Cardiology Care Services

Your heart’s in good hands with PromiseCare. The cardiologists at PromiseCare are among the best.

The cardiologists at PromiseCare provide diagnosis, treatment and coordination of patient care with primary care physicians and surgeons using their expertise in all types of cardiovascular diseases and underlying conditions. We offer comprehensive heart care services to you and your family across Riverside County – from Temecula to Riverside – via the latest in medical technology, making our team of experts available where and when you need them.

PromiseCare diagnoses and treats the following conditions:

  • Arrhythmia
  • Cardiomyopathy
  • Congenital heart defects
  • Heart attack
  • Heart disease
  • Heart failure
  • Heart valve disease
  • Structural heart disease

 

A PromiseCare cardiologist also assists patients in managing, reducing or eliminating heart disease risk factors, such as high blood pressure, high cholesterol, and diabetes.

CONDITIONS & TREATMENTS

Heart Transplant

Transplanting a heart involves removing the diseased heart from a patient and replacing it with a healthy one from an organ donor.

Two or more healthcare providers must declare the donor brain-dead before removing the heart.

A heart transplant is not for everyone.

A transplant team reviews the evaluation due to the wide range of information needed to determine if a person is eligible for transplant.

An organ transplant team consists of a transplant surgeon, a transplant cardiologist (a doctor specializing in treating the heart), nurse practitioners or physician assistants, one or more transplant nurses, a social worker, and a psychiatrist or psychologist.

Other members of the team may include a dietitian, a chaplain, a hospital administrator, and an anesthesiologist (a doctor who uses medicines to keep you asleep during surgery).

Preparation for Surgery

The following is what you can expect to prior to an cardiovascular operation:

Psychological And Social Evaluation

Organ transplants have psychological and social consequences, such as stress, financial difficulties, and support from loved ones.

All of these can have a significant impact on your recovery.

Blood Tests

In order to find a good match and improve the chances of not rejecting the donor heart, blood tests are necessary.

Diagnostic Tests

Your lungs will have to be tested, as well as your overall health.

X-rays, ultrasound procedures, CT scans, pulmonary function tests (PFTs), and dental exams are some examples.

Women may receive a Pap test, a gynecological examination, and a mammogram.

Before The Procedure

An open heart transplant requires hospitalization and open heart surgery.

Your healthcare provider’s practice and your condition may determine the procedure to follow.

To inject medicine into your body and to administer IV fluids, a healthcare professional will start an intravenous (IV) line in your hand or arm.

Your blood pressure and heart rate will be monitored and samples taken with additional catheters in your neck and wrist.

Additional catheters may be inserted under the collarbone and in the groin.

You will be asleep during the surgery (under general anesthesia).

During The Procedure

When you are asleep, a breathing tube will be inserted into your lungs through your mouth.
During the operation, the tube will be attached to a machine (ventilator) that will breathe for you.

During the surgery, the anesthesiologist will monitor your heart rate, blood pressure, and blood oxygen levels.

There will be an incision (cut) made from just below the Adam’s apple to just above the navel in the center of your chest.

The breastbone (sternum) will be cut in half by the surgeon.
To reach your heart, he or she will separate the two halves of your breastbone.

The surgeon will insert tubes into your chest so that your blood can be pumped through your body by a heart-lung (cardiopulmonary bypass) machine while your heart is stopped and replaced.

The diseased heart will be removed after all the blood has been diverted into the bypass machine and is being pumped by the machine.

The surgeon will sew the donor heart in place.

After your new heart is in place, the doctor will carefully connect the blood vessels to prevent leaks.

When your new heart is fully connected, the blood flowing through the bypass machine will be allowed to return to the heart and the tubes to the machine will be removed.

The surgeon will shock the heart with small paddles to restart its beating.

Once the new heart starts beating, your healthcare team will watch it to make sure it’s working properly and there are no leaks.

Pacing wires may be inserted into the heart.

A pacemaker outside your body can be attached to these wires for a short period of time to pace your new heart, if needed, during the initial recovery period.

The surgeon will stitch the skin back together over the sternum. Surgical staples or sutures will be used to close the incision.

After The Procedure

Several days after the surgery, you will be monitored closely in the recovery room or intensive care unit (ICU).

You will be connected to machines that display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.

Surgery for a heart transplant requires a hospital stay of 7 to 14 days.

Depending on your needs, you may receive pain medicine either from a nurse or by pushing a button on a device attached to your IV line.

In order to remove air from your stomach, you may have a thin, plastic tube that goes through your nose and into your stomach.

After your bowels are working normally, you will remove the tube.

Until the tube is removed, you will not be able to eat or drink.

Your new heart will be monitored regularly, as well as other body functions.

You will also be monitored for lung, kidney, liver, and blood problems.

A special IV medicine may be prescribed for you to help your blood pressure, your heart, and to control bleeding.

Your doctor will gradually decrease, then stop, these medications as your condition stabilizes.

Additionally, if you have pacing wires in your heart, they will be removed as well.
After you have been stabilized and your breathing and stomach tubes have been removed, you can drink liquids.

Once you are able to handle solid foods, you can add them gradually.

Anti-rejection (immunosuppression) medicines will be closely monitored by your healthcare team so you get the right dose and the right combination of medicines.

As you begin physical therapy and breathing exercises, you will receive assistance from nurses, respiratory therapists, and physical therapists.

You will be moved from an ICU to a private room on a surgical unit or transplant unit once your healthcare provider determines you are ready.

The recovery process will then continue there.

You can gradually increase your activity as you get out of bed and walk around for longer periods of time.

If you can, eat solid food.

Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself when you return home.

After you are treated, your healthcare team will arrange for you to return home and schedule a follow-up appointment.

Once You’re Home

Once you have returned home, it will be important to keep the surgical area clean and dry.

Your doctor will give you specific instructions regarding bathing.

In a follow-up visit, your doctor will remove the sutures or surgical staples, if they were not removed before you left the hospital.

Do not drive until your healthcare provider gives you the go-ahead.

Your healthcare provider may also place other restrictions on your activities.

After the transplant, you will need frequent follow-up visits.

A blood test, X-rays of the chest, and a biopsy may be required during these visits.
In a biopsy, your doctor removes tissue from the heart to examine under a microscope.

You’ll be informed of the schedule for these visits and tests by the transplant team.
Rehabilitation will last several months.

You will need to take medicines for the rest of your life to protect the transplanted heart from rejection.

Side effects can vary from person to person.

Your healthcare provider will design a medication plan that is specific to your needs.

A number of anti-rejection medicines may be given to you at first.

These doses may change frequently depending on your response.

Infections are more likely if you take anti-rejection medicines since they affect the immune system.

It’s important to maintain a balance between preventing rejection and making you vulnerable to infection.

You will be especially susceptible to infections such as oral yeast infection (thrush), herpes, and respiratory viruses.

During the first few months after your surgery, avoid crowds and anyone who has an infection.

Routine right heart biopsies will likely be performed to look for signs of rejection.

Following transplantation, biopsy is typically done once a week in the early stages, then at monthly or longer intervals.

Eventually, the procedure may be stopped.

As an outpatient procedure or as an inpatient if you are already in the hospital, a right heart biopsy can be performed.
Right heart catheterization is involved in the procedure.

In order to insert a catheter into the right atrium of your heart, a vein in your neck or groin is threaded.

A doctor takes four to six tiny tissue samples through the catheter and checks them for rejection.

Your doctor may adjust your anti-rejection medicine if he or she finds signs of rejection.

Your healthcare provider will discuss the biopsy procedure’s instructions and risks with you.

Heart Rejection

The new heart may be rejected by your immune system.

It is your body’s natural reaction to an object or tissue that is foreign.

The immune system attacks the new organ when you get a new heart because it perceives it as a foreign threat.

Medicines will be needed to ensure that the transplanted organ survives in a new body.

It will trick the immune system into accepting the transplant and keep it from attacking it.

To prevent or treat rejection, you will need to take medicines for the rest of your life.

These medications also have side effects. The side effects will vary from medication to medication.

Heart Failure

A condition in which the heart is unable to pump blood throughout the body is end-stage heart failure.

There are two upper chambers and two lower chambers in a typical heart.

Blood is pumped into the atria – the upper chambers of the heart.

The lower chambers of your heart – the right and left ventricles – pump blood out. 

The heart’s valves, which control blood flow, are located near the openings (tricuspid and mitral valves) and exits (pulmonary and aortic valves).
Sometimes heart failure develops after other conditions have damaged or weakened the heart.

A stiff heart can also cause heart failure.

There are no treatments for heart failure other than a heart transplant available.

A person with end-stage heart failure does not have any other options.

A diagnosis of heart failure does not mean the heart is about to stop beating.

Failure means that the heart muscle isn’t able to pump blood normally because it is damaged, very weak, or both.

As a result of heart failure, the main pumping chambers of the heart (the ventricles) may become stiff and may not fill properly between beats.

A damaged or weak heart muscle may occur in some people.

If the ventricles are too stretched, the heart cannot pump enough blood through the body.

As we age, the heart is unable to keep up with the typical demands placed upon it to pump blood throughout the body.

By measuring the amount of blood pumped out of your heart with each beat, your doctor can determine how well your heart is pumping.

Heart failure can be classified and treated based on the ejection fraction.

An ejection fraction of 50% or higher indicates that more than half of the blood that fills the ventricle is pumped out with each beat.

It is still possible to have heart failure despite a normal ejection fraction.

In conditions such as high blood pressure, the heart muscle becomes stiff.

Heart failure may affect the left side (left ventricle), the right side (right ventricle), or both sides of your heart.

Heart failure usually begins on the left side, specifically the left ventricle – the main pumping chamber of the heart.

There are several conditions that can damage or weaken your heart and lead to heart failure.

Coronary Artery Disease And Heart Attack

The most common form of heart disease and the most common cause of heart failure is coronary artery disease.

The disease is caused by the accumulation of fat deposits in the arteries, which reduces blood flow and can lead to heart attacks.

Heart attacks occur when a coronary artery becomes completely blocked.

After a heart attack, your heart may not be able to pump as well as it used to.

Heart failure may be caused by a single risk factor or by a combination of risk factors.

Heart failure complications are determined by severity of heart disease, your overall health, and other factors, such as your age.

Reducing your risk factors is the key to preventing heart failure.

Making healthy lifestyle changes and taking your doctor’s prescribed medications can help you control or eliminate many of the risk factors for heart disease.

Heart Attack

When your coronary arteries become blocked, you suffer a heart attack.

When fatty deposits, such as cholesterol, accumulate over time, they form substances called plaques, which can narrow arteries (atherosclerosis).

This condition is called coronary artery disease. It is the biggest cause of heart attacks.

When a plaque ruptures, cholesterol and other substances are spilled into the bloodstream.

Blood clots form at the rupture site.

A large clot can block blood flow through the coronary artery, causing ischemia (shortness of breath).

The spasm of a coronary artery can also cause a heart attack by cutting off blood flow to part of the heart muscle.

Tobacco and illicit drugs, such as cocaine, can cause life-threatening spasms.

Fat deposits build up in the arteries throughout your body as a result of certain factors (atherosclerosis).

Many of these risk factors can be improved or eliminated to reduce your risk of having a heart attack.

What To Do During A Heart Attack

A heart attack can be fatal.

The first thing you should do if you suspect a heart attack is to call 911 or receive emergency medical help.

Heart attacks are not all the same or all have the same severity of symptoms.

Pain levels can vary from mild to severe.

Not everybody experiences symptoms. In some cases, sudden cardiac arrest may be the first sign.

In general, the more warning signs you have, the greater your chances of having a heart attack.

The signs and symptoms of heart attacks can appear hours, days or weeks before a heart attack.

Symptoms may begin as recurrent chest pain or pressure (angina) that’s triggered by activity and relieved by rest.
A temporary decrease in blood flow to the heart leads to angina.

Take immediate action. There are many people who wait too long because they fail to recognize the important signs and symptoms. 

Call For Emergency Medical Help

Do not hesitate to seek medical attention if you suspect you are having a heart attack.

Call 911 or your local emergency number right away.

You should have someone drive you to the nearest hospital if you do not have access to emergency medical services.
If you have no other choice, drive yourself. You and others are at risk if you drive yourself while your condition worsens.

What If Someone Else Has A Heart Attack?

You should seek emergency medical attention if you see someone unconscious and believe they are having a heart attack.

Make sure the person is breathing and has a pulse. If the person isn’t breathing or doesn’t have a pulse, then you should begin CPR.

You should apply pressure to the person’s chest in a pretty rapid rhythm – about 100 to 120 compressions per minute.

If you haven’t been trained in CPR, only perform chest compressions.

If you have been trained in CPR, you can move on to opening the airway and restoring breathing.

Cardiology Care Services FAQ

A heart attack can cause pressure, tightness, pain, or a squeezing or aching sensation in your chest, arms, or neck that may spread to your neck, jaw, or back, as well as nausea, indigestion, heartburn, and shortness of breath.

Heart attacks can be treated effectively, especially if medical attention is received immediately.
Nowadays, heart attacks have a 90% survival rate.
This is because doctors can diagnose and treat heart attacks much more easily now.

For this reason, you should seek medical help immediately.

Any condition that makes your artery walls weak may lead to one.

High blood pressure and atherosclerosis are the two most common causes.

Aneurysms can also be caused by deep wounds and infections.

Some people are born with weak arteries.

Medical attention is needed immediately.

A ruptured brain aneurysm is often described as the most severe headache of a person’s life.

It often occurs suddenly and lasts for days.

Heart failure is classified into four stages: A, B, C, and D. Stages A, B, and C are at highest risk of developing heart failure, while stage D is more advanced.

The most common form of heart disease and the main cause of heart failure is coronary artery disease.

Fat deposits build up in the arteries, reducing blood flow and causing heart attacks.

When a coronary artery becomes totally blocked, a heart attack occurs suddenly.