One in twenty American adults has peripheral arterial disease, or PAD, a narrowing of the blood vessels caused by cholesterol plaque buildup. Several different risk factors contribute to the development of PAD:
high blood pressure
A family history of PAD also increases one’s risk. Those with PAD may experience pain in the calf muscle or buttock with walking, especially brisk walking or walking uphill. Some patients may develop skin discoloration of the toes or feet and even develop ulcerations and wounds that are slow to heal.
PAD is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.
Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease and go undiagnosed as symptoms may be attributed to other causes such as joint pain or back disease.
Alarmingly, many with the disease have no symptoms at all. Studies have shown that the disease may be overlooked even if a patient is followed by a cardiovascular specialist.
Diagnosing PAD involves a noninvasive test called an ankle-brachial index or ABI in which a reading is taken of the arms and the legs using a standard blood pressure cuff and the ratio of these readings is used to assess blood flow to the lower extremities (legs and feet). A provider may also recommend more advanced imaging such as Magnetic Resonance (MR) or Computed Tomography (CT) scans.
Once diagnosed, patients are treated according to the severity of their symptoms and care is also focused on the prevention of future events. Patients may be started on medications in conjunction with a walking program to improve their symptoms. If medicine and lifestyle intervention are unsuccessful or if a patient’s lower extremity is in jeopardy, a procedure to improve the circulation may be indicated.
There are several minimally invasive procedures that can improve the blood flow to the lower extremities. These so-called “endovascular” procedures are done under fluoroscopic (a type of X-ray) guidance and utilize small medical tubes called catheters to deliver therapy. A small balloon may be threaded into the blockage and used to dilate the vessel, called angioplasty. New technology allows these balloons to deliver medication to the blockage to prevent vessel re-narrowing after the procedure.
In a similar way, small metal-alloy tubes called stents can also be used to expand the blockage from within and also may have medication coating to keep the vessel open. These minimally invasive procedures often allow the patient to be treated and sent home on the same day. If a patient is not a candidate for an endovascular approach, a more traditional open surgery called surgical bypass may be required.
Living with PAD
All patients with PAD should have their medications adjusted to prevent heart attack and stroke—the major health threats to those with this disease.
Taking daily aspirin and cholesterol-lowering medications can dramatically reduce the incidence of serious health events.
Blood pressure and blood sugar levels for diabetic patients need to be strictly controlled.
Patients with PAD should exercise caution with skin and nail care. The skin of the feet should be kept clean and moisturized to prevent cracking and infection. Frequently, podiatrists are consulted for routine care so as to prevent inadvertent injury during nail trimming.
Finally, it is absolutely critical that PAD patients quit smoking.
Accurate diagnosis of PAD is important as it allows for comprehensive changes to both lifestyle and medications which can save lives. New technologies are available which help to restore circulation in those affected. Early recognition of PAD is essential to halting this insidious and sometimes silent disease.
Do you have risk factors or symptoms of PAD?
The Cardiology Center can help. Schedule an appointment with one of our highly skilled providers today.
From chocolates to festive decor, you can’t go anywhere during the month of February without seeing hearts. But just because you can’t see your heart as easily as the Hallmark cards lining the stores right now, that doesn’t mean it doesn’t deserve some much-needed attention. It’s the only one you have, and we at Appalachian Regional Healthcare System want yours ticking for a very long time.
In celebration of Heart Health Awareness month, here are three easy ways to make sure your heart is getting the love it deserves:
Eat a Healthy Diet
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Give your body the fuel it craves most. According to the CDC, increasing your intake of fresh fruits and vegetables while limiting the amount of sodium and processed or fried foods can help you avoid heart disease.
Need inspiration to kick start a love of heart-healthy foods? The Paul H. Broyhill Wellness Center offers nutritional cooking classes to its members for $10 a class. Enjoy a hands-on experience learning to prepare delicious food combinations that are sure to give your heart the boost it needs. Taught by the Wellness Center’s on-staff nutritionist, Heather Casey, the classes focus on practical recipes that “can be incorporated into a busy lifestyle.”
Engage in Regular Physical Activity
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We all know we need to exercise to maintain a healthy weight and functioning body, but how much actually makes a difference? The Surgeon General recommends that adults engage in moderate-intensity exercise for at least 2 hours and 30 minutes a week. This could be as simple as a brisk walk or bike ride on the Greenway once the weather finally thaws or signing up for a water aerobics class or personal training at The Paul H. Broyhill Wellness Center.
Apprehensive to join a gym and don’t know where to start? Our Thrive program offers supervised training and instruction for participants to achieve their personal health goals. There are currently three tracks that are tailored to your needs: weight loss, cardiopulmonary, and oncology.
Click here to find out more and download the referral form for your healthcare provider.
Listen to Your Heart
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While living a healthy lifestyle is integral in maintaining a functional and thriving heart, it’s also important to be active about what your body is telling you. Know the signs of a heart attack and be proactive about seeking help when you know you feel “off.” According to Heart.org, signs to look for include discomfort in the center of your chest that lasts more than a few minutes or goes away and comes back. The sensation can feel like uncomfortable pressure, squeezing, fullness, or pain.
For those aspiring for better health, a lower resting heart rate is typically one of the most common goals. But what happens when your heart starts beating too slowly?
Fatigue, lightheadedness, and confusion are all symptoms of a heart that’s working inefficiently and may be in need of a pacemaker. Used to regulate the rhythm of the heart in both speed and frequency, pacemakers weigh anywhere between 25 to 35 grams and are used in patients with slower heartbeats around 40 or 50 beats per minute or less.
This tiny device can make a huge improvement in your life if your doctor thinks you’re a candidate for the treatment. Here are four things you should know about this life-altering device:
1. Pacemakers can improve your quality of life
Since the 1950s, pacemakers have been used to improve the overall quality and longevity of life in many heart patients. According to Livestrong.org, pacemakers even made an impact on mortality, reducing death rates by 22 percent and hospitalizations by 37 percent. Other studies found that pacemaker recipients have reported significantly more energy and overall feel happier in their everyday activities.
2. Pacemakers can be disrupted by external forces.
Regardless of whether your pacemaker is surgically implanted or an external temporary one, it uses battery-operated power to send electrical impulses to your heart. Patients need to be aware of their surroundings to avoid risk of interference. According to Heart.org, devices like metal detectors and even anti-theft systems at the entrance of businesses can cause disturbances. When near these kinds of technology, it’s important to not linger and move quickly through the detectors or entrances. Headphones too can cause issues and should be kept away from your pacemaker, particularly avoiding being stored in a shirt pocket above your heart.
3. Pacemakers are one of the most common reasons for medical ID jewelry.
When you’re in a scary situation and need medical attention fast, a piece of medical ID jewelry could be a lifesaver. If something were to go wrong with your pacemaker, your bracelet or necklace could help emergency medical personnel know your current heart conditions faster, which leads to quicker life-saving treatments and safer choices for your care. And thanks to the era of online shopping, there are tons of styles to choose from to make this important piece of fashion more fun. Jewelry not your thing? No worries! Heart.org has an easy-to-download card you can fill out to use for identification.
4. Pacemakers don’t last forever.
Thanks to long-lasting batteries, a pacemaker can last between five to 10 years. However, it is essential to have regular checks to ensure your pacemaker is working properly and being as effective as possible for you to live your best, healthiest life. Appalachian Regional Healthcare System offers high quality cardiovascular services equipped with the staff and technology to help you with your pacemaker needs. Whether you’re about to start your pacemaker journey or you’re looking for ongoing care, you can trust us with your whole heart.
Atrial Fibrillation is a common condition where the heart beats irregularly and causes inefficient blood flow. Whether your doctor recently discussed your symptoms and diagnosis with you or you suspect you may have this arrhythmia, here are five things you may not be aware of when it comes to AFib and how it can affect you.
Anyone Could Have It
While it’s more common in people over 60, AFib can occur in anyone at any time and any age. According to the CDC, an estimated 2.7 to 6.1 million people in the United States have AFib. There are some factors that can increase your likelihood of developing the condition, such as obesity and diabetes, but regardless, it’s important to know the signs. If you feel an off-kilter fluttering in your chest, it may be time to get checked out by your doctor.
Alcohol and Caffeine Could Be a Factor
While unwinding is good for the soul, too much can be detrimental to the heart. According to AFibMatters.org, too much caffeine could raise one’s blood pressure and increase heart rate, triggering the condition. However, with moderation, even those diagnosed with AFib can enjoy two to three daily cups of coffee and an occasional drink as long as alcohol consumption is kept between two to three units a day. Two to three days a week should also be completely alcohol free.
AFib Increases Risk of Stroke
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Because AFib causes the heart to beat irregularly, those who have the condition could potentially have blood pool in the atria since it’s not efficiently being pumped between ventricles. This means a blood clot could break off and lodge itself into the artery leading to the brain. According to Heart.org, 15-20 percent of stroke victims have AFib.
Knowing the symptoms of a stroke could save your life. The acronym BE FAST not only reminds us to act quickly, but to also be on the lookout for Balance problems, Eyes blurred, Face drooping, Arm weakness, Speech difficulties, and Time everything started.
There are Different Types of AFib
While the symptoms are the same, there are actually five different kinds of AFib that medical professionals use to classify patients. From the most mildest case being paroxysmal fibrillation with symptoms presenting only a few times a year, to long-standing AFib where symptoms last more than twelve months, talk with your doctor to classify your symptoms and find the best course of treatment.
It is Treatable
Fortunately in many cases, AFib is treatable. There are medications to control the heart’s rhythm, blood thinners are often used to prevent clots from forming, surgery can make an impact, and a healthy lifestyle can often manage AFib risk factors.
The Appalachian Regional Healthcare System is equipped with top-of-the-line facilities and services to treat cardiopulmonary patients within the High Country. The Cardiology Center has AFib monitors and knowledgeable cardiologists who are able to help you manage this condition.
Have a question about how we can help you? Call the Cardiology Center at (828) 264-9664.
What happens during a cath procedure and a surgical procedure?
During a catheter procedure, a catheter (small tube) is inserted in the artery in the groin which is then maneuvered into the heart and coronary arteries. A dye is then inserted through the tube to show the cardiologist where the blockage is in the coronaries.
A surgical procedure involves an incision made in the chest, usually to sew in permanent bypass repair and/or replace valves.
What is an angioplasty?
Angioplasty is a surgical procedure performed usually on the arteries and occasionally on the veins. A small tube (catheter) is inserted in the groin which is then maneuvered into the heart and coronary arteries. A balloon is then inserted through the catheter. The balloon is inflated inside a blood vessel to flatten any plaque that blocks it and cause it to become narrowed, decreasing the blood flow. Inflating the balloon dilates the artery by breaking apart the atherosclerotic plaque.
What is an intervention?
An intervention generally refers to a procedure that opens up a blocked artery, such as a balloon angioplasty or stent.
What is a stent?
A stent is a circular screen cage-like device which is placed inside a blockage after some balloon procedures to prevent the blockage from collapsing and blocking the artery again.
If I have a catheter procedure will I have to spend the night?
It depends on the findings of the cath procedure and how much disease/blockage there is in the heart. Several things could happen. The physician may let you go home and ask that you follow up with an office visit. There may be further intervention required by the cardiologist which would require you to stay overnight or you may have a consult with a cardiac surgeon for a surgical procedure.
How will I know what the results are of the procedure?
Families are informed immediately after the cath procedure and as soon as your medication has worn off the physician will speak with you directly about the results of the procedure, usually while you are in the holding area or in your room. Families for surgical procedures will be informed after the procedure ends and be able to see you within the hour after they talk with the surgeon.
How often will I need to see a cardiologist or cardiac surgeon after my procedure?
It depends on the level of intervention. If you undergo a cath procedure, you may see the cardiologist once or twice after discharge and then you go back to yearly visits given no other complications.
If you undergo a surgical procedure, you will probably have to see the surgeon at least once and the cardiologist once or twice every month for one to three months. The surgeon releases you to be followed by the cardiologist. Once the cardiologist feels you have recovered, you are released to your primary care physician.
Does Medicare pay for cath interventions?
Yes, at least 80 percent.
The heart is an amazing organ. Every part of your body depends on it. It speeds up when you exercise, are excited or scared. It slows down when you are relaxed or resting. On average, it beats about 70 times a minute, every minute of your life – more than 2.5 billion times over an average lifetime.
But sometimes the heart doesn’t beat the way it should. It may beat too fast, as if you were running for your life instead of just sitting on the sofa. It may beat too slowly. It may skip beats. It may beat at the right speed, but pound like a sledgehammer. It may do any or all of these things, then settle down as if nothing were wrong.
Irregular heartbeat is called cardiac arrhythmia. An arrhythmia can be a serious, life-threatening event, or it can be an inconvenience that interrupts the activities of daily living.
Appalachian Regional Healthcare System comprehensive line of EP services and procedures includes:
• Holter and event monitoring
• Tilt table testing
• Implantable Devices
• Resynchronization therapy for heart failure
Signs & symptoms
• Palpitations (the feeling like your heart is “running away”), fluttering, skipping beats
• Dizziness, feeling light-headed, fainting
• Pounding in your chest, chest discomfort, shortness of breath, weakness or fatigue
*** Severe symptoms may be a medical emergency: Call 911 ***
Heart Failure FAQs:
What is heart failure?
Heart failure is a condition in which your heart becomes too weak to pump blood as effectively as it should. It may come on suddenly, after a heart attack for example, or it may develop slowly as you age or in response to a variety of diseases and conditions, especially high blood pressure. Symptoms may develop so slowly that your body at first is able to compensate. As the disease progresses, however, symptoms will become noticeable and may eventually interfere with your enjoyment of life.
Is heart failure a “death sentence”?
Definitely not. Heart failure can be controlled and managed. Modern treatments such as those available through St. Mary’s and Athens Cardiac Arrhythmia Center can help most heart failure patients continue to lead active, meaningful lives for many years. Talk to your cardiac specialist to develop the treatment plan that is right for you. Common treatment options include:
Weight loss and management – Because the swelling, fatigue and shortness of breath that often come with heart failure can make exercise difficult, many heart failure patients become overweight. Excess weight increases the strain on all parts of your body, including your heart, and also makes exercise harder and more uncomfortable. Safe, supervised weight loss can reduce symptoms, improve heart function, and help other organs such as the lungs, brain and kidneys.
Medication therapy – Medicines such as ACE-inhibitors and diuretics can reduce the workload on the heart and relieve the build-up of fluids in the body
ICRDs – Implantable cardiac resynchronization devices help the chambers of the heart contract at the right time and can boost the strength of heart contractions. Improved strength and timing boosts the heart’s efficiency and helps move more blood through the heart.
Cardiac Rehabilitation – Carefully monitored and supervised exercise can strengthen your heart while improving your overall fitness and lifestyle.
More about ICRDs…
Appalachian Regional Healthcare System makes it possible for cardiac specialists to implant the newest, most sophisticated ICRDs available. Features of this new generation of implantable devices include:
Defibrillation. For patients at risk of fibrillation, in which the heart loses its normal rhythm and quivers without pumping, these ICRDs can deliver a life-saving electrical jolt to restart the heart.
Pacemaking/Resynchronization. For patients whose hearts beat irregularly or in poor synchronization, these devices can set a steady beat and cause chambers of the heart to contract together at the right moment.
Wireless monitoring. The ICRD monitors and records its own activity. When the patient goes to bed at night, a small unit by the bedside automatically uses wireless technology to download information from the ICRD. This information, along with other information the patient can manually enter (especially each day’s weight), can be transmitted directly to the physician anywhere in the world via the Internet.
Miniature size. Thanks to rapidly evolving technology, new ICRDs are smaller than a credit card and not much thicker. They can now be implanted under the skin near the collarbone in a fast, minimally invasive procedure performed under mild sedation. Improved battery technology allows them to work for many years before replacement is necessary.
What causes heart failure?
The leading cause of heart failure is coronary heart disease, in which the arteries providing blood to the tissues of the heart become narrowed by accumulations of plaque on the inside of artery walls. The heart, like all other muscles, must have its own blood supply to work; it cannot absorb the oxygen and nutrients it needs from the blood in its chambers.
When a spot in a coronary artery becomes too narrow, blood can’t pass freely through it and may form a clot, entirely blocking the artery. Just like closing a dam on a river, blood stops flowing to tissues “downstream” of the blockage. Within minutes, the muscle tissue that depends on that artery for its blood supply begins to die. The sudden distress and death of this tissue is what causes the pain and disability of a heart attack, technically known as a myocardial infarction, or MI).
If the blocked coronary artery is small, serving only a small amount of heart muscle, the damaged area is small. While immediate risk of death is not great, the damaged area will have a mild but permanent affect on the heart’s ability to function. Multiple “mild” MI’s can cause severe heart failure.
If the blocked coronary artery is large, serving a significant part of the heart muscle, the damaged area potentially is very large. The risk of immediate death is high, and the damage could have a serious effect on heart function
Can a heart attack be stopped once it starts?
The clot-busting drug TPA, available at Appalachian Regional Healthcare System, can dissolve clots, which restores blood flow and can save tissues that are in distress but have not yet died. However, TPA is effective only if given soon after the onset of symptoms. No drug can restore life to dead tissues. This is why is essential that people who suspect they may be having a heart attack should get medical care immediately. Time is muscle! Call 911!
What are the symptoms of a Heart Attack?
Pressure, squeezing, fullness or pain in the chest
Pain or discomfort in other areas of the upper body, including the arms, jaw, neck, back or stomach
Shortness of breath
Nausea, lightheadedness, breaking out in a cold sweat
While some heart attacks produce sudden, severe symptoms, most come on with mild symptoms that many people ignore or think will go away. Women are especially likely to experience mild, ambiguous symptoms. Remember, delaying treatment increases your risk of death and disability.
What other factors can cause heart failure? In addition to coronary heart disease, other causes of heart failure include:
high blood pressure
high cholesterol levels
alcohol and drug abuse
certain infectious diseases
congenital heart disease
heart valve damage
some genetic disorders
How is heart failure diagnosed? Usually, the appearance of symptoms is the first clue. If your symptoms point toward heart failure, your regular physician may order a diagnostic test such as an echocardiogram or refer you to a cardiac specialist. An echocardiogram uses safe, painless sound waves to determine how well the heart is functioning, including providing your ejection fraction. This is the percentage of blood that is pumped out of the heart with each contraction. An EF of 50 percent is below normal. (see related article, Ejection Fraction).
Computed tomography (CT)
Appalachian Regional Healthcare System features a 64-slice CT scanner, the only kind of CT scanner available today fast enough to capture detailed 3-D images of the heart between beats. With these images, physicians can diagnose potential blockages in coronary arteries, study valve and chamber structure, assess pumping efficiency and measure ejection fraction. CT studies are fast and non-invasive, usually lasting just a few minutes and requiring a low dose of x-rays and the injection of a medically approved dye, called contrast, that highlights blood vessels in x-ray images.
Appalachian Regional Healthcare System, state-of-the-art cardiac cath lab allows cardiologists to diagnose problems with the heart and its blood vessels. While the patient rests under mild sedation, the cardiologist carefully guides a wire into the heart and injects contrast solution. X-ray images highlight the heart’s blood vessels and can reveal a wide array of potentially dangerous conditions, including coronary artery disease.
Appalachian Regional Healthcare System Cardiac/Vascular Services Department provides inpatient and outpatient EKG, echocardiogram and stress echocardiogram testing. St. Mary’s Doppler ultrasound systems use safe, painless sound waves to create images of the heart in action. “Echoes” are done on patients as they lie comfortably in a darkened room; “stress echoes” are performed on patients as they exercise on a treadmill, which provides information on how well the heart functions as the body’s needs increase.
Pulmonary function testing
Many heart failure patients have trouble with shortness of breath due to fluid build-up in and around the lungs and from the heart’s reduced ability to provide enough blood for gas exchange (giving up waste carbon dioxide and absorbing needed oxygen). Appalachian Regional Healthcare System pulmonary function lab provides accurate, detailed information that can help your physician assess lung capacity and function.
Treatment & Continuing Care:
The Cardiology Center
Our facility provides a “one-stop shop” where patients can receive all phases of care – from diagnosis to treatment – under one roof. TCC provides all levels of arrhythmia care, including initial assessments, medication management, patient education, and device therapy.
Several types of devices can be implanted at Appalachian Regional Healthcare to improve heart function and return the heart to a normal rhythm. Broadly, these devices fall into three types. All can be implanted under the collarbone and linked to the heart with tiny wires in a simple surgical procedure that is performed under mild sedation.
Pacemakers – Help hearts keep a steady and appropriate pace
ICDs – Implantable Cardioverter Defibrillators constantly monitor heart rhythm and can deliver a life-saving shock if the heart begins fibrillating.
ICRDs – In addition to helping the heart maintain an appropriate pace and delivering a shock if the heart begins fibrillating, implantable cardiac resynchronization devices help the appropriate chambers contract at the same time. Simultaneous contractions help improve heart function and boost the ejection fraction.
Appalachian Regional Healthcare Cardiac Rehabilitation Program helps people across High Country prevent and recover from heart problems by focusing on creating healthy lifestyles. The program features exercise, dietary changes and other lifestyle improvements, with one-on-one care provided by specially trained personnel and provides ongoing exercise in a class setting at the Paul H. Broyhill Wellness Center to help the patient continue to make progress and reduce the risk of further heart problems. Exercise, camaraderie and dietary education are the cornerstones of Phase III.
Paul H. Broyhill Wellness Center provides a wide variety of group fitness classes and equipment to help people of all ages and fitness levels improve and maintain their strength, flexibility and cardiovascular fitness. Membership includes fitness assessment and body composition analysis; assistance with goal-setting; access to all equipment and classes, including Yoga,, Spin, Zumba and many others. In addition, the highly qualified fitness staff can help you move through your Wellness journey, regardless of what step you’re on.
For more information, call (828)-266-1060 or come by and tour the facility and talk to the staff. We feel certain we can find the right program for you.
How can I prevent Heart Failure?
Most of the factors that cause heart failure also cause heart attack, stroke and other serious health problems. The good news is that many of the most important factors are within your control. They include:
Hypertension (high blood pressure). Experts recommend a BP of 120/80 or lower
Diabetes (“blood sugar”). Experts recommend a fasting blood sugar level of 99 or less
Cholesterol. Experts recommend a fasting LDL (“bad” cholesterol) of 100 or less and HDL (“good” cholesterol) of 40 or more
Tobacco use. Smoking is the leading cause of preventable death and disability. If you don’t smoke, don’t start. If you do smoke, talk to your doctor about effective ways to end your tobacco addiction
Maintain a healthy weight. Obesity is the second leading cause of preventable death and disability, exceeded only by smoking. A good general rule of thumb is the Body Mass Index. A healthy BMI is 19-25
Exercise. Exercise is a key factor in managing your weight, enhancing the health of your heart and lungs, and controlling other factors such as blood pressure, blood sugar and cholesterol. Get at least 30 minutes of cardiovascular exercise a day, at least five days a week
Watch what you eat. Choose a diet rich in whole grains, vegetables, and fruits, low in fats, sugars and processed foods. For most heart failure patients, it is especially important to control sodium intake, especially salt or foods high in salt. Cut back on portion sizes. A registered dietitian can help you make the transition from an unhealthy diet to a healthy one; ask your doctor for a referral.
Use alcohol in moderation or not at all. Some research indicates that a glass of wine now and then may actually be helpful, but too much alcohol damages your blood vessels, brain and other internal organs.
Don’t use cocaine. Cocaine and certain other illegal substances can cause serious damage to the heart, sometimes on the first use.
Some factors are not in your control. These include:
Age. Your risk of heart problems increases as you get older.
Family history of heart disease. You are at higher risk if a parent or sibling had cardiovascular disease, especially at an early age.
Congenital defects. Birth defects that affect the size, shape or function of the heart can cause heart failure and other cardiac problems.
Since some factors are beyond your control, it’s doubly important to focus on the factors you CAN control.
Find out more!
Your best source of information is your doctor. If you are concerned about your risk factors or believe you may be developing early symptoms, schedule an appointment with him or her. Be sure to write down your questions and bring them with you. It’s also good to bring a family member or friend to help you remember what the doctor says.
For even more details, there are many excellent articles, websites and books about heart health; ask your doctor for some recommendations. Be aware that not all materials are evidence-based, especially on the Internet. Be sure to note the credentials of the author and his or her sources; information about a field should come from people who are specialists in that field. Research papers should be peer-reviewed and articles and books should state that they have been reviewed by a medical specialist in the field. Look for endorsements by reputable organizations such as the Centers for Disease Control, the American Heart Association, or major research institutions such as the Mayo Clinic.
• Barnes-Jewish Hospital, “Understanding Ejection Fraction”
• MayoClinic.com, “Ejection fraction: What does it measure?”
• Guidant Corporation
• Discovery Hospital
• National Institutes of Health, Medline Plus
• “Managing Heart Failure,” Hospital Educators Resource Catalogue, Inc. (HERC Publishing)