  • Illnesses during pregnancy. Having some conditions during pregnancy, such as uncontrolled diabetes or a rubella infection, increases your baby’s risk of developing heart defects and a heart murmur.
  • Taking certain medications or illegal drugs during pregnancy. Use of certain medications, alcohol or drugs can harm a developing baby, leading to heart defects.

Hypertension Management (High Blood Pressure)

High blood pressure is abnormally high blood pressure with no known cause. Blood pressure measurements are read as two numbers:

  • Systolic pressure: higher number, normal reading is 120 millimeters of mercury (mmHg) or less
  • Diastolic pressure: lower number, normal reading is 80 mmHg or less

High blood pressure is defined as systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg. You are considered prehypertensive if your systolic blood pressure is between 120-139 mmHg, or your diastolic pressure is between 80- 89 mmHg.

High blood pressure puts stress on the heart, lungs, brain, kidneys, and blood vessels. Over time, this condition can damage these organs and tissues.

Organs Impacted by High Blood Pressure

organs blood pressure

What causes it? The cause of primary hypertension is not known.

Risk Factors

High blood pressure is more common in men, postmenopausal women, older adults, and people of African American descent.

Factors that may increase your risk of high blood pressure include:

  • Overweight
  • Heavy drinking of alcohol
  • Smoking
  • Use of oral contraceptives (birth control pills)
  • Sedentary lifestyle
  • Family history
  • Kidney disease
  • Diabetes
  • High-fat, high-salt diet
  • Stress


High blood pressure usually does not cause symptoms. But, the condition can still damage your organs and tissues.

Occasionally, if blood pressure reaches extreme levels, you may have the following:

  • Headache
  • Blurry or double vision
  • Abdominal pain
  • Chest pain
  • Shortness of breath
  • Lightheadedness


High blood pressure is often diagnosed during a doctor’s visit. Blood pressure is measured using an arm cuff and a special device. If your reading is high, you will come back for repeat checks. If you have 3 visits with readings over 140/90 mmHG, you will be diagnosed with high blood pressure.

Sometimes people become anxious at the doctor’s office. This may result in a higher than normal blood pressure reading. You may be asked to measure your blood pressure at home or in another location.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Images may be taken of your chest. This can be done with chest x-rays.

Your heart’s activity may be measured. This can be done with an electrocardiogram (ECG, EKG).


Lifestyle Changes

  • Maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, talk to your doctor about ways to quit.
  • Eat a healthful diet, one that is low fat, low salt, and rich in fiber, fruits, and vegetables.
  • Drink alcohol in moderation. Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women and older adults.
  • Manage stress.


Medications may include:

  • Diuretics
  • Beta blockers
  • Calcium channel blockers
  • Angiotensin receptor blockers
  • Aldosterone blockers
  • Alpha blockers
  • Alpha-beta blockers
  • Angiotensin converting enzyme inhibitors (ACE inhibitors)
  • Nervous system inhibitors
  • Vasodilators

Untreated high blood pressure can lead to:

  • Heart disease
  • Heart attack
  • Stroke
  • Kidney damage

If you are diagnosed with high blood pressure, follow your doctor’s instructions.


To help reduce your risk of getting high blood pressure, take the following steps:

  • Eat a well-balanced diet. A diet that is rich in fruits, vegetables and low-fat dairy foods, and low in saturated fat, total fat, and cholesterol—may help keep your blood pressure in the healthy range.
  • Exercise regularly.
  • Maintain a healthy weight.
  • If you smoke, talk to your doctor about ways to quit .
  • Drink alcohol in moderation. Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women and older adults.

Left Ventricular Hypertrophy

Left ventricular hypertrophy is enlargement and thickening (hypertrophy) of the walls of your heart’s main pumping chamber (left ventricle).

Left ventricular hypertrophy can develop in response to some factor — such as high blood pressure or a heart condition — that causes the left ventricle to work harder. As the workload increases, the muscle tissue in the chamber wall thickens, and sometimes the size of the chamber itself also increases. The enlarged heart muscle loses elasticity and eventually may fail to pump with as much force as needed.

Left ventricular hypertrophy is more common in people who have uncontrolled high blood pressure. But no matter what your blood pressure is, developing left ventricular hypertrophy puts you at higher risk for a heart attack and stroke. Treating high blood pressure can help ease your symptoms and may reverse left ventricular hypertrophy.

Left ventricular hypertrophy usually develops gradually. You may experience no signs or symptoms, especially during the early stages of the condition.
As left ventricular hypertrophy progresses, you may experience:

  • Shortness of breath
  • Fatigue
  • Chest pain, often after exercising
  • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
  • Dizziness or fainting

Leg Pain

Leg pain can be constant or intermittent, develop suddenly or gradually, and affect your entire leg or a localized area, such as your shin or your knee. It can take a number of forms — stabbing, sharp, dull, aching or tingling.

Some leg pain is simply annoying, but more-severe leg pain can affect your ability to walk or to bear weight on your leg.

Most leg pain results from wear and tear, overuse, or injuries in joints or bones or in muscles, ligaments, tendons or other soft tissues. Some types of leg pain can be traced to problems in your lower spine. Leg pain can also be caused by blood clots, varicose veins or poor circulation.

Some common causes of leg pain include:

  • Achilles tendinitis
  • Achilles tendon rupture
  • Ankylosing spondylitis
  • ACL injury (Anterior cruciate ligament injury)
  • Baker’s cyst
  • Bone cancer
  • Broken leg
  • Bursitis
  • Chronic exertional compartment syndrome
  • Claudication
  • Deep vein thrombosis (DVT)
  • Gout
  • Growing pains
  • Growth plate fractures
  • Hamstring injury
  • Herniated disk
  • Infection
  • Juvenile rheumatoid arthritis
  • Knee bursitis
  • Legg-Calve-Perthes disease
  • Meralgia paresthetica
  • Muscle cramp
  • Muscle strain
  • Night leg cramps
  • Osgood-Schlatter disease
  • Osteoarthritis
  • Osteochondritis dissecans
  • Osteomyelitis
  • Paget’s disease of bone
  • Patellar tendinitis
  • Patellofemoral pain syndrome
  • Peripheral artery disease
  • Peripheral neuropathy
  • Posterior cruciate ligament injury
  • Pseudogout
  • Psoriatic arthritis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Sacroiliitis
  • Septic arthritis
  • Sciatica
  • Shin splints
  • Spinal stenosis
  • Stress fractures
  • Tendinitis
  • Thrombophlebitis
  • Torn meniscus
  • Varicose veins

Mitral Valve Prolapse

Mitral valve prolapse is a common cause of a heart murmur caused by a “leaky” heart valve. Most cases of mitral valve prolapse are not serious and only need to be monitored.

Mitral valve prolapse is associated with many other symptoms and conditions. But experts aren’t sure that mitral valve prolapse is what causes them.

What Is Mitral Valve Prolapse?

The mitral valve is a valve that lets blood flow from one chamber of the heart, the left atrium, to another called the left ventricle. In mitral valve prolapse, part of the mitral valve slips backward loosely into the chamber called the left atrium. This happens when the main heart muscle, called the left ventricle, squeezes during each heartbeat. Mitral valve prolapse differs from mitral valve stenosis. In mitral valve stenosis, the mitral valve is stiff and constricted.

In mitral valve prolapse, the valve slips backward due to the abnormal size of or damage to the mitral valve tissues. For most people with mitral valve prolapse, the cause is unknown.

Mitral valve prolapse can run in families. It can also be caused by conditions in which cartilage is abnormal (connective tissue disease). Nearly 8 million people in the U.S. have mitral valve prolapse.

Symptoms of Mitral Valve Prolapse

Most people with mitral valve prolapse have no symptoms. They also never experience any health problems due to mitral valve prolapse.

Chest pain is the most frequent symptom in people who have symptoms with mitral valve prolapse. The chest pain may be very bothersome and frightening, but it does not increase the risk of heart attack, death, or other heart problems.

Mitral valve prolapse is the most common cause of mitral regurgitation. That’s a condition in which some blood flows backward through the mitral valve with each heartbeat. Over years, moderate or severe mitral regurgitation can cause weakness of the heart muscle, known as congestive heart failure. Symptoms of congestive heart failure include:

  • Shortness of breath with exertion
  • Swelling in the legs and feet

Mitral valve prolapse has also been associated with other symptoms:

  • Fluttering or rapid heartbeat called palpitations
  • Shortness of breath, especially with exercise
  • Dizziness
  • Passing out or fainting, known as syncope
  • Panic and anxiety
  • Numbness or tingling in the hands and feet

When these symptoms occur together, they are sometimes called mitral valve prolapse syndrome. However, experts don’t know if mitral valve prolapse itself causes these symptoms. Since these symptoms and mitral valve prolapse are so common, they could often occur together by chance.

Diagnosis of Mitral Valve Prolapse

A doctor may suspect mitral valve prolapse after listening to someone’s heart with a stethoscope. The abnormal movement of the mitral valve can make a distinct sound, called a “click.” If mitral regurgitation is also present, a doctor may hear a heart murmur caused by the backward flow of blood.

Definite diagnosis of mitral valve prolapse requires an echocardiogram, which is an ultrasound of the heart. A doctor can watch the abnormal valve movement on a video of the beating heart. Mitral regurgitation, if present, will also be seen with an echocardiogram

Treatment of Mitral Valve Prolapse

Mitral valve prolapse causes no problems for most people, so treatment is usually not needed.

People who develop severe mitral regurgitation due to mitral valve prolapse often can benefit from surgery to repair or replace the leaky valve. For people with symptoms of congestive heart failure caused by mitral valve prolapse with mitral regurgitation, surgery is usually the best treatment.

If no mitral regurgitation is present on echocardiogram, symptoms of mitral valve prolapse rarely pose any risk. The best treatment for each person may vary, but can include:

  • Exercise
  • Pain relievers
  • Relaxation and stress reduction techniques
  • Avoidance of caffeine and other stimulants

Beta-blockers, which are medications to slow the heart rate, may be helpful in people who have episodes of palpitations with a rapid heartbeat, known as tachycardia, with mitral valve prolapse.

Follow-Up of Mitral Valve Prolapse

Most people with mitral valve prolapse never experience health problems related to the condition. Experts recommend that people with mitral valve prolapse see a doctor on a regular basis. That way, any developing problems can be found early:

  • Most people with mitral valve proplapse should see a cardiologist every 2 to 3 years. They do not need regular echocardiograms.
  • People with mitral valve prolapse and moderate or severe mitral regurgitation should see a doctor and undergo echocardiography every 6 to 12 months.
  • Echocardiography and a doctor’s visit are also recommended if a person develops new symptoms, or if the symptoms change.

In the past, doctors recommended that people with mitral valve prolapse take antibiotics before medical or dental procedures to prevent infection of the heart valve, known as endocarditis. The American Heart Association has determined that taking antibiotics before procedures is not helpful for people with mitral valve prolapse and is no longer recommended.

Myocardial Infarction

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don’t get help immediately. It’s important to know the symptoms of a heart attack and call 9­1­1 if someone is having them. Those symptoms include:

  • Chest discomfort ­ pressure, squeezing, or pain
  • Shortness of breath
  • Discomfort in the upper body ­ arms, shoulder, neck, back
  • Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat ­ called an arrhythmia ­ that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.

Orthostatic Hypotension

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.

Orthostatic hypotension is often mild, lasting a few seconds to a few minutes after standing. However, long-lasting orthostatic hypotension can be a sign of more-serious problems, so talk to your doctor if you frequently feel lightheaded when standing up. It’s even more urgent to see a doctor if you lose consciousness, even momentarily.

Mild orthostatic hypotension often doesn’t need treatment. Many people occasionally feel dizzy or lightheaded after standing, and it’s usually not cause for concern. The treatment for more-severe cases of orthostatic hypotension depends on the cause.

The most common symptom of orthostatic hypotension is feeling lightheaded or dizzy when you stand up after sitting or lying down. This feeling, and other symptoms, usually happens shortly after standing up and generally lasts only a few seconds. Orthostatic hypotension signs and symptoms include:

  • Feeling lightheaded or dizzy after standing up
  • Blurry vision
  • Weakness
  • Fainting (syncope)
  • Confusion
  • Nausea

When to see a doctor

Occasional dizziness or lightheadedness may be relatively minor — the result of mild dehydration, low blood sugar, or too much time in the sun or a hot tub, for example. Dizziness or lightheadedness may also happen when you stand after sitting for a long time, such as in a lecture, concert or church. If these symptoms happen only occasionally, it’s usually not cause for concern.

It’s important to see your doctor if you experience frequent symptoms of orthostatic hypotension because they sometimes can point to more-serious problems. It can be helpful to keep a record of your symptoms, when they occurred, how long they lasted and what you were doing at the time. If these occur at times that may endanger you or others, discuss this with your doctor.

When you stand up, gravity causes blood to pool in your legs. This decreases blood pressure because there’s less blood circulating back to your heart to pump.

Normally, special cells (baroreceptors) near your heart and neck arteries sense this lower blood pressure and send signals to centers in your brain that in turn signal your heart to beat faster and pump more blood, which stabilizes blood pressure. In addition, these cells cause blood vessels to narrow, which increases resistance to blood flow and increases blood pressure.

Orthostatic or postural hypotension occurs when something interrupts the body’s natural process of counteracting low blood pressure. Orthostatic hypotension can be caused by many different conditions, including:

  • Dehydration. Fever, vomiting, not drinking enough fluids, severe diarrhea and strenuous exercise with excessive sweating can all lead to dehydration. When you become dehydrated, your body loses blood volume. Mild dehydration can cause symptoms of orthostatic hypotension, such as weakness, dizziness and fatigue.
  • Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. These conditions may cause orthostatic hypotension because they prevent your body from being able to respond rapidly enough to pump more blood when needed, such as when standing up.
  • Endocrine problems. Thyroid conditions, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure. Diabetes can also damage the nerves that help send signals regulating blood pressure.
  • Nervous system disorders. Some nervous system disorders, such as Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis, can disrupt your body’s normal blood pressure regulation system.
  • After eating meals. Some people experience low blood pressure after eating meals (postprandial hypotension). This condition is more common in older adults.

The risk factors for orthostatic hypotension include:

  • Age. Orthostatic hypotension is common in those who are age 65 and older. As your body ages, the ability of special cells (baroreceptors) near your heart and neck arteries to regulate blood pressure can be slowed. Also, when you age, it may be harder for your heart to beat faster and compensate for drops in blood pressure.
  • Medications. People who take certain medications have a greater risk of orthostatic hypotension. These include medications used to treat high blood pressure or heart disease, such as diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates.Other medications that may increase your risk of orthostatic hypotension include medications used to treat Parkinson’s disease, certain antidepressants, certain antipsychotics, muscle relaxants, medications to treat erectile dysfunction and narcotics.Using medications that treat high blood pressure in combination with other prescription and over-the-counter medications may cause low blood pressure.
  • Certain diseases. Some heart conditions, such as heart valve problems, heart attack and heart failure, and certain nervous system disorders, such as Parkinson’s disease, put you at a greater risk of developing low blood pressure.
  • Heat exposure. Being in a hot environment can cause you to sweat and, possibly, cause dehydration, which can lower your blood pressure and trigger orthostatic hypotension.
  • Bed rest. If you have to stay in bed a long time because of an illness, you may become weak. When you try to stand up, you may experience orthostatic hypotension.
  • Pregnancy. Because your circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you’ve given birth.
  • Alcohol. Drinking alcohol can increase your risk of orthostatic hypotension.

While mild forms of orthostatic hypotension may be a nuisance, more-serious complications are possible, especially in older adults. These complications include:

  • Falls. Falling down as a result of fainting (syncope) is a common complication in people with orthostatic hypotension.
  • Stroke. The swings in blood pressure when you stand and sit as a result of orthostatic hypotension can be a risk factor for stroke due to the reduced blood supply to the brain.
  • Cardiovascular diseases. Orthostatic hypotension can be a risk factor for cardiovascular diseases and complications, such as chest pain, heart failure or heart rhythm problems.


Heart palpitations (pal-pih-TAY-shuns) are the feelings of having rapid, fluttering or pounding heart. Heart palpitations can be triggered by stress, exercise, medication or, rarely, a medical condition.

Although heart palpitations can be worrisome, they’re usually harmless. In rare cases, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that may require treatment.

Heart palpitations can feel like your heart is:

  • Skipping beats
  • Fluttering
  • Beating too fast
  • Pumping harder than usual

You may feel heart palpitations in your throat or neck, as well as your chest. Heart palpitations can occur whether you’re active or at rest, and whether you’re standing, seated or lying down.

When to see a doctor

Palpitations that are infrequent and last only a few seconds usually don’t require evaluation. If you have a history of heart disease and have frequent palpitations or have palpitations that worsen, talk to your doctor. He or she may suggest heart-monitoring tests to see if your palpitations are caused by a more serious heart problem.

Seek emergency medical attention if heart palpitations are accompanied by:

  • Chest discomfort or pain
  • Fainting
  • Severe shortness of breath
  • Severe dizziness

Often the cause of your heart palpitations can’t be found. Common causes of heart palpitations include:

  • Strong emotional responses, such as stress or anxiety
  • Strenuous exercise
  • Caffeine
  • Nicotine
  • Fever
  • Hormone changes associated with menstruation, pregnancy or menopause
  • Taking cold and cough medications that contain pseudoephedrine, a stimulant
  • Taking some asthma inhaler medications that contain stimulants

Occasionally heart palpitations can be a sign of a serious problem, such as an overactive thyroid gland (hyperthyroidism) or an abnormal heart rhythm (arrhythmia). Arrhythmias may include very fast heart rates (tachycardia), unusually slow heart rates (bradycardia) or an irregular heart rhythm.

You may be at risk of developing palpitations if you:

  • Are highly stressed
  • Have an anxiety disorder or regularly experience panic attacks
  • Are pregnant
  • Take medicines that contain stimulants, such as some cold or asthma medications
  • Have an overactive thyroid gland (hyperthyroidism)
  • Have other heart problems, such as an arrhythmia, heart defect or previous heart attack

Unless a heart condition is causing your heart palpitations, there’s little risk of complications. For palpitations caused by a heart condition, possible complications include:

  • Fainting. If your heart beats rapidly, your blood pressure may drop, causing you to faint. This may be more likely if you have a heart problem, such as congenital heart disease or certain valve problems.
  • Cardiac arrest. Rarely, palpitations can be caused by life-threatening arrhythmias and can cause your heart to stop beating effectively.
  • Stroke. If palpitations are due to atrial fibrillation, a condition in which the upper chambers of the heart quiver instead of beating properly, blood can pool and cause clots to form. If a clot breaks loose, it can block a brain artery, causing a stroke.
  • Heart failure. This can result if your heart is pumping ineffectively for a prolonged period due to an arrhythmia, such as atrial fibrillation. Sometimes, controlling the rate of an arrhythmia that’s causing heart failure can improve your heart’s function.

Peripheral Artery Disease

Peripheral Artery Disease and Critical Limb Ischemia

Peripheral vascular disease (PVD) affects the arteries, the veins or the lymph vessels. The most severe type of PVD is peripheral artery disease (PAD), which affects the arteries that carry blood to the legs, arms, stomach or kidneys. In PAD, atherosclerosis (hardening of the arteries) causes the arteries to narrow, restricting the amount of oxygen and nutrients flowing to these parts of the body. This disease process is most commonly diagnosed in the legs, yet is similar to coronary artery disease and carotid artery disease.

Understanding Peripheral Artery Disease

More than 10 million people in the United States have PAD. The likelihood of PAD increases with age, diabetes, high blood pressure, high cholesterol level or smoking. For instance, by age 65, about 10-15 percent of the population has PAD, of which a significant number of patients are symptomatic. Diagnosis is critical, as patients with PAD have a four- to five-fold higher risk of heart attack or stroke.

Symptoms of PAD depend on which arteries are affected and how severely the blood flow is reduced. In the legs, moderate reduction on arterial blood flow results in muscle cramps with walking, also known as claudication. As arterial blood flow reduction becomes more severe, patients may experience constant pain, numbness or tingling of the feet, and develop non-healing sores or gangrene of the feet. This more severe form of PAD is known as critical limb ischemia, and intervention is essential to avoid major amputation.

Your doctor may rely on the following tests to diagnose PAD in the legs:

  • physical examination to document the quality of the peripheral pulses, and to assess the affected limb for ischemic sores or gangrene
  • ankle brachial index (ABI) to measure blood pressure at the ankle and in the arm while a person is at rest
  • ultrasound Doppler and/or angiography (CT scan or MR scan using contrast dye intravenously) to view blood flow in the arteries of the legs in order to locate the segments of narrowed or occluded arteries.

Treating Peripheral Artery Disease

Treatments typically include lifestyle changes, medication, walking exercise, balloon angioplasty and stenting , bypass surgery, or a combination of these therapies.

Although lifestyle changes, medication and walking exercise don’t eliminate the narrowing of the arteries, they can help improve the efficiency of the heart and leg muscles and reduce symptoms such as leg pain, cramping, and weakness. Patients diagnosed with PAD are at increased risk of stroke and heart attack. At Manatee Cardiovascular, we work hard to control your cardiovascular risk factors.

Treatment options include:

  • percutaneous transluminal angioplasty (balloon angioplasty or PTA)
  • stent and covered-stent placement
  • atherectomy devices

Premature Ventricular Contractions (PVC)

Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of your heart’s two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a flip-flop or skipped beat in your chest. Premature ventricular contractions are very common — they occur in most people at some point.

Premature ventricular contractions are also called:

  • Premature ventricular complexes
  • PVCs
  • Ventricular premature beats
  • Extrasystoles

If you have occasional premature ventricular contractions, but you’re an otherwise healthy person, there’s generally no reason for concern, and no treatment is needed. If you have frequent premature ventricular contractions or underlying heart disease, you may need treatment to help you feel better and treat underlying heart problems.

Premature ventricular contractions often cause no symptoms. But you may feel an odd sensation in your chest, such as:

  • Flip-flops
  • Fluttering
  • Pounding or jumping
  • Skipped beats or missed beats
  • Increased awareness of your heartbeat

When to see a doctor

If you feel flip-flops, a sensation of skipped heartbeats or odd feelings in your chest, talk to your doctor. You’ll want to identify the source of these symptoms. Premature ventricular contractions may be the problem, but other conditions also may be to blame, including other rhythm problems, serious heart problems, anxiety, anemia or infections.

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial node (SA node) — or sinus node — an area of specialized cells located in the right atrium.

This natural pacemaker produces the electrical impulses that trigger the normal heartbeat. From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood out to your lungs and body.

Premature ventricular contractions are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is atria first, then ventricles. As a result, the extra, out-of-sync beats are usually less effective in pumping blood throughout the body.

Why do extra beats occur?

The reasons aren’t always clear. Certain triggers, heart diseases or changes in the body can make cells in the ventricles electrically unstable. Underlying heart disease or scarring may also cause electrical impulses to be misrouted.

Premature ventricular contractions may be associated with:

  • Chemical changes or imbalances in the body
  • Certain medications, including common asthma medications
  • Alcohol or illegal drugs
  • Increased levels of adrenaline in the body that may be caused by caffeine, tobacco, exercise or anxiety
  • Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or heart failure

The following stimulants, conditions and triggers may increase your risk of premature ventricular contractions:

  • Caffeine, tobacco and alcohol
  • Exercise
  • High blood pressure (hypertension)
  • Anxiety
  • Underlying heart disease, including congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)

Pulmonary Hypertension

Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart.

In one form of pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs’ arteries. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and fail.

Some forms of pulmonary hypertension are serious conditions that become progressively worse and are sometimes fatal. Although some forms of pulmonary hypertension aren’t curable, treatment can help lessen symptoms and improve your quality of life.


The signs and symptoms of pulmonary hypertension in its early stages might not be noticeable for months or even years. As the disease progresses, symptoms become worse.

Pulmonary hypertension symptoms include:

  • Shortness of breath (dyspnea), initially while exercising and eventually while at rest
  • Fatigue
  • Dizziness or fainting spells (syncope)
  • Chest pressure or pain
  • Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites)
  • Bluish color to your lips and skin (cyanosis)
  • Racing pulse or heart palpitations


Your heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through your heart, the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery).

Chambers and valves of the heart

Chambers and valves of the heart

In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart. Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs.

With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes can cause the walls of the arteries to become stiff and thick, and extra tissue may form. The blood vessels may also become inflamed and tight.

These changes in the pulmonary arteries can reduce or block blood flow through the blood vessels. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries.

Pulmonary hypertension is classified into five groups, depending on the cause.

Group 1: Pulmonary arterial hypertension

Pulmonary hypertension

Pulmonary hypertension

  • Cause unknown, known as idiopathic pulmonary arterial hypertension
  • A specific gene mutation that can cause pulmonary hypertension to develop in families, also called heritable pulmonary arterial hypertension
  • Certain drugs — such as certain prescription diet drugs or illegal drugs such as methamphetamines — or certain toxins
  • Heart abnormalities present at birth (congenital heart disease)
  • Other conditions, such as connective tissue disorders (scleroderma, lupus, others), HIV infection or chronic liver disease (cirrhosis)

Group 2: Pulmonary hypertension caused by left-sided heart disease

  • Left-sided valvular heart disease, such as mitral valve or aortic valve disease
  • Failure of the lower left heart chamber (left ventricle)

Group 3: Pulmonary hypertension caused by lung disease

  • Chronic obstructive pulmonary disease, such as emphysema
  • Lung disease such as pulmonary fibrosis, a condition that causes scarring in the tissue between the lungs’ air sacs (interstitium)
  • Sleep apnea and other sleep disorders
  • Long-term exposure to high altitudes in people who may be at higher risk of pulmonary hypertension

Group 4: Pulmonary hypertension caused by chronic blood clots

  • Chronic blood clots in the lungs (pulmonary emboli)

Group 5: Pulmonary hypertension associated with other conditions that have unclear reasons why the pulmonary hypertension occurs

  • Blood disorders
  • Disorders that affect several organs in the body, such as sarcoidosis
  • Metabolic disorders, such as glycogen storage disease
  • Tumors pressing against pulmonary arteries

Eisenmenger syndrome and pulmonary hypertension

Eisenmenger syndrome, a type of congenital heart disease, causes pulmonary hypertension. It’s most commonly caused by a large hole in your heart between the two lower heart chambers (ventricles), called a ventricular septal defect.

This hole in your heart causes blood to circulate abnormally in your heart. Oxygen-carrying blood (red blood) mixes with oxygen-poor blood (blue blood). The blood then returns to your lungs instead of going to the rest of your body, increasing the pressure in the pulmonary arteries and causing pulmonary hypertension.

Risk factors

Your risk of developing pulmonary hypertension may be greater if:

  • You’re a young adult, as idiopathic pulmonary arterial hypertension is more common in younger adults
  • You’re overweight
  • You have a family history of the disease
  • You have one of various conditions that can increase your risk of developing pulmonary hypertension
  • You use illegal drugs, such as cocaine
  • You take certain appetite-suppressant medications
  • You have an existing risk of developing pulmonary hypertension, such as a family history of the condition, and you live at a high altitude


Pulmonary hypertension can lead to a number of complications, including:

  • Right-sided heart enlargement and heart failure (cor pulmonale). In cor pulmonale, your heart’s right ventricle becomes enlarged and has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries.At first, the heart tries to compensate by thickening its walls and expanding the chamber of the right ventricle to increase the amount of blood it can hold. But this thickening and enlarging works only temporarily, and eventually the right ventricle fails from the extra strain.
  • Blood clots. Clots help stop bleeding after you’ve been injured. But sometimes clots form where they’re not needed. A number of small clots or just a few large ones dislodge from these veins and travel to the lungs, leading to a form of pulmonary hypertension that can generally be reversible with time and treatment.Having pulmonary hypertension makes it more likely you’ll develop clots in the small arteries in your lungs, which is dangerous if you already have narrowed or blocked blood vessels.
  • Arrhythmia. Irregular heartbeats (arrhythmias) from the upper or lower chambers of the heart are complications of pulmonary hypertension. These can lead to palpitations, dizziness or fainting and can be fatal.
  • Bleeding. Pulmonary hypertension can lead to bleeding into the lungs and coughing up blood (hemoptysis). This is another potentially fatal complication.

Renal Artery Stenosis

renal-artery-stenosisRenal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Most often seen in older people with atherosclerosis(hardening of the arteries), renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage. The body senses less blood reaching the kidneys and misinterprets that as the body having low blood pressure. This signals the release of hormones from the kidney that lead to an increase in blood pressure. Over time, renal artery stenosis can lead to kidney failure.

Causes of Renal Artery Stenosis

More than 90% of the time, renal artery stenosis is caused by atherosclerosis, a process in which plaque made up of fats, cholesterol, and other materials builds up on the walls of the blood vessels, including those leading to the kidneys.

More rarely, renal artery stenosis can be caused by a condition called fibromuscular dyplasia, in which the cells in the walls of the arteries undergo abnormal growth. More commonly seen in women and younger people, fibromuscular dyplasia is potentially curable.

Risk Factors for Renal Artery Stenosis

Renal artery stenosis is often found by accident in patients who are undergoing tests for another reason. Risk factors include:

  • Older age
  • Being female
  • Having hypertension
  • Having other vascular disease (such as coronary artery disease and peripheral artery disease)
  • Having chronic kidney disease
  • Having diabetes
  • Using tobacco
  • Having an abnormal cholesterol level

Symptoms of Renal Artery Stenosis

Renal artery stenosis usually does not cause any specific symptoms. Sometimes, the first sign of renal artery stenosis is high blood pressure that is extremely hard to control, along with worsening of previously well-controlled high blood pressure, or elevated blood pressure that affects other organs in the body.

Renal Vascular Disease

Understanding Renal Artery Stenosis

The renal artery provides blood flow to the kidneys. When this artery is blocked, it may cause kidney failure and high blood pressure. The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

A partial blockage of the artery is called renal artery stenosis and may be caused by atherosclerosis (build-up of plaque, which is a fatty material), or other conditions, such as fibromuscular dysplasia (a condition that weakens the walls of medium-sized arteries and occurs in young women). Atherosclerosis causes 80-90 percent of renal artery stenosis. Smoking, obesity, advanced age, high cholesterol, and diabetes are factors which may increase the chance of developing atherosclerosis.

Symptoms of renal vascular disease include sudden onset of hypertension, hypertension not responsive to three or more blood pressure medications, increased urea (waste product excreted by kidneys) in blood, and unexplained kidney failure.

Diagnosing and Treating Renal Artery Disease

To evaluate your renal arteries, one or more of the following may be ordered:

  • ultrasound, which uses sound waves to assess the structure and function of the kidneys and how fast blood flows through the arteries
  • angiography, in which a dye is injected into the arteries as X-rays are taken
  • magnetic resonance angiography (MRA), which uses magnetic fields to visualize renal arteries
  • computed tomographic angiography (CTA), which images renal arteries with contrast dye to visualize renal arteries
  • renography, a nuclear radiology procedure which assesses the function and structure of the kidneys

Not all patients need surgery right away. Treatment for renal artery stenosis is needed in patients who have uncontrolled hypertension despite medication and severely blocked renal arteries. Once the diagnosis of significant renal artery stenosis is made, the most appropriate therapy is vascular surgery, which may include renal artery angioplasty and stenting or open surgical bypass or endarterectomy of the narrowed or blocked renal artery.

Renal Artery Angioplasty and Stenting

In the procedure, the surgeon introduces a needle into the artery in the groin after injecting numbing medicine. A catheter (flexible plastic tube) is inserted into the artery and carefully guided into the renal artery. Live X-rays, called fluoroscopy, are taken to see the artery during the procedure.

The surgeon then passes a guidewire through the catheter through the blockage. A small balloon is guided over the wire and into the blockage. The balloon is inflated and presses against the inside walls of the artery to open the artery and allow better blood flow to the kidney.

Finally, a stent (wire mesh tube) is placed across the blocked area to help keep the artery open after balloon treatment.

Renal Artery Bypass or Endarterectomy

The vascular surgeon uses a bypass to create a detour around the narrowed or blocked segments of the renal artery. The surgeon connects a man-made material, called a bypass graft, to the artery above and below the blocked area. This creates a new path for blood to flow to the kidneys.

In renal artery endarterectomy, the surgeon removes the inner lining of the renal artery which contains the plaque, thereby leaving a smooth, wide-open artery. The artery is then closed with a patch of vein.

Understanding Renal Artery Aneurysm

A renal artery aneurysm is a bulging, weakened area in the wall of an artery to the kidney. Most of these aneurysms are small (less than two centimeters, or about three-quarters of an inch) and without symptoms. Renal artery aneurysms are uncommon and are generally discovered while diagnosing other conditions.

There are four types of renal artery aneurysms:

  • saccular – bulges or balloons out only on one side of the artery
  • fusiform – bulges or balloons out on all sides of the artery
  • dissecting – weakened artery wall due to a tear in the inner layer of the artery wall
  • intrarenal – occurs on an artery inside the kidney

Saccular aneurysms may occur as a result of a congenital (present at birth) weakness of an artery wall or trauma. Atherosclerosis may also be a factor. Fusiform aneurysms most often occur with fibromuscular dysplasia. Intrarenal aneurysms may be congenital, or may result from trauma.

Renal artery aneurysm is generally asymptomatic, though hypertension may be present in up to 90 percent of patients with renal artery aneurysm.

Treating Renal Artery Aneurysm

Treatment of a renal artery aneurysm depends on factors such as size and location of the aneurysm and whether or not symptoms are present. Certain types of small (less than two centimeters, or about three-quarters of an inch) aneurysms may not be treated, but may be observed for growth or development of other complications.

Larger aneurysms (greater than two centimeters or three-quarters of an inch), dissecting aneurysms, aneurysms causing lack of blood flow to the kidneys and hypertension, aneurysms that are growing larger, and aneurysms causing symptoms may be treated surgically. Because of the increased risk for rupture, a renal artery aneurysm in a pregnant woman or a woman of child-bearing age will generally be treated surgically.

Shortness of Breath

Most cases of shortness of breath are due to heart or lung conditions. Your heart and lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing.

Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including:

  • Asthma (bronchospasm)
  • Carbon monoxide poisoning
  • Cardiac tamponade (excess fluid around the heart)
  • Hiatal hernia
  • Heart failure
  • Low blood pressure (hypotension)
  • Pulmonary embolism (blood clot in an artery in the lung)
  • Pneumothorax (collapsed lung)
  • Pneumonia (pulmonary infection)
  • Sudden blood loss
  • Upper airway obstruction (blockage in the breathing passage)

In the case of shortness of breath that has lasted for weeks or longer (called chronic), the condition is most often due to:

  • Asthma
  • COPD (chronic obstructive pulmonary disease)
  • Deconditioning
  • Heart dysfunction
  • Interstitial lung disease
  • Obesity

A number of other health conditions also can make it hard to get enough air. These include:

Lung problems

  • Lung cancer
  • Pleurisy (inflammation of the membrane lining the chest)
  • Pulmonary edema (excess fluid in the lungs)
  • (scarred and damaged lungs)
  • Pulmonary hypertension (high blood pressure within the lungs’ blood vessels)
  • Sarcoidosis (collections of inflammatory cells in the body)
  • Tuberculosis

Heart problems

  • Cardiomyopathy (problem with the heart muscle)
  • Heart arrhythmias (rhythm problems)
  • Heart failure
  • Pericarditis (swelling of the membrane surrounding the heart)

Other problems

  • Anemia
  • Broken ribs
  • Choking: First aid
  • Epiglottitis (swelling of part of the windpipe)
  • Foreign object inhaled: First aid
  • Generalized anxiety disorder
  • Guillain-Barre syndrome
  • Myasthenia gravis (condition causing muscle weakness)
  • Skipped Heart Beats
  • Slow Heart Rate
  • Syncope
  • Thoracic Aneurysm
  • Ventricular Tachycardia

Sudden Cardiac Arrest

Cardiac arrest occurs when the heart suddenly stops functioning. With no effective heartbeat, the brain and other vital organs are deprived of blood, leading to death within minutes.

Cardiac arrest is not a heart attack. The heart usually continues beating during a heart attack; however, cardiac arrest may occur as a result of a heart attack.

An estimated 250,000 to 450,000 Americans suffer cardiac arrest each year. Ninety-five percent die, often before receiving advanced medical attention.

Causes of Cardiac Arrest

Electrical signals in the heart synchronize heart function so that the heart beats properly and pumps blood through the body. Arrhythmias (abnormal heart rhythms) can interfere with normal heart function.

Ventricular fibrillation is a dangerous type of arrhythmia and the most common cause of cardiac arrest. It makes the lower chambers of the heart beat rapidly or chaotically. Other types of electrical problems that can lead to cardiac arrest include electrical signals that slow and stop, or the heart muscle’s inability to respond to electrical signals.

Cardiac Arrest Risk Factors

Several factors can increase the risk for developing the electrical problems that can trigger cardiac arrest.

  • Coronary artery disease
  • Heart attack
  • Abnormal heart rhythms
  • Heart failure
  • A personal or family history of cardiac arrest or other genetic heart conditions that increase the risk for arrhythmias
  • Changes in the heart structure
  • Electrocution
  • Drug abuse
  • Excessive alcohol consumption
  • Cardiac arrest can also occur for no known reason.

Symptoms of Cardiac Arrest

People who suffer cardiac arrest lose consciousness and stop breathing. They have no pulse or blood pressure. An electrocardiogram shows either no electrical activity in the heart or a rhythm that is inadequate for heart function.

Treatment of Cardiac Arrest

When victims experience cardiac arrest, immediate treatment with a defibrillator (a device that delivers an electrical shock to the heart) can help restore the heart’s normal rhythm. CPR (Cardiopulmonary resuscitation), when performed properly, can help provide adequate blood circulation until defibrillation and other emergency care is available.

Preventing Cardiac Arrested

Different strategies are available for preventing cardiac arrest, depending on a person’s risk. Doctors may recommend that patients who are at very high risk for or have survived cardiac arrest undergo surgery to place an implantable cardioverter defibrillator under the skin of their abdomen or chest. These devices have tiny wires that connect to the heart and constantly monitor heart rhythms. When they detect dangerous arrhythmias, they deliver electrical shocks that help reestablish normal heart rhythm.

Doctors may also prescribe beta-blocker medications or perform procedures to address underlying coronary artery disease and other problems that can cause cardiac arrest.

Those who have no known risk can take these steps to help prevent cardiac arrest:

  • Get regular medical care
  • Follow a healthy diet, be physically active, lose extra pounds and quit smoking
  • Work with a doctor to control chronic conditions, such as diabetes, high blood pressure and high cholesterol

What can bystanders do?

The odds of surviving cardiac arrest decline dramatically during every minute that defibrillation and/or CPR is not provided. A bystander who sees someone who may be suffering cardiac arrest should call 911 immediately and, if possible, use an automated external defibrillator (AED). AEDs are portable defibrillator devices posted in many public areas. If an AED is not readily available, the bystander should perform CPR until the victim has access to defibrillation.

Thoracic Aortic Disease

There are several diseases of the thoracic aorta which can weaken the wall of this major blood vessel. These are known as thoracic aortic aneurysm (TAA), aortic dissections and aortic ulcerations. In our center, a multidisciplinary approach to the evaluation and management of thoracic aortic disease is offered, involving specialists from cardiac and vascular surgery, cardiology, medical genetics and radiology.

Thoracic aortic aneurysms may be related to hypertension, bicuspid aortic valves, inflammatory conditions, trauma or an underlying genetic disorder, such as Marfan syndrome, Loeys-Dietz aneurysm syndrome, Turner syndrome, familial thoracic aortic aneurysm and dissection syndrome, and vascular Ehlers-Danlos syndromes. Successful management requires expert diagnosis and appropriate treatment and follow-up. Proper therapy can often be life-saving.

Understanding Thoracic Aortic Aneurysm

The heart pumps blood directly into the thoracic aorta, and the aorta then acts as a pipe to deliver blood to other blood vessels throughout the body. Weakening of the wall of this blood vessel causes the aorta to bulge, and this bulge is known as a thoracic aortic aneurysm (TAA). If the blood vessel wall becomes severely weakened it can burst or dissect (tear). Aortic dissection and aortic rupture may be fatal and require emergency care at a center with expertise in the care of patients with these conditions. It is important to recognize and treat thoracic aortic aneurysm before a life-threatening complication occurs.

Most thoracic aortic aneurysms do not cause symptoms and are not detectable on a routine physical examination. Thoracic aortic aneurysms may be uncovered by chest X-ray, but imaging such as echocardiogram, CT scan and MRI scan are necessary for complete evaluation. Aneurysms may cause chest or back pain which could be a sign that the wall is too weak to support the pressure of the blood inside. Aneurysms associated with pain may pose a particular risk of rupture and should be evaluated promptly by a specialist.

Treating Thoracic Aortic Aneurysm

Tremendous progress has been made in recent years in the treatment of aortic aneurysms. Some small aneurysms do not require surgical repair but may require treatment with medications to lower blood pressure. If surgery is not necessary, the aneurysm is routinely checked by echocardiograms, CT and MRI scans to monitor its growth. To prevent the rupture of a large aneurysm, the weakened wall needs to be replaced with stronger tubing.

There are several different options for thoracic aneurysm repair. An open aneurysm repair is performed through a large incision in the chest, and the surgeon directly replaces the diseased portion of the aorta with a fabric-covered tube which is sewn into place. Endovascular aneurysm repair uses smaller incisions in the lower abdomen or groin, and the tubing is advanced into the aneurysm using x-rays to direct the surgery. Not every patient can be treated with an endovascular aneurysm repair. However, compared to open surgery, endovascular aneurysm repair often results in quicker recovery following surgery. Endovascular repair may be helpful in treating high-risk patients who cannot be treated with open aneurysm repair.

Valvular Heart Disease

The heart valves play a critical role by regulating blood flow through the heart and preventing blood from flowing the wrong way. When the valves are formed abnormally or stop functioning as they should, blood flow to the body can be restricted or can flow backwards. Over time, heart valve disease can cause heart failure or predispose a patient to abnormal heart rhythms.

Understanding Valvular Heart Disease

There are two main types of valvular heart disease:

        • Valvular stenosis: The heart valves are stiff and don’t open completely. Over time, they can become too narrow and can interfere with heart function, limiting blood flow to the body.
        • Valvular regurgitation: The valves do not close properly or completely, and blood flows backwards or regurgitates.

Some people are born with abnormal heart valves. Others develop valvular disease as a consequence of:

        • infections such as rheumatic fever and endocarditis
        • coronary heart disease
        • myocardial infarction
        • aging
        • radiation
        • other diseases that lead to their deterioration, such as Marfan syndrome.

Some people may suffer from mitral valve prolapse, a type of valve disease in which the valves are abnormally shaped and do not close properly. With time, as the valve problem worsens, the heart cannot compensate and symptoms begin to occur. Symptoms can include unusual tiredness or fatigue, shortness of breath, chest pain during exertion, passing out, dizziness, irregular heartbeat and swelling of the ankles, feet and sometimes the abdomen.

Treating Valvular Heart Disease

People with slightly damaged valves may not require any treatment except medications and close follow-up with their physicians. They may need to take medications to control cardiac risk factors to lower the risk of developing other heart problems. When treatment is needed, medicines and lifestyle changes often can relieve symptoms. However, surgery may eventually be needed to repair or replace a malfunctioning heart valve.

Varicose and Spider Veins

Varicose veins and spider veins are enlarged superficial veins that afflict millions of Americans, primarily women. The effects can range from unsightly blue or red lines under the skin to more serious itching, aching, night cramps and feelings of fatigue after standing.

Manatee Cardiovascular offers many treatments for varicose and spider veins that can improve cosmetic appearances, reduce discomfort and prevent further complications.

Understanding Varicose and Spider Veins

Varicose Veins

VericoseVeinPhoto1_002_thumbPregnancy, weight gain, long periods of standing, and a family history are all risk factors for varicose veins. Varicose veins can cause bulging under the skin, aching, ankle swelling, night cramps or feelings of leg fatigue or heaviness after prolonged periods of standing.

If left untreated, varicose veins can progress and cause skin damage, including brown pigment deposits under the skin or skin ulcers. Occasionally, the stagnant blood in varicose veins can clot, called superficial phlebitis. Patients with varicose veins also have a slightly increased chance of developing deep vein thrombosis (DVT). DVT may cause sudden, severe leg swelling. DVT is a serious condition that requires immediate medical attention.

Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70. Pregnancy often results in the first noticeable appearance of varicose veins, which sometimes improve after childbirth.

Spider Veins

SpiderVeinPhoto_thumb_thumb_thumbSpider veins are not a serious medical problem, but they can be a cosmetic concern, and they can cause symptoms of aching or burning pain, or itching. Spider veins are tiny varicose veins. They look like a nest of fine red or blue lines just under the skin.

Diagnosis and Treatment

VeinIllustration2_thumbIn addition to a physical exam and patient history, clinicians might use a venous duplex ultrasound to diagnose varicose veins. Duplex ultrasound uses painless, high-frequency sound waves to look for clotted segments of vein or for blood that is flowing the wrong way through damaged valves.  This test can take approximately 20 minutes for each leg.

If you have mild to moderate varicose veins, elevating the legs can help reduce leg swelling and relieve other symptoms. Feet may need to be propped up above the level of the heart three or four times a day. When standing for a long time, the legs should be flexed occasionally to keep the blood flowing from the legs up toward the heart.

For more severe varicose veins, compression stockings may be prescribed. Compression stockings are tall, elastic socks that squeeze the veins and stop excess blood from flowing backward. They also can help relieve symptoms of leg discomfort or even heal skin sores and prevent them from returning. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems. However, they may be needed every day for the rest of a patient’s life, and they do not actually cure the underlying problem.

Several surgical and minimally invasive therapies are available to repair or remove the damaged segments of vein, including:

        • Radiofrequency ablation:  If testing shows that the saphenous vein, the largest superficial vein in the leg, has damaged valves allowing blood to flow the wrong way, this outpatient procedure may be recommended. Radiofrequency ablation (RFA) uses a thin, flexible tube to destroy the area of the vein that is damaged. The tube is inserted into the vein and then withdrawn. A heated tip on the end of the tube heats the walls of the varicose vein and destroys the vein tissue. The vein is then no longer able to carry blood, and it is eventually absorbed by the body. Eliminating the “wrong-way” blood flow in the saphenous vein will relieve the heaviness and discomfort caused by reflux and limits the formation of new varicose veins. The procedure takes less than an hour to complete, and anesthesia is provided for comfort. No incision is required, other than a small nick in the skin for the catheter to enter.
        • Micro-incision venectomy:  A different procedure, called micro-incision venectomy, or ambulatory phlebectomy, can be done along with radiofrequency ablation or as a separate procedure. Tiny incisions are made in the leg to remove areas of varicose vein clusters. This is typically done as an outpatient procedure while the veins are surrounded by local anesthetic, and recovery time is minimal.
        • Vein stripping:  Vein stripping is a less common procedure that has been almost completely replaced by the less invasive ablation procedures. To perform vein stripping, a small incision is made in the groin area and usually another incision is made in the calf below the knee. The major varicose vein branches associated with the saphenous vein are tied off, and then the saphenous vein is removed from the leg.
        • Sclerotherapy:  During sclerotherapy, tiny needles are used to inject a chemical into spider veins and small varicose veins. The chemical irritates the veins from the inside out so the abnormal veins can no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through other veins. The body eventually absorbs the veins that received the injection. Typically sclerotherapy will be performed 2-4 times before a final cosmetic appearance is obtained. This procedure doesn’t require any anesthesia or sedation, though compression stockings may be required while the sclerotherapy sites heal.

For more information, please go to our Vein Center page to learn more.