My Doctor Online The Permanente Medical Group

Symptoms

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Symptoms of a heart attack include:

Chest discomfort or pain that lasts longer than 5 minutes AND is not relieved by rest or nitroglycerin AND feels like:

• Pressure
• Tightness
• Squeezing
• Crushing
• Intense burning
• Aching

You might also have (especially if you are a woman):

• Pain that moves to your back, shoulder, neck, jaw, teeth, arm, or wrist.
• Shortness of breath.
• Sweating.
• Dizziness.
• Fainting.
• Nausea (sick to your stomach).
• Vomiting (throwing up).
• Unusual weakness.
• Fast or irregular heartbeat.
• Sense of impending (coming) doom.

If you think that you might be having a heart attack, act quickly. Getting medical attention right away – within 1 hour – can save your life and lessen the amount of heart muscle that gets damaged.

• Call 911 emergency services before you call anyone else if your symptoms are not relieved in 3 to 5 minutes by nitroglycerin and rest.
• Stop what you are doing.
• Sit or lie down.
• Take nitroglycerin. If you have not taken Viagra, Levitra, or Cialis in the past 72 hours, and you have a prescription for nitroglycerin, place 1 nitroglycerin tablet (0.4 mg) under your tongue. Let it dissolve. Do not chew or swallow the pill.
• Continue to put 1 nitroglycerin tablet under your tongue every 5 minutes until your symptoms are relieved.
• Do not drive yourself to the Emergency Department.
• Chew one adult-strength (325 mg) uncoated aspirin tablet or 4 "baby" aspirins (81 mg each) if you have them, are not allergic to aspirin, and are not already taking daily aspirin.

Diagnosis

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Once you arrive at the Emergency Department, several tests will be done to confirm or rule out the diagnosis of a heart attack:

• An electrocardiogram (EKG / ECG), which tests the electrical activity of your heart.
• A brief physical examination of the heart, lungs, and abdomen.
• Blood tests to look for heart muscle damage.
• Chest X-rays.

Treatment

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The treatment you receive in the Emergency Department will depend upon:

• How long ago your chest pain started.
• Results of your blood test.
• If you have ongoing symptoms. 
• The size of your heart attack.
• The area of your heart that is affected.
• The pattern of your electrocardiogram (EKG/ECG).

In the Emergency Department you will probably have:

• A catheter placed into a vein (IV).
• Oxygen.
• Medication to dissolve the blood clot, relieve your pain, and lower your heart rate and blood pressure.

You may receive additional nitroglycerin from the paramedic or Emergency Department staff. It is important that you notify all of these caregivers immediately if you have taken Viagra, Levitra, or Cialis within the prior 72 hours, since these medicines can have a fatal interaction with nitroglycerin.

If you did not have a heart attack, we may still be concerned about your chest pain. You may need to stay in the Emergencey Department longer so that we can run more blood tests or do a stress test before you are released to go home. Other tests and procedures may include:

You may be admitted to the hospital or transferred to another hospital. If the electrocardiogram and blood tests determine that the best treatment would be to open or repair the artery responsible for the blockage right away, you may need a cardiac catheterization or bypass surgery.

A cardiac catheterization allows us to see what blockages exist. During this procedure, a catheter is placed in a large artery of your leg or arm and guided into the arteries of your heart. The arteries can often be opened with a small balloon (angioplasty) and held open with a small expandable wire tube, called a stent.

Coronary artery bypass graft (CABG) surgery is sometimes needed. If the angioplasty is unable to reach or open a blockage, this surgical procedure takes veins from another part of your body and uses them to go around the blocked artery in your heart.

Recovery and Medications

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Recovery

To help you recover from a heart attack, we may recommend that you stay in the hospital, and we will provide you with discharge instructions before you go home.

Expect to stay in the hospital for a few days to a week. This will depend upon the type of heart attack you had and the treatment you received, as well as your general health before your heart attack.

Make the most of your recovery while you are in the hospital. You may receive physical therapy, occupational therapy, and respiratory therapy while you are in the hospital. We may also give you a stress test to help us evaluate your recovery and make physical activity recommendations.

We will help you prevent another heart attack and avoid future problems. When you are discharged from the hospital, you will receive instructions about medications to take and suggestions for a healthy lifestyle that will support your recovery.

Medications

Medications may include:

• Aspirin.
• Beta blockers.
• Statins.
• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB).
• Antiplatelets (if you have a stent).

Certain types of medications to cut down on stomach acid should not be taken with antiplatelet medication. Please discuss this with us if you are taking any type of antacids.

Lifestyle Changes and Management

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It’s never too late to make lifestyle changes that can improve the health of your heart. A heart-healthy lifestyle consists of maintaining a healthy weight, managing your diabetes, staying active, managing stress, and avoiding tobacco.

Healthy lifestyle recommendations:

• If you use tobacco, we strongly advise you to stop. Your risk of having a heart attack goes down within the first 24 hours after your last cigarette.
• Eat a diet that is low in saturated fat and trans fat, but one that is high in fiber with lots of fruits and vegetables.
• Make physical activity part of your daily routine.
• Maintain a healthy weight.
• Recognize and manage stress and depression.

We will work with you to:

• Control your blood pressure.
• Lower your cholesterol.
• Manage your blood sugar levels if you have diabetes.

We will provide you specific guidelines about the type of activities you can do and when it will be safe to do them. We may have you take an exercise stress test to determine what type of activity to recommend.

If you are not having chest discomfort or other complications, you will probably be able to return to your usual activities, including driving, within a few weeks. Ask your doctor when you will be able to resume sexual activity.

Depending on your occupation and the severity of your heart attack, you may be able to return to work in 2 to 6 weeks. Start slowly. Allow yourself plenty of time to regain your strength and energy.

Cardiac rehabilitation program participation

We strongly recommend that you participate in a cardiac rehabilitation program such as MULTIFIT to help you recover and to support you in achieving a healthy lifestyle. You will learn about the process of heart disease, proper physical activity, heart-healthy eating, and medications that protect your heart. In MULTIFIT, your personal care manager, together with your physician, will support and guide you while you learn how to live better and healthier with your condition.

Your Care with Me

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If you think you may be having a heart attack, or if you have chest pain or pressure that lasts more than 5 minutes, call 911 or seek other emergency services immediately.

If you have emergency symptoms as described above, do not use this website to e-mail your doctor, but instead call us immediately.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If cardiologist’s care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you have been seen before by a cardiologist outside of Kaiser Permanente, please bring those medical records with you. Also, please bring with you all your containers with any prescription medications and any over-the-counter medications you are taking.

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If you have been seen before by a cardiologist outside of Kaiser Permanente, please bring those medical records with you. Also, please bring with you all your containers with any prescription medications and any over-the-counter medications you are taking.

I may order additional tests to be completed at a subsequent visit. I may also prescribe medications, and I will talk to you about how to take the medications.

If I prescribe nitroglycerin for you, keep a fresh prescription (filled within the past 6 months) with you at all times. If you have chest pain or discomfort, sit down and rest, and take the nitroglycerin as directed. If your chest pain does not get better in 5 minutes, call 911. 

If you have had a recent heart attack, heart surgery, or a procedure on your heart, I may refer you to our MULTIFIT cardiac rehabilitation program or other cardiac classes or programs to help you with your recovery. The nurse or pharmacist care manager will contact me regularly about your health. A good place to start is by attending a heart health class. If you have a weakened heart muscle, I may refer you to our Heart Failure Care Management Program. The nurse or pharmacist care manager will adjust your medications to help improve the function of your heart. We also have a series of classes to learn about heart failure.

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Contacting Me

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Seek immediate medical care if:

• You are having chest pain of more frequency, duration, or severity than usual.
• You feel lightheaded or dizzy, have palpitations (sense that your heart is racing) for greater than 15 to 20 minutes, or feel you might faint.
• You are having worsening and/or sudden shortness of breath.

Also call 911 if you have signs of a stroke. These may include:

• Sudden numbness or weakness in your face, arm, or leg, especially on only one side of your body.
• New problems with walking or balance.
• Sudden vision changes.
• Slurred speech.
• New problems with confusion, speaking, or understanding simple statements.
• A sudden, severe headache that is different from past headaches.

If you had surgery or a procedure, please call me if you notice any swelling, bleeding, redness, pain, or discharge at the incision site.

Take your medication exactly as prescribed. If you are having problems with or have any questions about any of the medications I have prescribed for you, let me know. Do not stop taking them without notifying me.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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If Surgery or a Procedure is a Treatment Option

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If you are considering surgery, a procedure, or want more information about your heart problem, please review our health tool called “Preparing for Your Procedure” (Emmi). Emmi programs are available for the following cardiology topics related to your problem:

• Angiogram with Possible Angioplasty
• Coronary Artery Bypass Surgery (CABG)

Emmi programs are also available for the following cardiology topics:

• Anesthesia for an Adult
• Atrial Fibrillation Overview
• Aortic Valve Replacement
• Cardiac Catheter Ablation (SVT)
• Cardiac Catheter Ablation (VT)
• Cardiac Pacemaker
• Defib (Cardiac Resynchronization Therapy Defibrillator)
• Defib (Implantable Cardioverter Defibrillator)
• Mitral Valve Repair or Replacement
• Taking Warfarin (Coumadin®)
  

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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