Brigham and Women's Cardiovascular Associates at Care New England

Brigham and Women’s Cardiovascular Associates at Care New England offers expert care for any condition affecting your heart’s valves or chambers. We use the latest treatments, including minimally invasive techniques and procedures.

The Care New England Advanced Valvular and Structural Heart Disease Clinic at Kent Hospital features a local heart care team lead by Cardiologist Alice Kim, MD, and Cardiothoracic Surgeon Tsuyoshi Kaneko, MD, who are both affiliated with Kent Hospital and Brigham and Women's Hospital.  Dr. Kim and Dr. Kaneko evaluate and manage patients who have advanced valvular disease and structural heart disease with the opportunity to have expert care for these complex conditions in a setting close to home.

Office visits, imaging studies, and diagnostic testing are performed locally in Rhode Island. Patients who require valve interventions such as transcatheter therapies or minimally invasive or traditional cardiac surgery at Brigham and Women’s Hospital will have the convenience of receiving pre and post-procedure care locally.

This unique link between the cardiologists at CareNew England and the team at the Heart and Vascular Center at Brigham and Women’s Hospital has widely advanced the options available for patients in Rhode Island who need cardiac care. 

We believe in the practice of patient-focused and evidence-based care delivered by a regional heart team of general cardiologists, cardiothoracic surgeons, interventional cardiologists, cardiac imaging specialists, and cardiac anesthesiologists.  We work together with the patient and their families in shared decision-making for optimal patient care, safety, and outcomes. 

Conditions Treated

• Atrial septal defect
• Mitral valve prolapse
• Patent foramen ovale
• Valve failure
  • Bioprosthetic aortic valve insufficiency
  • Bioprosthetic aortic valve stenosis
  • Prosthetic paravalvular leak
• Valve regurgitation (leaky valves)
  • Aortic
  • Mitral
• Valve stenosis (narrowed valves)
  • Aortic
  • Mitral

What is heart valve disease?

Heart valve disease involves two main types of conditions: regurgitation and stenosis.

• Regurgitation – The valve does not completely close, causing the blood to flow backward. This forces the heart to pump more blood on the next beat, making it work harder.
• Stenosis - The valve opening becomes narrowed, which limits the flow of blood. This causes the heart to pump blood with more force in order to move blood through the narrowed valve.

Heart valves can develop in both conditions at the same time. The consequences for the heart can be severe. Blood will not pump properly through the body.

Risk Factors

• Aging
• Congenital birth defect
• Heart attack
• History of rheumatic fever
• Infection
• Myxomatous degeneration
• Syphilis

Symptoms

• Abdominal pain
• Chest pain
• Dizziness
• Fatigue
• Low blood pressure
• Palpitations
• Shortness of breath

Diagnosis

• Cardiac catheterization
• Cardiac ultrasound (echocardiography)
• Chest X-ray
• Electrocardiogram

Procedures and Treatment

• Balloon mitral valvuloplasty – Widen narrowed heart valves using a catheter.
• Catheter-based repair of prosthetic paravalvular leaks using devices tailored to someone’s valve mechanics.
• Closure of atrial septal defect (ASD) and patent foramen ovale (PFO).
• Complex valve surgery to repair or replace the aortic, mitral, tricuspid, or pulmonary valve. We offer minimally invasive surgery, giving you a quicker recovery and a shorter hospital stay.
• Left atrial appendage closure – Implanting a closure device, which can reduce the risk of stroke and other complications
• Transcatheter mitral valve repair – Using a clip-like device to repair the mitral valve, ensuring blood continues to move through the heart.
• Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI - A minimally invasive technique to replace the aortic valve with new tissue or a biologic valve. It is performed using a catheter and small incisions.

What are the types of replacement valves?

• Biologic valves are made from animal tissue, such as from a pig or cow, or a donated human heart. The animal tissue valves are sterilized and chemically treated for human use and then sewn onto a frame (stented) or left intact. A blood-thinning medication is not required but may be needed immediately after surgery.
• Mechanical valves are made of graphite and pyrolytic carbon, or other synthetic materials. Mechanical valves may require blood-thinning medications to avoid blood clots forming on the valve.

What are the repair or replacement procedures?

• Aortic root replacement
• Aortic valve replacement 
• Homograft mitral valve surgery
• Leaflet repair
• Ring annuloplasty
• Root-enlarging procedure
• Stented biological aortic valve replacement
• Stentless biological aortic valve replacement
• Valve-sparing root surgery
• Tricuspid valve surgery

Minimally Invasive Surgery Procedures

• Lower sternotomy
• MitraClip
• Percutaneous mitral valvuloplasty (widening of the valve)
• Percutaneous aortic valvuloplasty
• Transcatheter aortic valve replacement (TAVR)
• Upper mini-sternotomy 

What is Amyloid Heart Disease? 

Amyloidosis refers to a group of diseases caused by deposits of abnormal proteins, known as amyloid, in one or more organs of the body. Deposition of amyloid in the heart is known as cardiac amyloidosis or amyloid heart disease. When this occurs, the heart becomes stiff, causing fluid build-up in the lungs that leads to breathlessness and fluid buildup in soft tissues, which, in turn, leads to leg and abdominal swelling.

• There are several types of amyloidosis that can affect the heart, and it is vital that the correct type is identified, as treatment differs greatly depending on the specific form.
• Transthyretin-related (TTR) amyloidosis is derived from transthyretin, a small molecule mainly produced by the liver. There are 2 types of TTR-related amyloidosis: a genetic form known as hereditary transthyretin-related amyloidosis, (hATTR), and a nonhereditary form called wild-type ATTR (previously known as senile systemic amyloidosis).
• ATTR is the most common type of cardiac amyloidosis, it can also involve ligaments and tendons, causing spinal stenosis, carpal tunnel syndrome, and biceps tendon rupture.
• The peripheral and autonomic nerves can also be involved in hATTR, causing symptoms like numbness, tingling, and dizziness.
• In AL amyloidosis, the commonest organs to be damaged are the heart in the kidney. However, amyloid deposits may also occur in the gut, skin, soft tissues such as the tongue, nerves, lungs, and liver. Early diagnosis of AL cardiac amyloidosis is important since patients experience the most rapid disease progression.
• Secondary (AA) amyloidosis usually causes liver or kidney problems and rarely affects the heart.
• Localized amyloid deposits may occasionally occur in isolation without evidence of a generalized disease. Isolated bladder amyloid and amyloid in the trachea are the forms most commonly seen.

If you or a loved one have an aortic aneurysm or another condition affecting your aorta, the boy’s largest blood vessel, it’s important to get timely treatment to prevent life-threatening complications.

Aortic Conditions We Treat

• Aneurysms of the aorta, including abdominal and thoracic aortic aneurysms. A thoracic aortic aneurysm occurs in the chest, while an abdominal aortic aneurysm occurs in the abdomen. 
• Genetic conditions that increase the risk for aortic disease, including bicuspid aortic valve disease, Marfan Syndrome, Loeys-Dietz Syndrome, Ehlers-Danlos Syndrome and Turner Syndrome.
• Aortic dissection, a tear in the inner layer of your aorta. When blood gets behind the tear, it further separates the aorta’s inner and middle layers, increasing the chances of blocked blood flow, aortic rupture or other complications.
• Aortic rupture, a breaking or bursting of the aorta that can cause extensive, life-threatening internal bleeding.
• Aortic coarctation, a narrowing of the aorta that causes your heart to work harder to pump blood through the narrowed section. Aortic coarctation is usually something you’re born with, and it can range from mild (slightly narrow) to severe (very narrow).

What is an aneurysm?

• An aneurysm is a bulging, weak area in the wall of a blood vessel. This weakened section is at risk of tearing (aortic dissection) or bursting (aortic rupture), which can lead to internal bleeding or other complications. Treating an aortic aneurysm early lowers the chance for a tear or rupture.

An aneurysm may be found in many areas of the body, such as: 

• Aorta (aortic aneurysm)
• Blood vessels in the legs (femoral, iliac, or popliteal aneurysm)
• Brain (cerebral aneurysm)
• Intestines
• Kidney
• Neck
• Spleen

 The most common type of aneurysm is in the aorta. The aorta carries oxygenated blood from the heart to the rest the body.

What causes an aneurysm?

An aneurysm may be caused by factors that result in the breakdown of the artery wall. Atherosclerosis (hardening of the arteries) may be a cause.

Other causes of aneurysms are related to where they occur. Examples may include:

Risk Factors

• Age
• Atherosclerosis
• Congenital heart disease
• Diabetes
• Family history
• Gender
• Genetic factors
• Giant cell arteritis
• Head injury
• High cholesterol
• High blood pressure
• Infection
• Injury
• Obesity
• Pregnancy
• Smoking

Symptoms

Aneurysms may have no symptoms. If there are symptoms, they will depend on the location of the aneurysm in the body.

Some include:

• Pain in the abdomen, chest, groin, legs, or lower back
• Headache
• Nausea
• Vomiting
• Dizziness or loss of consciousness
• Pulsing artery in the groin or in the back of the knee
• Sores on lower extremities

Diagnosis

• Arteriogram (angiogram) - X-ray image of the blood vessels used. Dye is injected through a thin tube placed in an artery. This dye will make the blood vessels visible on the X-ray.
• CT scan - X-rays and computer technology to make images of the body that are more detailed than traditional X-rays.
• Echocardiogram - Sound waves are recorded on an electronic sensor that creates a picture of the heart and heart valves and how they are functioning.
• MRI - Magnets, radio waves, and a computer to make detailed images of organs and other parts inside the body.
• Ultrasound - High-frequency sound waves and a computer are used to create images of blood vessels, tissues, and organs and how they interact.

Procedures and Tests

• Emergency repair of aortic dissection or rupture.
• Endovascular aortic repair – A catheter is used to place a stent (tube) within the abdominal section of the aorta and seal the aneurysm off from the inside.
• Open-heart surgery to repair aneurysms when minimally invasive approaches aren’t an option.
• Thoracic endovascular aortic repair – A catheter is used to place a stent (tube) within the thoracic (chest) section of the aorta and seal the aneurysm off from the inside.
• Clinical trials to provide access to minimally invasive repair techniques that aren’t widely available elsewhere.

Other alternatives include:

• Aortic root replacement - Removing the diseased portion of the aortic root and reconstructing it using a custom-designed synthetic tube.
• Ascending aortic replacement – Removing the diseased section of the ascending aorta and reconstructing it with a custom-designed synthetic tube.
• Aortic arch reconstruction or replacement – Removing the diseased section of the aortic arch and reconstructing it with a custom-designed synthetic tube.
• Aortic coarctation repair- Removing the narrowed portion of the aorta and replacing it with an open synthetic tube.

What is atrial fibrillation?

Atrial fibrillation, or AFib, is the most common type of abnormal heart rhythm, or arrhythmia. A group of cells signals the heart to begin a heartbeat. This signal originates in the right atrium, which is the upper right chamber of the heart. It travels through the heart to the upper-left chamber or the left atrium and then to the pumping chambers. The heart contracts and blood is moved.

During atrial fibrillation, the signals are not regular and not organized. The blood is not being provided to the body, and blood can also pool and cause clots to form. These clots are usually found in the left atrium because of an area in the chamber where several lobes are located. These clots can be pumped to the brain and cause a stroke.

Atrial fibrillation is normally classified into three types:

• Parosyxmal – Brief quivering or fibrillation and then stops and goes away. It may then return to normal rhythm.
• Peristent – Treatment is used to return the heart to a regular rhythm.
• Permanent – Even through treatment, the rhythm cannot be restored to normal.

Risk Factors

There are many causes, but some include:

• Age
• Congenital heart defects
• Coronary artery disease
• Diabetes
• Heart failure
• High blood pressure
• Hyperthyroidism
• Obesity
• Obstructive sleep apnea
• Pericarditis
• Rheumatic heart disease from a Streptococcus infection

Symptoms

• Chest pain
• Confusion
• Dizziness
• Fatigue
• Heart skipping a beat
• Shortness of breath
• Swelling of lower extremities

Diagnosis

• Blood tests
• Echocardiogram
• Sleep study (for sleep apnea)
• Stress testing

Treatment and procedures

Medication

• Angiotensin converting enzyme inhibitors
• Antiarrhythmics
• Anticoagulant medication
• Beta-blockers
• Calcium-channel blockers
• Digoxin

Procedures

• Cardioversion
• Catheter ablation
• Surgery

What is atherosclerosis?

Atherosclerosis is a buildup of plaque (mainly cholesterol deposits) within the arteries. This thickening of the artery walls decreases the flow of blood and oxygen to vital body organs and extremities, which can lead to severe cardiovascular diseases, such as:

Coronary heart disease (CHD) occurs when plaque builds up in the lining of the coronary arteries. The resulting narrowing of the arteries prevents blood and oxygen from flowing easily to the heart muscle, which may cause angina (pain, discomfort, or pressure in the chest). If blood flow is completely blocked by plaque or by a blood clot that forms inside the narrowed coronary artery, a heart attack may occur.

• Carotid artery disease, also called carotid artery stenosis or carotid artery occlusive disease, is characterized by the narrowing of the carotid arteries, the main blood vessels carrying oxygenated blood to the brain. This is most commonly related to atherosclerosis in the artery. If the narrowing becomes severe enough to block blood flow to the brain, or if a piece of plaque breaks off and obstructs blood flow, a stroke may occur.
• Peripheral artery disease (PAD) is a slow and progressive circulation disorder affecting the arteries that supply the legs or arms with blood and is usually caused by atherosclerosis. In the United States, about seven million people have peripheral artery disease. It is frequently found in people with coronary artery disease.

Cardiovascular specialists at Brigham and Women’s Cardiovascular Associates at Care New England offer comprehensive, compassionate, and innovative inpatient and outpatient services to adults with conditions related to atherosclerosis. We offer a broad range of diagnostics and cutting-edge medical, interventional, and surgical therapies.

Significant advances in cancer treatment have helped us to more effectively control cancer and markedly extend the lives of patients. However, some of these advanced therapies can also produce serious cardiovascular side effects.

Many cancer patients develop some type of heart complication as a result of cancer therapy. Potential complications include heart failure and cardiomyopathy, arrhythmia, and hypertension.

Brigham and Women’s Cardiovascular Associates at Care New England brings together expert cardiovascular specialists and oncologists to provide optimal care for cancer patients during and after cancer treatment.

We care for cancer patients who have pre-existing heart conditions and those who develop cardiac side-effects to cancer treatment. Working together as a team, we help minimize cardiotoxicity during cancer treatment and cardiovascular risks during cancer survival. Specialized surgical care is also available for patients who have non-cancerous tumors of the heart or atrial myxoma.

With Brigham and Women’s Cardiovascular Associates at Care New England, a multidisciplinary team of specialists collaborates to provide the most appropriate and effective care for patients with cardiac sarcoidosis and inflammatory heart disease.

What is sarcoidosis?

Sarcoidosis is a rare inflammatory disease of adults that can occur in almost any organ. It affects the lungs (pulmonary sarcoidosis) in most patients. Sarcoidosis can affect the heart in about 20 percent of patients and is called cardiac sarcoidosis.

Risk factors

The cause of sarcoidosis remains unknown.

Symptoms 

Sarcoidosis can be difficult to diagnose because symptoms often do not appear in the early stages and when they do, they can mimic other diseases. When sarcoidosis appears in the heart (cardiac sarcoidosis), patients may experience:

• Palpitations (feeling like your heart has skipped or added a beat)
• Shortness of breath
• Fatigue
• Lightheadedness
• Dizziness
• Fainting

Diagnosis

Cardiac sarcoidosis can be challenging to diagnose because symptoms can often mimic those of other diseases.

To effectively diagnose sarcoidosis, your physicians will review any results from tests you have already had done and may recommend others (see services below). These can include imaging studies and biopsies, among other tests.

Treatment

If your symptoms are not severe, treatment may not be necessary and the disease may resolve on its own. If it does not resolve, the multidisciplinary medical team will recommend an individualized treatment plan which may include:

MEDICATIONS

• Anti-inflammatory drugs
• Immunosuppressive agents
• Newer biologic therapies
• Heart medications (such as beta-blockers, renin angiotensin system inhibitors and/or diuretics) to reduce strain on the heart, help the heart beat stronger and more regularly, and/or reduce fluid in the body

LIFESTYLE

• Stopping smoking and alcohol consumption
• Weight loss
• Reducing fat and salt in your diet
• Exercise and stress reduction
• Blood pressure control

Additionally, if your cardiac sarcoidosis has caused heart rhythm issues (arrhythmias), we may recommend one or more of the following:

• An electrophysiology study
• A ventricular tachycardia (VT) ablation
• Placement of an implantable cardioverter defibrillator (ICD)
• Placement of a permanent pacemaker

Brigham and Women’s Cardiovascular Associates offers comprehensive evaluation, diagnosis, and management for those who are at risk for or have an inherited cardiac disorder. Genetic testing can be used to create a diagnostic and treatment plan for each patient and their family members who also may be at risk.

Risk Factors

Screening should be done for patients whose blood relatives have certain cardiovascular diseases. Some of these conditions include:

• Arrhythmogenic right ventricular dysplasia
• Cardiomyopathy
• Coronary artery disease and myocardial infarction
• Dilated cardiomyopathy
• Inherited aortic aneurysms
• Inherited arrhythmias such as Brugada syndrome and Long QT syndrome
• Marfan syndrome and connective tissue disorders

Diagnosis

Tests to evaluate patients may include:

• Cardiac magnetic resonance imaging (MRI)
• Cardiac ultrasound
• Electrophysiology studies
• Genetic screening and testing
• Nuclear scan
• Standard exercise stress test

Treatment

Treatment varies on a variety of factors, including age, health, family and medical history, and severity of a disease. Some treatment options can include:

• Cardiac ablation
• Cardiac resynchronization therapy
• Cardioverter defribrillator
• Coronary angioplasty
• Coronary artery bypass grafting
• Endarterectomy
• Pacemaker
• Stenting

What is carotid artery disease?

Also called carotid artery stenosis, is a narrowing of the carotid arteries. It is related to the build0up of plaque in the artery, or atherosclerosis. A stroke can occur is blood flow is obstructed to the brain.

Risk factors

Atherosclerosis is the main cause of the disease, and other factors may include:

• Age
• Gender
• Diabetes
• Diet
• Family history
• Elevated fat in the blood
• High blood pressure
• Obesity

Symptoms 

• Weakness or paralysis of an extremity, like an arm, hand, or leg
• Slurred or unusual speech
• Blurred vision or blindness in one eye
• Dropping of one side of the face

Diagnosis

Computed tomographic scanning and magnetic resonance imaging are used for evaluation. Some of these procedures may include:

• Carotid duplex ultrasound
• Cerebral angiography
• Computed tomographic angiography
• Magnetic resonance angiography

Treatment

The treatment for carotid artery disease varies on a variety of factors, but a specialist may prescribe:

MEDICATION

• Antiplatelets
• Antihyperlipidemics
• Antihypertensivds

SURGERY

• Balloon stent angioplasty
• Carotid endarterectomy

Cerebrovascular disease includes to conditions and diseases that impact blood flow to the brain, which can lead to a stroke. These include:

• Aneurysm
• Carotid artery disease

It is caused by a lack of blood flowing through the vessels, which can result in:

• Transient brain ischemia
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Ischemia

If you have advanced heart failure, you can manage it with world-class care from Brigham and Women’s Cardiovascular Associates at Care New England. From congestive heart failure to pulmonary hypertension, our comprehensive program treats every heart failure condition. Here’s what you can expect from our team, led by Garrick Stewart, MD:

Advanced Treatment Options

From medication and lifestyle management to surgery and heart transplant, Care New England offers every type of treatment you need to manage your heart failure. Our care offerings include:

• Advanced heart transplant expertise and evaluations
• Bypass surgery
• Heart valve surgery
• Implantable heart devices

What is congestive heart failure and cardiomyopathy?

Congestive heart failure is when the heart fails to sufficiently pump oxygenated blood. The heart continues to pump, but not as efficiently as a healthy heart.

Cardiomyopathy, which describes any disorder that affects the heart muscle, also can be a contributing cause of heart failure.

Three forms of cardiomyopathy are:

• Dilated cardiomyopathy, the most common type of cardiomyopathy, refers to an enlarged heart with an impaired ability to function properly.
• Hypertrophic cardiomyopathy is a rare condition that involves thickening of the left ventricle and stiffening of the heart, due to a genetic mutation in key proteins involved in heart muscle contraction.
• Restrictive cardiomyopathy occurs when the heart muscle becomes stiff due to progressive fibrosis or accumulation of abnormal substances and is unable to properly fill with blood.

Risk Factors

• Cancer therapy-associated heart failure
• Congenital heart disease or defects
• Coronary heart disease
• Diabetes
• Endocarditis
• Genetic diseases
• Heart rhythm disorders (cardiac arrhythmias)
• Heart valve disease
• High blood pressure
• Pregnancy-associated heart failure and peripartum cardiomyopathy
• Previous heart attacks

Symptoms

• Abdominal Pain
• Loss of appetite
• Nausea, abdominal pain, and loss of appetite
• Persistent cough
• Shortness of breath
• Weakness and fatigue
• Weight gain or a gain of more than two pounds overnight or five pounds in a week

Diagnosis

After an evaluation from a physician, a cardiologist may order one of these tests or procedures:

• Cardiac Biopsy
• Cardiac catheterization
• Cardiac CT
• Cardiac MRI
• Cardiac Ultrasound (Echocardiogram)
• Chest X-ray
• Electrocardiogram
• Nuclear scan
• Positron Emission Tomography
• Standard Exercise Tolerance Test

Treatments and Tests

Lifestyle Changes

• Alcohol elimination
• Blood pressure control
• Fat and salt intake reduction
• Smoking cessation
• Weight loss

Medication

• Angiotensin converting enzyme inhibitors
• Agiotensin II receptor blockers
• Alpha blockers
• Antiarrhythmics
• Antibiotics
• Antihyperlipidemics
• Anti-inflammatory medications
• Antiplatelet medications
• Antiproliferative agents
• Beta-blockers
• Bile acid sequestrants
• Calcium-channel blockers
• Cilostazol
• Digoxin
• Diuretics
• Endothelin receptor antagonists
• Fibrates
• Nicotinic acid
• Non-steroidal anti-inflammatory drugs
• Potassium-channel blockers
• Prostacyclin analogues
• Sodium-channel blockers
• Statins
• Thrombolysis
• Vasodilators

Procedures

• Cardiac ablation
• Cardiac resynchronization therapy
• Implantable cardioverter defibrillator
• Percutaneous catheter-based interventions
• Stents
• Percutaneous transluminal coronary angioplasty (
• Intra-aortic balloon pump
• Intravenous Ultrasound
• Oral and intravenous medications
• Percutaneous ventricular assist device

Surgery

• Aortic valve repair and replacement
• Coronary artery bypass grafting
• Ventricular assist device
• Left ventricular assist device
• Heart transplantation

What is coronary artery disease?

The heart is a muscle that needs oxygen in order to function and pump blood, and it receives the oxygen it needs from coronary arteries. Blood flows easily through the artery when it is healthy, but blockages inside the arteries can cause damage. These blockages include plaque, which can be caused by issues like cholesterol buildup, high blood pressure, and high blood sugar.

The arteries are narrowed, which, when the body is under stress, such as when exercising, can cause pressure, tightness, pain in the chest or in other parts of the body.

A blocked artery occurs when plaque breaks off inside the artery, or a blood clot forms, and blocks the passageway, which causes the blood flow to stop. This is the reason why a heart attack occurs.

Coronary artery disease, or coronary heart disease, is the most common type of heart disease.

Risk Factors

• Age
• Diabetes
• Excessive alcohol consumption
• Gender
• Family history
• High blood pressure
• High cholesterol
• Smoking

Symptoms

• Dizziness or cold sweats
• Fatigue
• Heart palpitations
• Indigestion or heartburn
• Nausea
• Shortness of breath
• Weight gain

Diagnosis

• Cardiac catheterization (link to P1)
• Cardiac ultrasound (echocardiogram)
• Chest X-ray
• Coronary angiogram
• Electrocardiogram
• Exercise Stress test
• Nuclear Scan

Treatments and Procedures

Medications

• Angiotensin converting enzyme inhibitors
• Antiplatelet medications
• Beta-blockers
• Statins
• Vasodilators

Procedures

• Angioplasty
• Artery Bypass Grafting
• Endarterectomy

What is deep vein thrombosis and a pulmonary embolism?

Deep vein thrombosis occurs when there are blood clots in the deep leg veins if the lower extremities. Pulmonary embolism occurs when a clot breaks off from the walls of a vein and then travels to the heart. This condition is very serious and can lead to a patient’s death.

Risk factors

There are various risk factors that include:

• Age
• Cancer
• Conditions like heart failure, high blood pressure
• Chronic obstructive pulmonary disease, and stroke
• Clotting
• Genetic conditions that are associated with risk of clots
• Medications like hormone replacement therapy or birth control
• Obesity
• Pregnancy
• Smoking
• Surgery
• Varicosse veins

Symptoms:

• Discolored skin that is red or white
• Leg swelling
• Fever
• Pain or tenderness in the leg
• Rapid heartbeat
• Warm skin
• Surface veins

During a pulmonary embolism some symptoms can include:

• Anxiety
• Chest pain
• Coughing up blood
• Dizziness
• Low blood pressure
• Palpitation
• Shortness of breath
• Sweating

Diagnosis:

• Blood tests for clotting
• Computed tomography scan
• Electrocardiogram
• Magentic resonance imaging
• Pulmonary angiogram
• Venous duplex ultrasound
• Venogram
• Ventilation-perfusion scan
• X-ray

Treatment

Treatment can involve:

MEDICATION

• Anticoagulants
• Thrombolytics

PROCEDURES

• Inferior vena cava
• Thrombectomy

What is endocarditis?

Endocarditis is an infection of heart valves or possibly the inner lining of the heart chambers. These infections can be caused by bacteria or a fungus.

Risk factors

Patients who have had heart valve replacement or have damaged valves are at the greatest risk, but there are a number of factors:

• Catheters
• Dental procedures
• Gum disease
• Surgery performed on the gall bladder or prostate
• Procedures involving airways, the gastrointestinal tract or urinary tract
• Tonsillectomy
• Individuals with congenital heart disease and implanted medical devices

Symptoms

• Fever
• Sweating
• Shortness of breath
• Chills
• Joint or muscle pain
• Lesions on the hands or feet
• Swelling of the feet, legs, or abdomen
• Hemorrhages under fingernails or toenails

Diagnosis

• Blood count
• Blood test
• Echocardiogram
• Electrocardiogram
• X-ray

Treatment

• Antibiotics
• Aortic or mitral valve repair or replacement

When a heart attack assaults the body, every second counts. Care New England is a regional leader in cardiac care and can provide the rapid and advanced response needed to provide life-saving care to those suffering from a heart attack.

If you or a loved one is experiencing symptoms of a heart attack, call 911 immediately.

What Causes a Heart Attack?

A heart attack occurs when the flow of blood to a portion of the heart is blocked suddenly. With coronary artery disease, a buildup of a fatty substance, which is called plaque, within artery walls leads to the development of atherosclerosis, or the stiffening and narrowing of the arteries. When a piece of plaque breaks or splits off, a blood clot forms inside the artery. That stops blood flow to that portion of the heart.

Risk Factors

• Diabetes
• Family history
• High blood pressure (hypertension)
• High LDL cholesterol
• Inactive lifestyle or lack of exercise
• Obesity
• Smoking

A heart attack can occur at any age but the risk increases over time.

Symptoms

• Sudden pain or discomfort in the chest
• Pain in the arms, jaw, neck, shoulders, or upper abdomen
• Shortness of breath

Not all heart attacks come on abruptly. Symptoms may be different for some individuals, including involving indigestion.

Learn more about how to detect a heart attack >>

How is a heart attack treated?

• Asprin or clopidogrel – Medication to prevent more blood clotting.
• Beta-blockers – Medication to help the heart muscle rest, decrease blood pressure, and prevent an irregular heartbeat.
• Fibrinolytic therapy – Intravenous medication to dissolve the blood clot
• Intravenous therapy -Medicines such as nitroglycerin and morphine are given through a tube into a vein.
• Oxygen therapy
• Pain medication
• Statins – Lower cholesterol

You may also need other procedures to restore blood flow to the heart. These may include: 

Percutaneous coronary intervention or coronary angioplasty

This procedure opens up a blocked or narrowed coronary artery by using a small balloon inserted with a catheter and then inflated inside the blocked artery, which helps open the blocked area. The blockage can also be cut out or destroyed using other methods. A special tube called a stent may also be placed inside the artery to help it open.

Coronary artery bypass graft

This surgery is also called bypass surgery. It is often done in people who have chest pain (angina) and severe coronary artery disease that can't be treated with percutaneous coronary intervention.

During the surgery, the surgeon makes a bypass to let blood flow around the blockage. This is done by grafting a piece of a vein from the aorta to the coronary artery beyond the blocked part of the artery. A healthy blood vessel is used for the graft and usually is taken from:

• Internal thoracic artery in the chest
• Radial artery in the wrist
• Saphenous vein in the leg

For personalized, comprehensive care of your irregular heartbeat (called an arrhythmia), the cardiac physicians of Brigham and Women’s Cardiovascular Associates at Care New England will develop a treatment plan that’s right for you.

From offering dedicated care for atrial fibrillation to the monitoring of your device, we combine deep clinical experience with expertise in the latest technologies.

Our experts are adept at providing exceptional care to patients with irregular heart rhythms, heart palpitations, and rapid heartbeats.

What is a heart rhythm disorder?

 Heart rhythm disorders (arrhythmias) are atypical heartbeats that cause the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly, which is caused by a problem with the heart’s electrical system.

Types of heart rhythm disorders

• Atrial fibrillation - Very irregular and fast contraction of the atria.
• Atrial flutter 
• Paroxysmal supraventricular tachycardia - Fast heart rate that begins and ends suddenly
• Premature beats - Fluttering in the chest.
• Supraventricular arrhythmias - Tachycardias that start in the atria or atrioventricular node.
• Ventricular arrhythmias - Begin in the ventricles, the heart's lower chambers.
• Ventricular tachycardia – Fast beating of the ventricles
• Ventricular fibrillation - Ventricles quiver.
• Bradyarrhythmia - Heart rate is slow and decreases blood flow, which can cause fainting.

Risk Factors

• Alcohol
• Caffeine
• Congenital heart disease
• Coronary artery disease
• Diabetes
• Drugs and supplements
• Genetics
• Heart valve disorders
• High blood pressure (hypertension)
• Obesity
• Sleep apnea
• Smoking
• Thyroid problems

Symptoms

• Chest pain or tightness
• Dizziness or lightheadedness
• Fainting
• Low blood pressure
• Palpitations
• Shortness of breath
• Weakness or tiredness

Diagnosis

After an evaluation from a physician, a cardiologist may order one or some of the following tests or procedures:

• Cardiac magnetic resonance imaging (MRI)
• Cardiac ultrasound (Echocardiography)
• Electrocardiogram
• Electrophysiology studies
• Event monitor
• Exercise stress test
• Holter ECG monitor
• Implantable loop recorder
• Transesophageal echocardiogram

Procedures and Treatment

Lifestyle Modifications

• No alcohol or caffeine
• Reduce stress

Procedures

• Antiarrhythmic medications
• Cardiac resynchronization therapy
• Cardioversion –Electrical current through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back while the patient is under anesthesia. The purpose is to interrupt the abnormal electrical pulses in the heart and restore a normal heartbeat. This procedure does not damage or injure the heart.
• Catheter ablation –Non-surgical procedure using heating or cooling ablation where a wire or tube is inserted through a vein in the leg and into the heart.
• Implantation of cardiac pacing devices – Pacemakers and implantable cardioverter-defibrillators.
• Laser and mechanical lead and device extraction – Removal of a damaged device or its wires when they are causing scarring or infection
• Surgical and minimally invasive surgical ablation – Creating minor lines or grooves on the heart that redirect irregular electrical movement.
• Left atrial appendage closure 
• antiarrhythmic medications
• Transvenous lead extraction

Blood pressure is the force of blood traveling through an artery. With each heartbeat, blood is pumped from the heart and into the blood vessels. Every time the heart beats, pressure is created inside arteries as the heart contracts and relaxes.

High blood pressure occurs when the force inside the arteries is too high during the contraction or relaxation.

Complications of high blood pressure include:

• Death
• Heart attack
• Heart failure
• Kidney failure
• Loss of eyesight
• Stroke

Risk Factors

• Diabetes
• Excessive alcohol consumption
• Family history
• High sodium
• Kidney disease
• Lack of physical activity
• Sleep
• Smoking
• Stimulant drugs
• Stress
• Weight

Symptoms

Very high blood pressure may exhibit:

• Changes in vision
• Chest pain
• Headache

Diagnosis

• Check blood pressure

  • Systolic pressure – top number is the pressure inside the artery when the heart contracts

  • Diastolic pressure- the bottom number is the pressure inside the artery when the heart is at rest

There are four ratings of blood pressure:

• Normal – 120/80 or less

• Elevated – Systolic 120-129 and diastolic less than 80

• Stage 1 high blood pressure – Systolic is 130-139 or diastolic is 80-89

• Stage 2 high blood pressure – Systolic is 140 or higher or diastolic is 90 or higher

Treatment

Lifestyle changes 

• Exercise

• High fiber foods

• Limit calories and fat in food

• Limit salt (sodium) in food

• Limit serving sizes in food

• Quit smoking

• Reduce alcohol consumption

• Reduce stress

• Sleep

• Weight

Medicine

• Alpha blockers

• Angiotensin-converting enzyme inhibitors

• Angiotensin II receptor blockers

• Beta blockers

• Calcium channel blockers

• Diuretics

What is pericardial disease?

Pericardial disease, or pericarditis, is inflammation of the thin membrane that surrounds the heart. The inflammation can cause the fluid that is present to increase and disrupt the heart to be able to fill and function properly.

Risk factors 

• Autoimmune disorders such as lupus or rheumatoid arthritis
• Bacterial or fungal infection
• Cancer
• Chest injury
• Inflammation after a heart attack or surgery
• Kidney failure
• Medication
• Radiation therapy
• Tuberculosis

Symptoms

• Chest pain
• Fever
• Shortness of breath

Diagnosis

• Blood tests
• CT scan
• Echocardiogram
• Electrocardiogram
• MRI
• X-ray

Treatment

MEDICATION

• Antibiotics
• Corticosteroids
• Non-steroidal anti-inflammatory drugs

PROCEDURES OR SURGERY

• Pericardiocentesis
• Balloon pericardiotomy
• Pericardiectomy

What is peripheral artery disease? 

It is a circulation disorder that affects the arteries in the arms and legs. It is closely associated with the narrowing and blocking of arteries in atherosclerosis, and it found often in patients with coronary artery disease.

Risk Factors:

• Diabetes
• Age
• High blood pressure
• High cholesterol
• Smoking

Symptoms:

• Leg cramping
• Pain in toes or feet
• Wounds that won’t heal in ankles or heels
• Weakness in muscles while walking
• Dead tissue or gangrene

Diagnosis:

• Ankle-bracahial infex
• Magnetic resonance angiography
• Exercise tolerance test
• Doppler ultrasound
• Pulse volume recording waveform analysis
• Segmental blood pressure measurements

Treatment

Lifestyle changes may be necessary, including exercise, diet, and quitting smoking, but a provider may prescribe other treatments:

MEDICATION

• Antiplatelets
• Lowering cholesterol
• Improving blood flow
• Controlling blood sugar
• Thrombolytic therapy

PROCEDURES AND SURGERY

• Peripheral artery angioplasty
• Stenting
• Peripheral bypass surgery

Pregnancy can have an impact on the heart. Changes to the heart and circulatory system during pregnancy include:

• Increased blood volume
• Increased amount of blood pumped by the heart
• Increased heart rate
• Lowered blood pressure

Combining clinical and research expertise in cardiovascular disease and high-risk obstetrics, Brigham and Women’s Cardiovascular Associates at Care New England work with medical teams at Kent Hospital and Women and Infants Hospital to provide care to women looking to get pregnant or have high-risk pregnancies.

Our specialists use a multidisciplinary approach to diagnose and treat women with arrhythmia, cardiomyopathy, coronary artery disease, structural heart disease, vascular disease, and other serious cardiovascular conditions. This includes care for women with pre-existing heart and vascular disease or for women who develop cardiovascular conditions during pregnancy.

This service, led by Fred Wu, MD, provides consultation for patients with pulmonary hypertension and symptoms that might require advanced medical or interventional management. This clinic also serves adult patients with a history of congenital heart disease requiring local follow-up.

Brigham and Women’s Cardiovascular Associates at Care New England brings together pulmonary and critical care medicine physicians, cardiothoracic surgeons, interventional cardiologists, and cardiovascular medicine clinicians who have extensive experience in the diagnosis of implementation of treatment for all forms of pulmonary vascular disease and hypertension.

What is pulmonary hypertension?

Pulmonary hypertension is high blood pressure in the blood vessels of the lungs. It occurs when the blood vessels that go through the lungs become thicker, constrictor becomes blocked. This leads to increased pressure in those vessels, which causes the heart to work harder to pump blood through the lungs. This weakens and enlarges the heart and its proper functions.

Risk Factors

 While the exact cause of pulmonary hypertension is unknown, there are a number of factors that may contribute, including:

• Connective tissue disease
• Family history
• HIV
• Liver disease
• Lung disease
• Valvular or hypertensive heart disease

Symptoms

• Fatigue or tiredness
• Shortness of breath, or dyspnea

Other common symptoms include:

• Ankle or leg swelling, which is commonly called edema
• Chest pain or pressure during activity commonly called angina
• Cough
• Dizziness
• Fainting
• Fast heart rate, or tachycardia
• Heart palpitations

Diagnosis

Pulmonary hypertension is rarely discovered during a routine medical examination, and it can be confused with other conditions that affect the heart and lungs.

Diagnosis typically is a process of exclusion. Diagnostic procedures may include:

• Cardiac catheterization
• Cardiac ultrasound (Echocardiography)
• Electrocardiogram
• Ventilation/Perfusion lung scan to detect a blood clot
• Pulmonary function tests 
  • Diffusion capacity
  • Lung volume
  • Spirometry

Treatment and Procedures:

Medication

• Calcium-channel blockers
• Digoxin
• Diuretics
• Endothelin Receptor Antagonists
• Intravenous treatment
• Oxygen therapy
• Phosphodiesterase Inhibitors
• Prostacylin Analogues
• Selective IP Receptor Agonists
• Soluable Guanylate Cyclase Stimulators
• Subcutaneous treatment
• Warfarin to prevent clotting

What is renal artery stenosis?

Renal artery stenosis is a blockage of an artery to the kidneys. This can be caused by atherosclerosis, or a build-up of plaque in the arteries, or by a condition such as fibromuscular dysplasia and Takayasu’s arteritis.

Risk factors

• Age
• Diabetes
• Gender
• High cholesterol
• High blood pressure
• Smoking

Symptoms

• High blood pressure (sudden)
• Blood pressure not responding to multiple medications
• Kidney failure
• Increased urea in blood
• Recurring build-up of fluid in the lungs

Diagnosis

• Renal angiography
• Magnetic resonance angiography

Treatment

MEDICATION

• Antiplatelets
• Antihyperlipidemics
• Antihypertensives

PROCEDURES AND SURGERY

• Angioplasty
• Artery bypass
• Endarterectomy
• Peripheral bypass surgery
• Stenting

Stroke Prevention

When blood flow is prohibited from traveling to the brain, a stroke can occur when a blockage occurs in one of the blood vessels or when a blood vessel bursts. Treating cardiovascular disease and managing cardiovascular conditions are vital to stroke prevention.

Learn More >>

What is thoracic outlet syndrome?

Thoracic outlet syndrome is characterized by conditions involving compression or tightening of arteries, nerves, or veins in the area between the spin, collarbone, and top rib. The condition can result in pain in the shoulders and neck as well as weakness, but it can also lead to blood clots.

There are different forms of thoracic outlet syndrome:

• Arterial
• Neurogenic
• Venous

Risk Factors

• Obesity
• Pregnancy
• Injury
• Anatomy
• The repetitive motion of arms
• Tumors
• Posture

Symptoms

• Numbness or tingling or arms or fingers
• Pain in the neck, hands or shoulders
• Weak grip
• Deterioration of ability of lower part of thumb, or Gilliatt-Sumner hand
• Swelling in the arm
• Bluish color to hand
• Blood clots in veins or arteries
• Weak pulse in arm
• Cold extremities
• Fatigue
• Throbbing near collarbone
• Thrombosis of the axillary vein, or Padgett-Schroeder Syndrome

Diagnosis

• Arm stress test
• CT scan
• Electromyography
• Nerve conduction study
• Thoracic outlet specific MRI
• Ultrasound
• Venography or arteriography
• X-ray

Treatment

• Medication to relieve pain or relax muscles
• Lifestyle changes such as avoiding strenuous activity, improving good posture, weight loss
• Physical therapy
• Thrombolytic therapy
• Surgery

What is ventricular tachycardia?

Ventricular tachycardia is a fast, abnormal heart rate. It starts in your heart’s lower chambers, called the ventricles. It is defined as a heartbeat that is three or more heartbeats in a row, at a rate of more than 120 beats per minute.

It can become life-threatening if it is sustained for more than 30 seconds. The rapid heartbeat doesn't give the heart enough time to fill with blood before it contracts again. This can affect blood flow to the rest of the body.  

Ventricular tachycardia is caused in two ways:

• An abnormal heart circuit in the muscle is triggered
• The muscle becomes self-activated

At Brigham and Women’s Cardiovascular Associates at Care New England, treatment is provided by some of the world's most experienced physicians in cardiac electrophysiology (the study of heart’s electrical system).

Risk Factors

• Cardiomyopathy
• Coronary artery disease
• Heart valve disease
• Sarcoidosis

Symptoms

• Cardiac arrest
• Chest pain
• Dizziness
• Fainting
• Heart palpitations
• Neck tightness
• Shortness of breath

Diagnosis

To diagnose ventricular tachycardia, the heart rhythm has to be recorded. That requires an electrocardiogram, or heart activity can be monitored using a Holter monitor or diagnosed from a stress test.

Treatment and Procedures

Medicine 

• Antiarrhythmics
• Beta-blocker

Procedures

• Cardiac ablation
• Cardiac defibrillator
• Cardiac resynchronization
• Cardioversion
• Transvenous lead extraction