New Patient Virtual Tour

Welcome to the Sugar Land Heart Center.

Hi! I am Dr. Nik Nikam, the medical director of the Sugar Land Heart Center. On behalf of my staff, I welcome you to our cardiology center (temple of heart healing!). We are pleased to take you on a "New Patient Virtual Tour." Hopefully, this will make you feel right at home when you visit us for the first time. Whether your primary care physician has requested you to consult with us or you have selected to consult with our cardiologists, we value your time as much as we value your life and heart.

In order to expedite your medical evaluation and make your initial visit a pleasant experience, we kindly request you to gather the following information before you come in:

A copy of our location map is available at this website and provides you with directions from all four corners of the city.

If you belong to an HMO, make sure that your primary physician has sent over referral. We may have to reschedule your appointment, if we do not receive your referral papers before you visit. Please bring your insurance information and wear a two-piece outfit anytime you visit us, to easily facilitate the complete cardiovascular evaluation: electrocardiograms, echocardiograms, and/or stress test. If you are scheduled to have a stress test, please wear a loose cotton clothes and bring a pair of sneakers.

It is vital for you to bring all the medicines you are currently taking, with you anytime you visit our office. This enables us to continually update your medicine chart, allowing us to determine what additional medicines might be needed in your case.

Make sure that you bring all medical records containing vital information from your primary care physician or other sources. Information regarding your medical history and prior tests (such as cholesterol level tests, kidney test, X-ray reports, etc.) are essential for your complete cardiac evaluation and management.

Please plan to arrive at our office 15-30 minutes before your scheduled time to avoid unexpected traffic delay or other situations that may setback your visit.

Check list-before your visit us for the first time:

At the Office: When you arrive at our office, our courteous staff will greet you and request that you complete the registration form, history-review of systems sheet, insurance form, medications chart, and authorization form. We encourage you to print these forms from our website and complete them at your convenience before you come to our office to save some time.

After the completion of your paper work, you will be directed to one of our examination rooms. Here, an assistant will record you weight, pulse, blood pressure, and an electrocardiogram.

Electrocardiogram: The electrocardiogram records the electrical activity of the heart. It enables our cardiologists to determine the heart rate, rhythm, and any extra beats. The cardiologist also can determine any cardiac enlargement or any evidence of a previous heart attack(s). This painless procedure takes only a couple of minutes. Here is a sample look of an electrocardiogram.

Consultations: Following the assistance evaluation, our physician will take a complete history and perform a thorough cardiovascular examination. Then, you will have a consultation with the cardiologist in his office. Anticipate one of Dr. Nikam's favorite questions, "Smoking, drinking, & cursing (stress)?" Finally, the cardiologist will take all the necessary time to discuss your cardiac evaluation in depth with you and answer any questions and concerns you may have. The cardiologist also will discuss your medicines and any additional tests you might need.

2D-Echocardiogram: An echocardiogram may be performed on you during your first visit or scheduled for a later time. It takes only 10-20 minutes for this painless procedure. An echocardiogram enables our cardiologist to visualize your heart size, muscle thickness, heart function, and any fluid around the heart. It is quite fascinating to watch your own heart pump-- beat after beat --even as you snore through the procedure!

Stress Tests: Based on your history and physical examination, The cardiologist will decide if you need a regular treadmill stress test or a nuclear stress test. For those patients who are not able to exercise on a treadmill, we perform a chemical stress test combined with nuclear scans.

Regular Stress Test: A regular stress test is performed in the office. You are advised not to eat anything for a couple of hours before the stress test, and we recommend that you bring your jogging gear.

You are connected to an EKG machine with 10 electrodes that monitor your electrocardiogram from 12 different angles. A blood pressure cuff is wrapped around your arm to monitor your blood pressure during and after the exercise. After recording your resting heart rate, blood pressure, and electrocardiogram, you are asked to walk on the treadmill that generally starts at a speed of 1.7 MPH with an elevation of 10%. At each three-minute interval, the treadmill machine will automatically increase speed and elevation, until you reach the target heart rate determined by your cardiologist [target heart rate is 85% of 220 minus your age]. For example, if you are 50, then your target heart rate is 85% of (220-50) or 85% of 170 or 145 beats per minute]. During this time, the staff will monitor your heart rate, rhythm, any changes in your electrocardiogram, and watch for extra heart beats. If the electrocardiogram is abnormal, then the staff may terminate your stress test before you reach your target heart rate. The cardiologist then will discuss the stress test results with you. This stress test takes approximately 30-60 minutes.

Nuclear stress test: This test combines a regular stress test with nuclear scans of the heart. A resting nuclear heart scan is done before the stress test by injecting an isotope that highlights your heart muscle. Then, you go through the same exercise procedure outlined in the regular stress test. One minute before you terminate your exercise, the technician injects the isotope again. After completion of the exercise test, you are allowed to eat some food before you come back and complete the nuclear scans. A nuclear specialist will review and compare your heart scans taken at rest and during exercise to determine if all the heart muscle regions are getting an adequate blood supply. Nuclear scans also enable us to determine your overall heart function.

Chemical (nuclear) stress test: This is similar to the nuclear stress test described above except you don't exercise on a treadmill. Instead, a chemical is injected into your vein that increases your heart work and chemically invokes heart stress without you exercising your skeletal muscles. A nuclear scan is also performed before and after the chemical injection.

Patient Instructions for stress testing: When you come for a nuclear stress test be prepared to spend 3-5 hours since you have to get the heart scan both before and after the stress test. Please do not take any food or drink before the nuclear stress test. Caffeine especially, should be avoided before the nuclear stress test, because it interferes with the test results. It may take 24 hours for us to receive your nuclear stress report. If you do not hear from us within a day, please be sure to call our office so that the doctor can discuss with you your results. If your stress test results are abnormal, then the cardiologist may recommend a cardiac catheterization to further evaluate your heart's condition.

Cardiac Catheterization: Patients who have had an acute heart attack, an abnormal electrocardiogram, or congestive heart failure may need cardiac catheterization for complete evaluation of their cardiovascular system. Cardiac catheterizations are commonly performed at the Methodist Sugar Land Hospital, next to our office. Following cardiac catheterization, you are likely to be discharged after 4-6 hour of bed rest if your results are normal. Your stay may be prolonged though if you develop any minor complication. If you need a balloon angioplasty to open up a critical narrowing in a coronary artery, you may be transferred to The Methodist Hospital on Fannin, at the medical center.

Cardiac Catheterization Patient-Instructions: When you come for cardiac catheterization, please follow these steps:

1. Bring your registration papers and any papers given to you by your doctor.

2. Bring the location map to The Methodist hospital, if you are planning on going to the Medical center.

3. Take all your medicines with you.

4. Be sure, to let the nurse or the doctor know if you are allergic to the contrast media (iodine), so they can prepare you with medications to prevent any allergic reaction.

5. Bring pajamas, just in case you have to spend the night at the hospital.

6. Make sure that you arrive 1-2 hours before the scheduled time. This provides enough time to get your blood results, and perform all the need tests before the procedure. If a person before you cancels, then you may be able to get an earlier spot, provided your doctor is ready. Arriving early provides extra time for you to settle down and relax. Don't rush and feel stressed out!

7. Make a list of the questions that you want to ask your physician before and after the cardiac catheterization.

8. Before you leave, request a copy of the heart diagram, for your own records.

9. Find out when you will need a follow-up visit with your physician after discharge.

Coronary Artery Stents: This is a procedure where a critically blocked coronary artery is opened by dilating balloon in the region of the blockage and then inserting a metal stent to keep the artery open. The newer, coated stents have been shown to have a very low rate of re-blockage, less than 5% per year. Patients who receive coronary stents should be on a blood thinner, Plavix for 6-9 months, along with other cardiac drugs.

For more information on cardiac catheterization click here.

Coronary Bypass Surgery: Patients with left main coronary artery disease or multi-vessel coronary artery disease along with diminished cardiac function; or those with coronary artery disease and diabetes may benefit from coronary artery bypass surgery. During cardiac surgery, an artery from the chest-wall is used to bypass one or two blocked coronary arteries, reestablishing the blood circulation in the artery again. Veins from the leg also are used to bypass other blocked coronary arteries. After surgery, most people spend 1-3 days in the ICU. Later, they recover for 3-6 days on a regular floor before they go home. For more information on cardiac surgery read the article, "John watches his own heart surgery."

Holter Monitor: Holter monitor which you wear for 24 hours, records your heart beat for 24 hours. The staff will then upload the information stored in the Holter monitor to the computer where the doctor can analyze your heart rate, rhythm, and beat, in addition to runs of irregular heartbeats or slow heart rates. This test also will enable your physician to determine if you need a pacemaker.

Conclusion: All in all, our office is equipped to provide services to patients with situations ranging from anxiety-induced chest pains to complex cardiovascular problems needing cardiac surgery, transplant, angioplasty, or a coronary stent. We also specialize in providing comprehensive dietary recommendations for reducing heart disease risk factors such as high cholesterol, smoking, weight problems, hypertension, stress, and lack of exercise.

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