Keith Gregory Hickey, MD?

Keith Gregory Hickey, MD

Cardiologist | Cardiovascular Disease

3/5(12)

2965 Gause Blvd # 2 Slidell LA, 70461 Show map

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About

Dr. Keith Hickey is a cardiologist practicing in Slidell , LA. Dr. Hickey specializes in diagnosing, monitoring, and treating diseases or conditions of the heart and blood vessels and the cardiovascular system. These conditions include heart attacks, heart murmurs, coronary heart disease, and hypertension. Dr. Hickey also practices preventative medicine, helping patients maintain a heart-healthy life.

Education and Training

Duke University Medical Center Internship General Surgery 1997

Xavier University BS Pharmacy 1986

Xavier University Pharm D 1990

Duke University Internship Internal Medicine 1999

LSUMC Internal Medicine 2001

Ochsner Clinic Foundation Cardiovascular Medicine 2003

La State Univ Sch of Med In New Orleans, New Orleans La 1997

Louisiana State Univ School Of Medicine In New Orleans 1997

Board Certification

American Board of Internal Medicine

Cardiovascular Disease (Internal Medicine)

American Board of Nuclear Medicine

Internal MedicineAmerican Board of Internal MedicineABIM- Cardiovascular Disease

Provider Details

Male English

Keith Gregory Hickey, MD

Keith Gregory Hickey, MD's Expert Contributions

My Answers

Ecg
Nothing!.. do not get caught up in ECG jargon. Those numbers represent the direction of the electrical vectors for p-wave (atrial depolarization) qrs (ventricular depolarization) and t wave (ventricular depolarization). The directional vectors are influenced by various cardiac conditions and pathological states ( hypertrophy, scarring from MI, etc). Those numbers on your ecg represent normal quadrants. But to understand the details and nuances of ECGs requires 3 years of cardiovascular fellowship training. And non specific T waves are just that. Non-specific. It tells nothing and many people with normal hearts have insignificant T- wave changes. Forget the ECG. Its a piece of information thats very nonspecific. I have patients with terrible heart disease and heart failure, who have normal ECGs. And vice versa, those who have really ugly ECGs and absolutely normal heart muscle. Cardiologist rely on echocardiograms images (ultrasound) to evaluate patients for structural heart disease. Because ECG leads measure amplitude and direction of the electrical conduction system of the heart. Those electrical vectors are affected by tissue, bone, etc (obesity, breast size, small patients) and age ( younger have higher amplitude) , in addition to cardiac abnormalities. And lead placement can also make the ECG abnormal. 12 leads are attached to the chest and misplaced leads can give the ecg the appearance of a previous MI So , your ECG is normal, like most 38 year old females. We dont see many abnormalities in young, otherwise healthy, females unless they were born with some form of congenital heart disease. I read between 5-10k ecg per year. More than 80% of those from the ER are completely normal or represent normal variants (like yours). Unless we capture an arrhythmia or do an ECG during an acute cardiac syndrome (MI), most are unremarkable. We dont rely READ MORE
Hypertension medication
At age 84 , our blood pressure goals do change. The side effect profile of many medications gets magnified by advanced age. To summarize the blood pressure goals based on the current cardiac guidelines, The ideal blood pressure is 120/80 or less. Pre-hypertension ( borderline high blood pressure) is 121-129. The cutoff is 130/80. Above that is stage 1 hypertension. 140/90 is the old cutoff . Now above 140/90 is stage 2,hypertension (old cutoff is 160/100). When we see patients, if either systolic (upper number) or diastolic (lower number) is above cutoff, then we round up. So 129/92 is Stage 2 hypertension (diastolic > 90). So we treat blood pressure aggressively. The cardiovascular treatment guidelines for hypertension were changed in 2017, because even mild longstanding hypertension leads :,to more myocardial infarctions (heart attacks); more congestive heart failure ; and more cerebral vascular accidents (strokes). Treatment starts with a long acting diuretic (chlorthalidone) and/or a calcium channel blocker (amlodipine). Its also reasonable to start with an angiotensin receptor blocker (losartan) or ARB. This is interchangeable with an angiotensin converting enzyme inhibitor ( lisinopril), particularly if they are diabetic or any form of heart failure. Beta blockers (metoprolol) are first line in patients with a history of coronary artery disease and MI. We often use 2 drugs at moderate doses (for the greater additive/ synergistic defects) ., rather than uptitrate mono therapy with READ MORE
Comcerns aboit pain in my shoulder
My mistake. You are female, I misread. One less risk factor and even less likely CAD. But my recs remain the same .. READ MORE
Heartbeats
Too many heart beats sounds like premature contractions coming from upper chambers ( premature atrial contractions) or lower chamber ( premature ventricular contractions). In themselves these are not a serious issue. Stimulants. Sinus meds, coffeine, electrolytes abnormalities can cause them. Anything that increases adrenaline in the body. Also electrolyte abnormalities. This can be related to an underlying problem with the heart muscle (cardiomyopathy), scars (previous MI / heart attacks) , or ischemic heart disease ( plaque blocking coronary blood flow). If you have those underlying conditions, see your cardiologist. The treatment can be watch and wait because they come and go spontaneously. Or medication to slow down the heart ( beta blockers) or true antiarrhythmic medications if they are frequent and symptomatic. The vast majority of the time this resolves with treatment and time. Everyone has them but not everyone feels them ( extra forceful beats if it PvC) . Of course this is a presumption on my part because the sentence the physician told you is very nonspecific. Perhaps he meant an underlying arrhythmia like atrial fibrillation or atrial flutter. I doubt that because he would have treated those conditions. The other possibility is gallop beats or abnormal heart sounds. These are not true extra beats but extra sounds blood makes when it fill a diseased abnormal left ventricle. Again, this would have warranted a much different discussion, work up and treatment. My best guess would be extra beats and you should be fine. As for the treatment of your cancer, the regimen used for colon cancer tends to not result in damage to the heart. In the old days high doses of anthracyclines ( doxorubicin and daunorubicin) for breast cancer and lymphomas, caused dilated weakened ventricles and heart failure. Oncologist are very careful in todays chemo regimens, and I have not seen a chemo induced , new cardiomyopathy in recent memory. The heart is monitored throughout if and when the cancer agent presents cardiac risk. This would have occurred before 2 years and you would have heart failure signs and symptoms ( shortness of breath, fluid build up). Radiation can also damage the heart if its in the x - ray field , which shouldnt happen with colon cancer. Best of the doctors vague explanation, I would be surprised if this is anything serious READ MORE
Heart attack iminent? Anxiety?
You are ok. First , the blood pressure. 130/80 is the cutoff. It said stage I because of the diastolic of 85. No doctor is going to initiate medical treatment for that minimal increase. You can lower it with diet and exercise. The DASH diet for cardiovascular health and low sodium for hypertension ( high blood pressure). Moderate intensity aerobic exercise for 30 minutes 4-5 times a week. You could benefit from some weight loss. You are overweight but not obese. Ideally your weight would be 170-180 for your height unless you were very muscular)muscle weighs more. But 10 lbs of weight loss can lower bp by 5-10mmhg. And diet and exercise another 5-10mmhg. Your physician can order ambulatory BP monitor to follow bp. If you want to do your own . Check it 3x a week at different times and record the numbers. We as physicians would much rather the healthy control of BP in 19 yo and try to avoid meds. After a few months if bp is still high on 3 mo follow up we could initiate a diuretic like chlorthalidone or amlodipine (vasodilator). But meds have potential side effects. Your bp might be ok on follow up. And stop worrying about it. Ideal bp 120/80 or less . You are not that high at all. Relax. Because stress increases bp. You should adapt a healthy lifestyle regardless of BP for overall health. Good luck READ MORE
Are they panic attacks or is it my heart?
Part 1 I agree with your others physicians . Your symptoms are very atypical and not consistent with true angina. Allow me to explain. Angina is a specific type of chest pain related to ischemia (lack of oxygen delivery to cardiac muscle) because of diminished blood flow. The diminished blood flow is caused by atherosclerotic plaque occluding part on the lumen of the coronary arteries. This plaque is the result on longstanding pathological processes, related to heredity and environmental factors (high fat, high carb American diet). The plaque consists of an inflammatory milieu of smooth muscle cells, macrophages and foam cells, fibroblasts, collagen, calcium, inflammatory cytokines, pro- coagulant factors and other free radicals . But the primary ingredient is low density lipoprotein (LDL), which makes up part of our total cholesterol. The LDL circulating in our bloodstream will attach to areas of damage to the inner lining of the coronary artery ( endothelial or intimal layer) , which is one cell thick. This process starts in our late teens and early 20s with the development of fatty streaks on the intimal layer of the aorta. Over time the ldl begets LDL. The plaque adds layers and enlarges. This will happen more rapidly if a person has hyperlipidemia or hypercholesterolemia (disease with elevated levels of lipoproteins due to diminished LDL receptors in the liver to breakdown and metabolize LDL). The plaque cannot enlarge outward to any significant degree because of the muscular layer in the middle of the artery (media) which prevents this progression. So over time ( years, not months) the plaque bulges , then protrudes, into the inner cavity of the artery where the blood flows (lumen). Over the years, as the plaque enlarges, and occludes more and more of the lumen, a patient can begin to develop symptoms. This level of obstruction to the degree of severity to cause symptoms has been studied exhaustively. The cutoff has been determined to be 70%. If the plaque burden obstructs less than 70% , the vast majority of patients will not have symptoms ( angina) with normal activity. Less than 50% wont cause symptoms with high intensity, strenuous workloads. Plaque size greater that 70% can cause symptoms with activity and also results in abnormal stress tests. The symptoms usually progress in an indolent manner over extended months. At first patients report diminished energy levels , with increasing fatigue, lethargy and somnolence. Patients report falling asleep and being exhausted getting home from work. A noticeably differently in functional capacity when compared to 6-12 months prior. Then as the blockage increases in severity, patients will develop dyspnea with exertion ( shortness of breath). Patients complain of being winded just going up one or two flights of steps at work. Then, as the obstruction grows, patients begin experiencing substernal chest pain with exertion or stress. This pain is characterized by pressure or heaviness, like someone is sitting on your chest. The symptoms tend to be at least moderate 5-6/10 , or worse. The pain is associated with shortness of breath, sweating ( diaphoresis) , nausea / occasional vomiting. The pain can radiate to the left arm, the neck or jaw, or both arms (90% specific). The duration is 5-10 minutes and the pain is relieved with rest or SL nitroglycerin. For men , the classic symptoms of angina occur while cutting the grass. They have to take multiple breaks. This is an important part. The symptoms occur with activities, not at rest. The coronary lumen can be blocked with plaque up to 95-99% , and there will be no anginal symptoms at rest. Because its based on supply and demand. As we move the heart has to pump blood to the large muscles of the glutes and legs. To do that work load the heart needs oxygenated blood cells . If theres significant plaque burden , ischemia will occur ( demand exceeds supply) and the pain will stop the activity to protect the heart . The same threshold will of strenuous activity will continually induce the symptoms. The anginal equivalent is repetitive and predictable. It can be induced with stress or anxiety also. If patients stop doing things they wont feel bad. The symptoms dont occur at rest or with minimal activity until patients are having an acute coronary syndrome ( unstable angina or subendocardial MI). If the patients arent very active, so no real pattern emerges, we can do a stress test. Either treadmill or pharmacologic, and with or without nuclear images. If a patient has significant plaque burden of 75% or more, they will stop the treadmill protocol after a few minutes and often have dyspnea and anginal symptoms with ECG changes in the ST segments . These anginal symptoms with exertion are consider typical chest pain or angina. If the symptoms have some of the characteristics of angina , but not others ( cp is sharp , radiates to the right arm, occurs while supine) , the chest pain is call atypical . Lastly , if the chest pain has no characteristics of angina, we term it noncardiac chest pain. This could be secondary to deep muscle strain in the chest wall, gastric reflux, nerve entrapment, stress/anxiety, pleurisy, and upper respiratory tract infections with excessive coughing . In these cases the pain patterns will be different. Most importantly, most other sources occur at rest , or have no changes with exertion and no pattern of occurance. A fixed blockage with heavy plaque burden will continue to cause symptoms with exertion until we dilate the artery more ( long acting nitroglycerin, ca channel blockers, beta blockers ) and reduce the stress /strain on the heart. Medication is the initial treatment but ultimately the patient will need angioplasty and stent deployment to obliterate the plaque volume. When the symptoms have some characteristic of angina but some are atypical , we use an algorithm called Bayes Theorem . With this theorem we look at the symptoms and the risk factors to be determine the pre-test probability of the diagnostic test being abnormal in a patient with the disease. We use screening tests like stress tests to to prove what it isnt . Screening test need high sensitivity ( very low percentage of FalseNegatives ). We dont want a patient with severe coronary disease walking around with a normal stress test . The trade off is higher false positives lower specificity. The risk factors for coronary artery disease are: male gender ; age > 50 for man ; > 60 for a woman; hypertension; hyperchesterolemia; diabetes; smoking; obesity; strong family history in 1st degree relatives (parents/ siblings) ; previous history of coronary disease or its equivalent ( peripheral artery disease, cva/tia/ strokes) . So if an 18 yo marine comes in with chest pain after a 10 mile run described as sharp with no associated anginal qualities , then he needs no further testing. But if his grandpa comes in complaining of worsening shortness of breath doing his woodwork and gardening along with chest tightness when he walks up a hill, we will not waste time with a stress test. Especially if he already has coronary stents or bypass of previous MI. We will schedule an angiogram urgently and optimize the medication. The marine has less than 10% chance of having coronary disease and has no risk factors. Give him ibuprofen. Even if he had an abnormal stress we wouldnt believe it and call it false positive. In grandpa his pre test probability is > 90 %. So no stress test and we proceed directly with angiogram. If his stress test was negative, I wouldnt believe it . Then we have the middle age female , similar to you. They are between 10 and 90. So we consider the stress test for screening. We will discuss this application to you in part 2 . Tomorrow.. READ MORE
34 M/ Just received my Echocardiogram results, very worried
That is a normal echocardiogram for a relatively young, healthy patient. I did extra training in echocardiogram and got board certified. Few cardiologist do that. Low normal EF 50-55% is still normal. We see this all the time in 20 yr olds. The heart is strong so it doesnt need to increased systolic squeeze to maintain cardiac output. All of your chambers are normal sized and all the valves are normal. I read 200 echos a month and you learn to read between the lines. I can tell by everything else being normal, they undercalled the EF. Its very subjective and if 10 cardiologist read your study there is a 5-10% difference in reporting. That has been proven and documented in cardiac literature. Yours is a normal study . Same thing with aortic root diameter. 2 d echo is very user dependent. If the calipers arent just right and the images were obtained correctly, its not uncommon to have standard deviations between interpretation of 3-5mm. That makes a size of a pinhead or thickness of a quarter. Its not a very accurate measure of the root or ascending aorta. We arent concerned about something like aneurysm until diameter is > 4-4.5 and surgery until its 5 or greater. They can recheck echo in a year. If its normal again then its usually nothing. If you are still concerned , have them order a CT scan with aortic angiography. That study (or MRA) is more accurate . For echocardiogram, a trans esophageal echo is good standard. We sedate you and put probe down throat. This has far superior spatial resolution then trans thoracic echo ( much less tissue artifact). Mostly RELAX READ MORE
pressure in chest and throat.
Unfortunately, your symptoms could be an anginal equivalent , related to significant underlying coronary artery disease. Your age is just one risk factor (the others: hypertension, Diabetes, hyperlipidemia, smoking, personal history of CV disease, and a strong family history of CV disease in first degree relatives), but it appears you have been fairly healthy. The symptoms are atypical, occurring in supine position and less pronounced when performing ADL. Atherosclerotic (lipid rich) plaque in the coronary arteries will induce exertional anginal symptoms when the lesion occludes more than 70% of the arterial lumen. This degree of stenosis would also result in an abnormal perfusion defect during a nuclear stress test. However, I have had many patients over the years with multiple 95% stenosis in more than one coronary artery. Also, subtotaled 99% stenosis with delayed string-like flow. But not one of those patients had symptoms at rest. Classic angina is induced with exertion or stress/anxiety, and it is relieved with rest and/or sublingual nitroglycerin. You had symptoms at rest to a much greater degree than with exertion, the opposite of what would be expected from a significant coronary stenosis. The symptoms you described would be considered atypical ( not classic, but could represent her anginal equivalent). Atypical symptoms occur most often in the elderly population, with female gender, and in patients with autonomic neuropathy ( long standing diabetes). These patients experience exertional fatigue, lack of energy and dyspnea with exertion. Their is also a rare form of angina , called angina decubitus, which occurs in the supine position and not so much with activity. While the pattern of your symptoms wasnt classic, the qualities were worrisome for true angina. Heaviness, and pressure sound like someone with underlying CAD. The biggest clue was the fact that the discomfort radiated to both shoulders/upper arms. That is 95% specific for true angina from underlying high grade atherosclerotic plaque. You should be treated medically now ( asa, nitrates, beta block er, statin) and undergo urgent nuclear stress testing or invasive coronary angiography. Assuming the angiogram was done and came back negative, What else could induce such symptoms, in this pattern? The answer is gastrointestinal reflux, with esophageal spasm. The internal organs in the thorax (lungs, heart ) are innervated by the autonomic nervous system, via the 10th cranial nerve, the Vagus. Unlike skeletal muscle, the brain cannot distinguish between the esophagus and the heart. The heart sits on top of the esophagus and the hydrochloric acid in the stomach is .1% molar. Unlike the stomach, the esophagus doesnt have the protective mucous and goblet cells. When the acid refluxes and hits the esophagus, it will spasm. This pain can be quite severe and mimic true angina in every way , except one. The pattern. Both respond to nitroglycerin and both can feel like burning or pressure, with radiation. However reflux is exacerbated after a meal or lying down. The effect of gravity is lost in the supine position. And the brain, as mentioned, cannot tell the difference between these organs, referring the symptoms to what it does know, skeletal muscle ( arms). The patient would benefit from nitroglycerin, long acting. Bland diet and weight loss. Mostly, proton pump inhibitor therapy . Their are long term complications from chronic reflux (Barrett esophagus) but Short term the risk is low. In your case , I would treat both conditions and cycle the cardiac enzymes, ecg , echo. Stress test is an option but have a low threshold to perform angiography if the stress is even mildly abnormal. Coronary angiography/ coronary catheterization is a low risk procedure and takes less than 30 minutes. when done through radial access the complication rate is <1%. But its the gold standard for diagnosing and treatment of CAD. Also , intracardiac Pressures in the LV can be measured and LV function can be estimated. If the angiogram were negative, the patient will also get peace of mind. The pt can be referred to GI for EGD as an outpatient. READ MORE
What to avoid if you have a stent?
The only thing to avoid with a stent in the coronaries or peripheral circulation that is absolute, is dont stop taking dual platelet inhibitors ( aspirin plus either clopidogrel prasugrel or ticagrelor). The stents are at risk for thrombosis ( clots) early in the first 6 months and stent restenosis with recurrent plaque later. We recommend at least a year for drug-eluding stents (coated with immunosuppressives like sirolimus) and a faction of cardiogists ( including me) believe in 2 years up to indefinite therapy , as long as its tolerated. Bare metal stents with no drug coating READ MORE
What activities to avoid with high blood pressure?
Good questions. The most important things to avoid in patients with hypertension (high BP) are things we ingest.. Sodium ,and food high in sodium content, is the number 1 offender . Na will cause elevated BP by several mechanisms , particularly effects on the renin - angiotensin-aldosterone feedback loop ,involving the kidneys. Also direct effects on the vascular endothelium occur and effects on the heart with increased wall stress / strain and the release of vasoactive hormones (BNP, vasopressin) . The last organ involved in sodium regulation and BP control, is the brain. The brain can auto regulate blood flow in times of shock and hypotension (low bp). Brain can cause vasoconstriction or dilatation via the autonomic nervous system and effect BP via hormones from the hypothalamus-pituitary gland- adrenal gland axis (negative feedback loop) . After sodium excess , the next offenders would also involve ingested of certain foods /products/ chemicals , such as alcohol, steroids and non steroidal anti-inflammatory meds(ibuprofen) . Steroids lead to sodium retention and change vascular tone. NSAIDS block prostaglandin effects on the afferent arterioles in the glomerulus of the nephrons , an additive effect to the negative impact of angiotensin on renal blood flow and perfusion. After the brain and heart, the kidneys have the next highest oxygen requirement, metabolic rate and the next highest percentage of the cardiac output auto- directed to its perfusion. These 3 organs, and the adrenal glands atop the kidneys , are the major players in BP control ..so it goes without saying that foodstuffs and drugs that have deleterious effect on these organs will effect BP. Many effective BP meds achieve lowered bp by its effect on these organs. Some chemicals ( , cocaine/meth / diet pills/ adderal )cause intense vasoconstriction with elevated HR. But any prescription drug or health product can potentially effect BP by effecting the above mentioned organs. Along with sodium content, alcohol , medications and illicit drugs, nicotine has the effect of raising bp by vasoconstriction. Other causes of elevated BP include intense pain, illness , stress/anxiety , and , the most common cause of refractory hypertension, medical noncompliance. There can be secondary causes of elevated BP such as fbromuscular dysplasia, renal art stenosis, adrenal hyperplasia (conns syndrome) or nodules , neuroendocrine tumor ( pheochromocytomas of the pancreas) and pituitary adenomas ( Cushings disease) ., Obesity , untreated sleep apnea and sedintary lifestyle. Like many things , bp can be lowered in many by non medical treatment modalities. The Dash diet, weight loss,wearing cpap, abstinince from alcohol tobacco and illicit drugs. Intervention or surgery for secondary causes. Aerobic exercise for 30 minutes 4-5 x week with mod intensity will lower bp by 10 mmhg. and medical compliance when meds are required to get to goal bp of less than 130/80. Ideal is 120/80. Stage 2 is >140/90. Because of long term deleterious effect of chronic hypertension on the cardiovascular system (MI,CHF, CVA), guidelines were changed and goals lowered in 2017. After all , Hypertension is the most common disease in this country (116 mil), so the greatest benefit on the population can be achieved by optimization. READ MORE
Can I go to the pool 10 days after stent surgery?
Well technically speaking, deploying a stent in a coronary artery, or any other artery for matter, is not considered a true surgical procedure. We do our work through catheters after we insert sheaths in the radial artery of the wrist or the femoral artery of the groin. It all starts with a needle puncture. And if it is a straightforward stenosis in a favorable location of the artery (a mid-RCA 80% discreet lipid filled soft plaque) the whole procedure might take 30 minutes or less. And most patients go home in a couple of hours. Complex lesions in the ostium of the left-sided coronaries (LAD, LCX) are more high risk and the patient may get kept in the hospital overnight. Hard plaque made predominantly of calcium , or completely occluded arteries (CTO), are much riskier with a higher complication rate because we have to drill/chisel through the lesion with an atherectomy device. We use clinical judgement, but would lean towards keeping those patients in the hospital overnight. Each case is a little different, but most patients can go swimming within a day or two. Particularly an elective, uncomplicated, outpatient case in a stable patient done radially with no significant co-morbidities and no procedural complications. The patient who is admitted with an acute coronary syndrome or acute infarction ( heart attack), with or without hemodynamic instability, may be taken to the Cath lab emergently , or at least urgently the next morning, will be in the hospital longer. They have some degree of acute muscle damage even when the procedure is successfully. Their heart damage was the result of complete thrombotic obstruction of the artery as a result of acute plaque rupture (platelets in the bloodstream aggregate or clump over the site of the plaque rupture which then completely occludes the artery). Once we re-establish blood flow by percutaneous intervention and stent deployment, the flood of blood to the ischemic portion of cardiac muscle causing myocardial stunning . That portion of the muscle will be dysfunctional for up to 6 weeks. Most eventually normalize. But the recovery from even a small to moderate myocardial infarction is 4-6 weeks. So they wont physically be able to swim after discharge for several weeks. They dont have the energy or stamina. The actual procedure doesnt determine when they can swim, but the clinical scenario. In general, from a wound and procedural standpoint, a patient could swim within 2 days of discharge ( maybe even the next day). READ MORE
Can I drink alcohol with heart palpitations?
No, you should not drink alcohol if you are experiencing palpitations. Alcohol is known to adversely affect the cardiac electrical conduction system. The mechanisms arent important. What is important is that binge drinking, in particular, can cause atrial fibrillation, even in younger patients. Its called the Holiday Heart syndrome. Atrial fibrillation comes with its potential complications, including thromboembolic CVAs. The thrombus, blood clot, that form in the left atrial appendage can leave the heart and travel up the carotid arteries to the middle cerebral artery. Eventually they obstruct the small arterioles and capillaries in the temporal- parietal lobes, leading to strokes that can paralyze one side of the body. ( hemiparesis) and affect speech permanently (Aphasia). Atrial fibrillation also causes sustained rapid heart rates or tachycardia, with ventricular rates as high as 150-180 bpm. The myocardium (heart muscle) can not sustain normal systolic function (contraction) if these rates persist for more than a couple of days. This can lead to tachycardic-induced cardiomyopathy and congestive heart failure. Atrial fibrillation is not the most common cause of palpitations. Most palpitations are related to premature ventricular contractions or PVCs, extra strong beats originating from electrically excitable myocardial cells in the ventricles. Alcohol can cause PVCs or exacerbate pre-existing ectopic beats from either chamber, including premature atrial contractions orPACs. To diagnose the cause we generally have the patient get an ecg in clinic then check electrolytes levels. If necessary they can wear a monitor for several days. The root cause is often malfunction of the autonomic nervous system and elevated levels of neurohormones, such as norepinephrine (an adrenaline analog). Alcohol will aggravate this type of automaticity and hyper excitable tissue. The treatment is usually beta blocker therapy (metoprolol) for most causes of palpitations. These drugs slow down heart rate and contractility and relax the excitable foci in the myocardial tissue. But avoidance of stimulants ( Sudafed, diet pills ADD meds, excessive caffeine), alcohol , and offending prescription drugs ( albuterol inhalers, steroids) are a necessary part of treatment. READ MORE
Can I drink coffee if I have high blood pressure?
The quick answer is yes, within reason.1-2 cups a day, but after the blood pressure is controlled. Consistently below 130/80 on average with a goal of 120/80 or less. Not below 100 systolic with the risk of presyncope. Of course decaffeinated coffee is fine. Different patients are effected by caffeine to various degrees. Based on tolerance, the dose (brewed coffee is approximately 150mg) , and individual physiology. Most patients require more than one medication (US pts avg 2.4 meds). Beta blockers would mitigate the stimulant effect of caffeine on heart rate and contractility. Over time the patient will find that middle ground where a cup of coffee has little effect on pulse and BP. The effect of caffeine is transient. Its short acting with beverages and the effect on blood pressure will be over in a couple of hours. So , if you have high BP and really like coffee, take your blood pressure and morning meds. Drink your brew 30-60 mins later and check pressure again at 30/60/90 mins. After a couple of hours it should be at baseline. You can always have your physician increase the dose or add another Med if bp is staying elevated. I have high BP controlled on 2 meds and caffeine has little effect. I drink a 32 oz ice coffee. But Im tolerant to the effects after so many years. Youll figure out your own pattern and adjustment. As long as you dont drink excessively, you shouldnt have to go without coffee. I know I wouldnt K READ MORE
Can a healthy diet fix high blood pressure?
Not unless its mildly elevated. The only 2 diets the ACC/AHA promote as heart healthy are the Mediterranean and DASH diets. They are very similar but DASH is low sodium for patients with hypertension (high blood pressure) . Its hard for patients to change their lifestyle and eating the average American diet is high is salt, fat and carbs. But if the DASH diet is followed religiously then the cardiovascular system is protected from future atherosclerosis and coronary events. These 2 diets have shown positive morbidity and mortality benefits over the long haul. The diet can lower blood pressure approximately 10 mmhg. The diet combined With moderate intensity exercise for 30 minutes 4-5 x week ( walkers do better than runners) and weight loss ( if overweight or obese) will improve that to 15-20mmhg. But thats following a strict regimen and significant changes in habits. Also we cant for get smoking cessation. That also lowers BP. So if all those modifications of lifestyle are adopted and stuck with day in and day out , its possible to avoid medication. Possible, not likely. But the medication I use for blood pressure also has cardiac benefits (beta blockers, acei, arbs) . Regardless of whether bp reaches a goal of less 120/80, the cv system benefits from those lifestyle changes. Its better to do the lifestyle changes and medication to reach the goal of BP, than to worry about needing to take medication. Cardiac meds have shown cv benefits in 100s of randomized trials in hundreds of thousands of patients. I wouldnt hesitate to prescribe these medications if necessary. I have high bp and take some of these myself. The benefits of controlling BP by all means is vital. Even mildly elevated BP can cause increased strokes, heart attacks and heart failure later in life. So think first of getting to the goal BP, and use a holistic approach. Diet, exercise, weight loss if needed, and smoking cessation for those who smoke. Then meds if needed. In my experience most patients would rather medication rather than strict wholesale lifestyle changes. But if you can do it the benefits go beyond just blood pressure control. Sometimes , no matter how stringent the diet and exercise, meds will be needed. Genetics play a large role. And race (blacks have higher bp and younger ages), stress levels and other meds (ibuprofen, steroids) . Dont forget alcohol. Binge drinking on weekends raises BP for 2-3 days after. 1-2 glasses red wine are ok. The beer and harder liquor have no benefits and harm in other ways ( bp, sugar intake, liver toxicity , and less healthy lifestyle). If bp is near 130, dash diet alone could do it. Give it 3 months and have your doctor re-evaluate. Again, if it doesnt quite get it done , a medication or 2 is worth reaching the goal BP. But stay on the diet and live longer .. READ MORE
Can you get heart arrhythmia from the COVID infection?
The more I learn about covid the less I know ! The best answer I can tell you is that covid can do anything to anyone at anytime.. sounds like a cop out but Im being honest , mostly. I should have said covid can do anything bad to anyone. No good comes from it. I had two patients get arrhythmias from covid vaccination, that stand out because of the complications. Both had atrial fibrillation and thromboembolic complications. Covid is an endothelial/ interstitial disease, infecting and inflaming the inner lining of blood vessels and organ tissues. Take the lungs, the virus attacks the lining in the small capillaries and arterioles where air crosses into the blood. Thats how oxygen gets from the air we breath and attached to the iron on the hemoglobin molecule on our red blood cells. That thin membrane of interstitial tissue becomes inflamed and leaky and causes the alveoli (air sacs) to become secondarily filled with fluid so their is little air exchange. The result is clinical pneumonia with low oxygen saturation (hypoxia ). This inflammatory state is hypercoaguable and blood clots form in the lungs and peripheral vascular circulation ,as in DVTs and pulmonary emboli. With the heart , covid can infect the lining ( endocardium) and the middle muscular layer ( myocardium) . This can lead to arrhythmias if the endocardium is affected in the electrical conduction system. The tissue inflammation can also cause myocarditis if the muscular myocardium becomes involved . .this can result in Atrial Fibrillation. A fib is the most common, but not the only arrhythmias noted to be the result of this process. Svt and other atrial tachycardia arrhythmias can occur. Sinus tachycardia (fast heart rate) is seen most commonly seen tach rhythm. Bradycardia, and slow rhythm like those of Heart block, and ventricular arrhythmias are less common. I have not personally seen a lot of primary cardiac manifestations of covid. In my clinic or in the hospital. Most of the hospital patients were for respiratory illnesses, including myself. I contracted pneumonia from covid in December of 2020. I had bilateral pneumonia with a pulmonary embolism that caused me to crash from a respiratory standpoint. Thankfully I was in good shape for my age, But I was still on oxygen for another month and missed 3 months of work - after 10 days in the icu ..I wasnt fully back to myself for almost a year . As for the 2 patients of mine that developed a-fib, both were after the maderna vaccine in 2021. They didnt actually get the virus. Pt A had a fib with a rate up to 170. Went into heart failure and had an embolus to his left foot. He had surgery and almost lost his leg. I did a trans esophagus echocardiogram and shocked him back into a regular rhythm. Sinus rhythm was maintained with anti arrhythmic meds. Angiogram confirmed no significant atherosclerosis of his coronaries..It took me a year to get him back to his normal baseline. But he was 63 yr old. Pt B was 25 years old. He got septic after the first dose of maderna and had high fever. After the second dose he had a fever of 105 and developed myocarditis , dilated cardiomyopathy with chf . and he secondary went into a fib from the dilated heart chambers. He developed a thrombus in the left ventricle at the apex ,or tip of the heart , that wasnt squeezing (mural thrombus). A part broke away and he a embolism to the vertebral arteries and a posterior cva (stroke) - involving the occipital lobe (part of the brain that has to do with vision). He lost peripheral vision in both eyes ( hemianopsia). I was able to convert him out of a fib with medication .. but he still has dilated weak heart and most likely has permanent peripheral blindness .. so with covid infection anything can happen. Myocarditis would be the most severe manifestation.. which could cause atrial fibrillation or even ventricular tachycardia. A fib and other arrhythmias can be caused directly by the virus and not be secondary to chf. Or even the older original version of the vaccines. The good news is like most viruses , covid has attenuated to the point where its no different than the flu, and no more virulent. I havent seen or heard of arrhythmias from covid in over a year. We have had very few respiratory failure patients or serious pneumonias. The atypical chest pain and shortness of breath that was prevalent ( due to dysautonomia) , has all but vanished .. READ MORE
How soon after stent surgery can I consume alcohol?
Technically alcohol has no effect on coronary disease or coronary interventions. In face there is some evidence that moderate alcohol intake is beneficial. I would never recommend alcohol beyond a glass of red wine at evening meals. If a patient has angiography followed by percutaneous Intervention with balloon angioplasty and stent placement , I would not let them drink alcohol that first night because of the sedation and pain meds we give for the procedure (versed and fentanyl ). That interaction can lead to adverse reaction which can be quite serious. But beyond that, a couple of cocktails or beers in the evening has no effect on the stents. But I think drinking excessively is not acceptable for many reasons. Heavy alcohol in a chronic fashion damages other organs which could eventually cardiac complications. Some are alcohol related dilated cardiomyopathy, new READ MORE
How can I sleep comfortably after heart artery surgery?
Thats an easier answer.. You cannot sleep comfortably early after coronary bypass surgery (CABG).. Generally, the first 2 days are in the icu and it is painful. Median sternotomy is essential cutting the sternum in half and closing it back with chicken wire. The surgery team orders out of bed within 14 hours and deep breathing with a pillow on sternum to clear the lungs. Day 3 is transfer day to a Step Down Unit bed. The pain is a little better at this point and patient is starting to walk in the room and sit in the recliner with his inspirometer and cough pillow. At this point, there is some improvement in functional capacity and pain severity with each passing day. By day 5-6, the patient is ready to be discharged to home. Pain levels are still moderate but treatment is effective with short acting opiates ( Oxycodone/hydrocodone) And the patient feels like a human again. The next 2 weeks are about recovering completely. Walking outside some , but not overdoing things. Each day shows incremental improvements. I generally do a follow up visit and tweak the cardiac meds and doses. This visit is short, just to put eyes on my patients. They are still not allowed to drive. Blood pressure usually runs on the low side while the body recovers. The skin staples are removed from the rather long surgical wound, which runs the length of the sternum. The next 4-6 weeks is movement/improvement time. Walking more briskly, and for longer distances. Appetite is better and bodily functions return to previous baselines. This is also the time to start driving short distance and for return to work. Short- term disability forms are completed. Patients are not allowed to lift more than 15 lbs or so. The READ MORE
How soon after stent surgery can I drink alcohol?
Ill pass on this question. Give to someone else. Basically a glass of wine ok anything else I say 6 weeks. But there are no set standards. When Im doubt , dont READ MORE
What diet is best after heart artery surgery?
Thats an easy answer. There are only 2 diets the ACC and AHA promote. The Mediterranean Diet and the DASH Diet. Both diets have a lot of overlap, but Dash is low sodium for patients with hypertension, CHF, etc. These 2 diets have been shown to improve overall cardiac health, including lowering of both CV morbidity and mortality. This benefit is, in part, due to the reduction of LDL cholesterol and triglycerides. Combined with moderate intensity aerobic exercise for 30 minutes 4-5 times a week, and health benefits improve exponentially. These 2 diets are both low in carbohydrates and saturated fats, with emphasis on olive oil, nuts etc. Warning: it is difficult to be 100% compliant with these diets. They are somewhat bland and not very enjoyable. Realistically, I tell my patients to shoot for a goal of dietary compliance 60-70% of the time. Any more would READ MORE
Can you fix heart arrhythmia without medications?
Thats a very generalized question. The short answer is yes.. Most arrhythmias originate in the upper chambers of the heart , known as the atria. These arrhythmias are also called supraventricular or above the ventricles. Ventricular arrhythmias originate in either the right or left ventricles. Ventricular arrhythmias are more rare and more dangerous. Arrhythmias that originate in either the right or left atria are not life threatening, with few exceptions. One such situation is when an AV node blocking drug is given to a patient in atrial fibrillation with an underlying electrical bypass pathway ( pre-excitation, such as WPW). The pathway connects the atrium directly to the ventricle, avoiding the physiologic pause in the AV node. The pre-excitation comes from the early depolarization of the ventricle, as the electrical conduction travels through the bypass pathway. This wave is followed shortly after by the slower conduction down the normal pathway of the AV node, bundle of his, and the right and left bundle branches. So the ECG shows a widened QRS with a delta wave, due to the fusion of the double depolarizations of the ventricles superimposed on each other. So if a medication is given that slows the AV node, the conduction down the bypass pathway is unabated. The atrial fibrillation becomes ventricular fibrillation , and cardiac arrest is likely. This is treated by emergent, electrical cardioversion, with successive shocks provided by the automated defibrillator. Ventricular fibrillation requires electrical cardioversion in every case, because it is the ultimate life-threatening arrhythmia. Fibrillation prevents ventricular contractions , and the complete loss of cardiac output, followed by imminent death. Most ventricular arrhythmias are the result of re-entry electrical pathways around scarred ventricular tissue , during or after a myocardial infarction (or heart attack). Antiarrhythmic drugs, such as amiodarone, help maintain sinus rhythm following direct-current cardioversion (shocks). AV nodal blocking agents ( beta-blockers and calcium channel blockers) are largely ineffective, because these arrhythmias originate below the AV node (in the ventricular tissue). There are several varieties of ventricular tachycardia, including inherited channelopathies ( Brugada, Long QT), those related to birth defects causing abnormalities in the ventricles (arrhythmogenic right ventricular dysplasia) , non-compaction syndromes of ventricular tissue , etc. These potentially life threatening arrhythmias are treated with antiarrhythmic drugs and often, implantation of a cardiodefibrillator or AICD. Some of these arrhythmias can be eliminated using ablation therapies by Electrophysiologists. Ablations are certainly a way to avoid long-standing medications. Atrial ,or Supraventricular, arrhythmias come in many forms. Sinus tachycardia is included, but is not considered a true arrhythmia. sinus tachycardia originates in the sinus node and follows the normal electrical conduction pathway. Sinus tach is secondary to increased sympathetic tone from the autonomic nervous system, mediated by the neurotransmitter norepinephrine, or adrenaline. This is triggered by pain, anemia, fever, thyroid hormone, infections etc. The treatment is to correct the underlying cause and slow down the sinus node depolarization and heart rate with the same meds that block the AV node. The true atrial arrhythmias are supraventricular re-entry electrical pathways, ( with or without inclusion of the AV node). Those that do involve the AV node (AVNRT, ectopic atrial tach,or EAT) are converted by maneuvers that increase vagal nerve tone and block the AV node ( valsalva, face submersion in ice water or carotid massage). Also the usual AV blocking meds are effective. The the re-entry arrhythmias that do not involve the AV node (AVRT, WPW), use a bypass pathway as part of the circuit. Since these arrhythmias do not involve the AV node , maneuvers and nodal blocking meds are ineffective. True anti-arrhythmic meds,or electrical shocks, are used to treat these. The most common atrial arrhythmias are atrial fibrillation and atrial flutter. Flutter tends to be unstable long term. Atrial flutter either converts to normal sinus rhythm or degrades into a -fib. The nodal blockers will slow the rates of these tachyarrhythmias, but will not convert them to sinus rhythm. That is done with true anti-arrhythmic drugs ( flecainide, amiodarone, sotalol, dofetillide, dronederone ) and/ or electrical cardioversion. As it pertains to your question, to avoid long term , potentially toxic, anti arrhythmic meds, then the best option is an ablation procedure. The success rate of ablation in AV nodal re-entry tachycardia, or AVNRT, is at 90%. Ablation of bypass pathways , like WPW or AVRT, has about the same efficacy. Ablation of atrial fib is now above 80% , since the pathways of re-entry are around the entry of the pulmonary veins into the left atrium. Ablation of atrial flutter is slightly more effective. the pathway involves the isthmus of the Inferior vena cava and annulus of the tricuspid valve, in the right atrium. In summary, ablation therapy has come a long way in the last decade, with better equipment, better techniques (radio frequency waves vs cryotherapy or freezing the tissue) and less adverse events. To completely avoid long-term medication, ablation procedures are the best option, whether the arrhythmias originate in or above the ventricles. Scar re-entry arrhythmias can usually be ablated, as can some inherited ventricular conduction pathways. However, avoiding long-term medication when treating ventricular arrhythmias might not be an option, regardless of the success of an ablation procedure. The potential for future adverse outcomes can be prohibitive. READ MORE

Areas of expertise and specialization

Cardiovascular diseases ( structural, congenital, valvular , arrhythmias, pericardial, vascular, venous, cardiomyopathies, coronary disease, heart failure, pulmonary hypertension, pulmonary vascular dz, thromboembolic diseases)

Faculty Titles & Positions

Ex Chief of Medicine 2010; ICU Medical Director River Parish Hospital 2010 - 2011

Awards

Junior AOA recipient 1996, AOA scholarship 1997, scholarship for ranked 2nd academically; Deans Award 1997; Pharmacology Award 1997 1995 LSU Medical School

Professional Memberships

Louisiana Pharmacists Association
American College of Cardiology

Charities and Philanthropic Endeavors

Kiwanis Club; Boys Hope; Knights of Columbus

Areas of research

Clinical ; Heart Failure; anticoagulant therapy ; Massive Pulmonary Embolism

Keith Gregory Hickey, MD's Practice location

Cardiovascular Medicine of Slidell

2965 Gause Blvd # 2 -
Slidell, LA 70461

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New patients: 985-503-7853

985-707-5128

Fax: 985-263-1771

Mon:09:00 AM - 05:00 PM
Tue:09:00 AM - 05:00 PM
Wed:09:00 AM - 05:00 PM
Thu:09:00 AM - 05:00 PM
Fri:09:00 AM - 05:00 PM
Sat:Closed
Sun:Closed

Keith Gregory Hickey, MD's reviews

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Patient Experience with Dr. Hickey

3.0

Based on 12 reviews

Keith Gregory Hickey, MD has a rating of 3 out of 5 stars based on the reviews from 12 patients. FindaTopDoc has aggregated the experiences from real patients to help give you more insights and information on how to choose the best Cardiologist in your area. These reviews do not reflect a providers level of clinical care, but are a compilation of quality indicators such as bedside manner, wait time, staff friendliness, ease of appointment, and knowledge of conditions and treatments.

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Get to know Cardiologist Dr. Keith Gregory Hickey, who serves patients throughout Louisiana.

A reputable cardiologist, Dr. Hickey opened his clinic, Cardiovascular Medicine of Slidell, in February 2023, after 16 years at Louisiana Heart Center. His goal remains the treatment of the whole patient, with a focus on cardiovascular prevention.

When I completed my Fellowship training in Cardiovascular Medicine in 2006, I wanted to be purely invasive, and do as many procedures as possible. I loved the hospital side of cardiology. But over the years I realized that this approach wasn’t benefiting my patients to the fullest. My ultimate goal was to prolong symptom free survival and prevent hospitalization. So I had a paradigm shift in the way I practiced cardiovascular medicine, emphasizing primary and secondary prevention. I still enjoyed doing procedures, but I began stressing diet, exercise, medication and patient education. Over time, things started falling into place. I communicated better and I got to know my patients personally. I let them talk while I listened. We both invested ourselves in their care. By doing this, we were able to define treatment plans tailored to the individual patient. Something amazing began to occur. A significant number of my patients started doing better. They wanted to live healthier lives and they looked forward to discussing labs and noninvasive testing. Many were proud of the positive changes that they had accomplished. I explained the diseases and treatment plans, for their understanding and inclusion. With that understanding, came investment and trust. A bond was formed. I stopped the volume clinic and started the patient oriented clinic. I really enjoyed my work again. My referral base grew as the patients began giving positive feedback to their primary care doctors. In my estimation, 2 to 3 patients out of 10 would need revascularization. Why not treat all 10, instead of focusing on the few higher risk folks. I know that this has made me an all around better doctor. After all, it’s not about me or my ego, but the individual patient and their families. I’m the facilitator and guide, but it’s their life. Honest discussions and feedback worked by staying aggressive with our care. We still do the invasive/ interventional/surgical approach when warranted. I’ll never go back to my old way of doing things. My job satisfaction has improved significantly.

Educated in the United States, Dr. Hickey graduated with his Bachelor of Science degree in Pharmacy from Xavier University in 1986. He worked for 7 years in retail pharmacy and went back to school in 1990 for his Pharm D. He then went on to medical school, and earned his medical degree from the Louisiana State University School of Medicine in 1997.

He started his training in Urologic Surgery at Duke University Medical Center in 1997, and he switched careers to Internal Medicine in 1999. He completed his residency at Louisiana State University Health Science Center in 2002. He went on to fellowship training in cardiovascular disease at Ochsner Clinic Foundation Hospital, finishing in 2006.

Licensed to practice medicine in Louisiana, Dr. Hickey is affiliated with the following hospitals and medical centers: North Oaks Medical Center, Lakeview Regional Medical Center, St. Tammany Parish Hospital, Slidell Memorial Hospital, and St. Bernard Parish Hospital.

Prior to his current endeavors, he served as a staff cardiologist at Heart & Vascular Clinic (7/06 – 4/07), pharmacy manager at Gambina’s Pharmacy (1/03 – 6/03), clinical data services senior associate with Quintiles Corporation – Research Triangle Park (10/00 – 12/00), and as the chief pharmacist at Walgreens Company (1/87 – 8/93).

With an unwavering commitment to his speciality, Dr. Hickey is board-certified in both internal medicine and cardiovascular disease by the American Board of Internal Medicine (ABIM). He also holds board certifications in Echocardiography and Nuclear Medicine.

In summary, Cardiology is a branch of medicine that deals with the disorders of the heart, as well as some parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Cardiologists are doctors who diagnose, assess, and treat patients with diseases and defects of the heart and blood vessels (the cardiovascular system).

Throughout his extensive career, Dr. Hickey has served as vice-president of community affairs, class of 1997 (8/93–5/94); director, Camp Tiger 1994 / fundraiser, Camp Tiger 1995, 1996; volunteer, LSUMC Homeless Clinic (8/95-5/97); volunteer, LSUMC Family Day (5/95); volunteer, American Diabetes Association, Lions Club Camp (7/95); volunteer, Freshman Orientation (8/94); class note taker 1994, 1995; tutor, LSUMC Department of Anatomy, Fall of 1994; and member of the Louisiana Pharmacists Association (1986-1993).

Since 1990, he has served as Big Brother of the Boys Hope Home for Disadvantaged Youths, and as a member of the Kiwanis Club.