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Internal Medicine Doctors of
Mill Basin & Bergen Beach, Brooklyn

6301 Mill Lane (Corner of East 63rd) in Mill Basin (11234)

718-942-4600

Dr. Bella Zimilevich

Dr. Bella Zimilevich, MD
Primary Care Doctor

Dr. Bella Zimilevich

Dr. Anatoly Pisman, M.D
Physical Medicine & Rehabilitation

Dr. Bella Zimilevich

Dr. Alexander Shapsis, M.D
Gastroenterologist

Heart Health

 

Why You Should Pay Attention to Angina

Posted by on September 19th, 2013

Dr. Bella Zimilevich, MD

“Angina is not a disease in and of itself; instead, it serves as a warning that an area of the heart is not getting enough oxygen. Angina should never be ignored- you should take it as the warning that it is and seek medical care if you experience chest pain or discomfort.”

-Dr. Bella Zimilevich, MD

 What is angina?

Angina is chest pain or discomfort that occurs when a portion of the heart does not receive enough oxygen-rich blood. It usually occurs due to coronary artery disease (CAD). If you have CAD, an artery (or more than one artery) becomes partially blocked with plaque, a waxy substance that can occlude arteries and block blood flow. High cholesterol can influence plaque formation, and high blood pressure can damage arteries, making them stiffer and less pliable, and thus less able to allow blood to flow freely. When plaque builds up, a clot can form, which can increase your risk of having a myocardial infarction (heart attack) if a clot happens to occlude an artery, completely blocking the flow of blood in the affected artery.

What are the types of angina?

Angina can take more than one form. It is important to determine which type of angina you have, as treatment may vary:

  • Stable angina– this is the most common type. In stable angina, the heart must work harder than normal to do its job, and anything that increases the workload of the heart may cause pain. In stable angina, you can usually predict what activities will provoke pain. The pain subsides when you rest or take your medication. Stable angina is a warning that a heart attack may occur in the future.
  • Unstable angina– unstable angina occurs not only during activity, but also at rest. Unstable angina is unpredictable and may not stop when you rest or take medication. Unstable angina is a warning that a heart attack may be imminent and should be taken very seriously.
  • Variant angina– this type of angina occurs when a coronary artery goes into spasm. It is very painful and often occurs in the middle of the night. It can often be controlled with medication.

Is all chest pain caused by angina?

No. Chest pain can be caused by many other conditions other than angina. This is why it is so important to see a doctor if you are experiencing chest pain. Chest pain can be caused by musculoskeletal injury to the chest wall, pulmonary embolism, pneumonia and other conditions, some of which may be very serious and some, like musculoskeletal injury, that are painful but not life-threatening.

What can I expect when I come and see you?

If you come in and see me with chest pain, I will ask about your past medical history, medications you are taking and any allergies you might have. I will also ask about your family history of heart disease.

I will examine you, paying close attention to your heart and lungs. I will order an ECG, which records the electrical activity of your heart and can tell me if you have an abnormal rhythm or if you have ECG changes that indicate your heart is not getting enough oxygen (“ischemic changes”). I will also check your blood pressure and other vital signs. I may order blood tests, depending on what I think the cause of your chest pain might be. Blood tests might include a complete blood count, cholesterol testing and other tests that will provide me with information regarding your general health status. I may also order a stress test, which measures how well your heart functions under “stress” (exercise).

If need be, I may refer you to a cardiologist if I feel you need to see a specialist. I can work with your specialist and you to ensure that your care needs are being met.

If you have angina or chest pain, don’t wait to come in to be seen. Chest pain should always be assessed by a medical professional to rule out cardiac disease or other serious conditions. If you have chest pain, don’t delay- make an appointment today.

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How I Can Help With Atrial Fibrillation

Posted by on September 19th, 2013

Dr. Bella Zimilevich, MD

“Atrial fibrillation is a relatively common cardiac arrhythmia in older patients. Although it is common, it should not be ignored, as it can lead to serious complications such as stroke. If you have symptoms of atrial fibrillation, it is important that you come in immediately to be seen”.

-Dr. Bella Zimilevich, MD

What is atrial fibrillation?

Atrial fibrillation is an abnormal rhythm of the atria, the upper chambers of the heart. In atrial fibrillation, instead of the atria contracting regularly and forcefully in concert with the ventricles, sending blood to the ventricles where it can be pumped out to the rest of the body, the atria quiver chaotically (and often very rapidly), resulting in decreased blood flow to the ventricles. This can cause fluid to back up into the lungs, causing symptoms of congestive heart failure. Atrial fibrillation is also a major risk factor for stroke. Why? When the atria quiver, blood can coagulate and form a clot, which may then be pumped out into the circulation and may eventually head for the brain, causing a stroke. Atrial fibrillation may be acute or chronic.

What are the symptoms of atrial fibrillation?

Some people are not aware that they have atrial fibrillation and do not notice that their heart is beating irregularly. Others, especially people who have chronic heart disease such as congestive heart failure, may experience:

  • palpitations, the sensation that their heart is beating irregularly or too quickly or is “flopping around” in their chest
  • shortness of breath
  • lightheadedness/weakness
  • chest pain
  • low blood pressure
  • confusion (due to lack of oxygen to the brain)
  • chest pain (Note: if you have chest pain and/or severe shortness of breath and palpitations, you should go to the nearest emergency room, as chest pain may indicate that you are having a heart attack. It’s always better to be safe than sorry.)

Paroxysmal atrial fibrillation may come and go. Chronic atrial fibrillation means that your heart rhythm is always irregular.

What causes atrial fibrillation?

Atrial fibrillation may occur in conjunction with, or because of, many other conditions:

  • previous heart attack- a previous heart attack may damage tissue that is normally responsible for regulating heart rhythm
  • diseased heart valves- heart valves that do not open and close properly, allowing blood to flow backwards in the heart (regurgitation) may cause atrial fibrillation
  • thyroid disease- if your thyroid is overactive, you may experience paroxysmal atrial fibrillation that can usually be treating your hyperthyroidism appropriately
  • high blood pressure- high blood pressure can damage the heart over time
  • congenital heart defects- if you are born with abnormalities of the heart, you may develop atrial fibrillation
  • lung disease- emphysema and COPD may cause atrial fibrillation
  • stimulants- caffeine, alcohol, tobacco or certain drugs may cause transient atrial fibrillation that will go away once the offending substance wears off
  • malfunctioning of the normal pacemaker of the heart (the SA node, which normally regulates heart rate)

What can you expect if you come and see me?

If you are experiencing symptoms such as palpitations, weakness, dizziness or shortness of breath, it’s very important that you be seen by a physician. Ignoring these symptoms may mean that you could suffer a stroke or other complication.

When you come to see me, I will ask you about your past medical history, looking for clues as to what may be causing your symptoms. I will want to know about all the medications you are taking, including over-the-counter and herbal remedies. I will also want to know if you have any allergies to medications.

I will need you to tell me in detail about your symptoms: When did they start? Do they come and go? Does anything make them better or worse? Be as specific as you can and tell me everything, even if you think it is not relevant.

After I have gathered some information, I will examine you. I will listen carefully to your heart and lungs. I may also assess your legs and abdomen for edema (excess fluid that has pooled in your legs or abdominal area). I will obtain your vitals (heart rate, blood pressure, oxygen saturation). I may also weigh you so that we have a baseline for comparison in the future.

I will order an ECG, which is a recording or your heart’s electrical activity. The test is not painful and takes only minutes to perform. It can provide valuable information on the condition of your heart. I may also order blood work, including a complete blood count and electrolytes to check for electrolyte imbalance and anemia, as well as liver function tests, cholesterol tests and others as I feel they are necessary.

If you have atrial fibrillation, we can talk about treatment. If I feel it is necessary, I may send you to a cardiologist. If you need to be seen by a heart specialist, I will work with your specialist to care for you, following your specialists’ recommendations. If you have atrial fibrillation, it will be important for you to be seen regularly in order to keep on top of your condition and prevent serious complications.

How is atrial fibrillation treated?

Treatment is aimed at prevention of blood clots and control of your heart rate. This is usually achieved with medications such as blood thinners and heart medications that slow your heart rate. Treatment will depend on how long you have had symptoms, how much your symptoms bother you and what the underlying cause of your atrial fibrillation is thought to be.

If you have symptoms of atrial fibrillation, do not ignore your symptoms. Make an appointment today.

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How I Can Help Manage Your Congestive Heart Failure (CHF)

Posted by on August 15th, 2013

Dr. Bella Zimilevich, MD

“Congestive heart failure is a chronic condition that can directly affect quality of life. If you have CHF, you will need to be diligent in caring for yourself, and you will need to partner will a physician who can help you manage your condition to avoid hospitalizations and complications. I would love to be your trusted resource and help you live your life to its fullest potential”.

-Dr. Zimilevich, MD

What is CHF?

Congestive heart failure is a condition that develops after your heart has suffered damage from a heart attack or other condition affecting the heart. In CHF, the heart is weak and is less efficient at pumping blood to other parts of the body. It is also sometimes less able to accept blood back into the heart that comes from the lungs, which accounts for many of the symptoms of this condition. Although there is no cure for CHF, with proper treatment you can live a long and full life; however, attention to your condition and proper medical care is important, which is why you need a doctor who you can trust, one who can help you learn about and manage your condition.

What causes CHF?

Having a heart attack is the most common cause of congestive heart failure. These other conditions can also cause CHF:

  • undiagnosed or improperly treated high blood pressure (hypertension)
  • disease of the heart valve(s)- leaking or narrowing of the valves
  • idiopathic heart muscle disease
  • obesity
  • diabetes
  • myocarditis or endocarditis- inflammation of the heart muscle caused by an infection
  • alcohol or drug abuse
  • anemia, thyroid disorders and other medical conditions
  • high blood cholesterol– over a long period of time

What are the symptoms of CHF?

When you understand what CHF is (the inability of your heart to pump blood properly to the rest of the body or to fill properly with blood returning from the lungs) it is easy to predict the symptoms you might experience:

  • shortness of breath- may be severe and may get worse when you lay flat due to excess fluid in the lungs
  • bloating or feeling full all the time- excess fluid in the abdomen can cause you to feel uncomfortably full
  • feeling tired all the time-lack of oxygen, or poorly oxygenated blood, can make you feel tired
  • swelling of the ankles, legs, abdomen or sacral area (base of the spine)- excess swelling is due to the heart’s inability to circulate properly, which leads to fluid accumulation
  • sudden weight gain (may be as much as 5 pounds in a week or 2 to 3 pounds in a day or two)- due to fluid accumulation
  • coughing or cold symptoms that last far longer than normal- coughing is due to fluid/congestion in the lungs
  • increased urination, especially at night- the body attempts to get rid of excess fluid through urination
  • loss of appetite- fullness in the abdomen and living with a chronic illness can dull the appetite

What can I expect when I come to see you in the clinic?

If you come to see me in the clinic with any of the symptoms described above, I will want to know how long you have had symptoms and whether you have any of the other symptoms listed above. I will question you closely about your symptoms and what brought you in to see me.

I will need to know about your past medical history, especially if you have had a heart attack in the past or have been diagnosed with another heart condition such as a valve problem. I will need to know what medications you are taking and any allergies you may have. I will also want to know if there is a family history of heart disease.

Next, I will examine you. I may ask that you change into a gown for this part of your visit, as it will be easier to pick up any signs of CHF. I will listen carefully to your heart and lungs for abnormal heart sounds and lung congestion. I will examine your abdomen for any swelling. I will also look at your legs, feet and ankles for signs of swelling. I may obtain your weight as a baseline. I’ll ask about cough, fatigue and increased urination, all of which you may have experienced if you have CHF.

Diagnostic tests can help me make the diagnosis. I may order blood work, an ECG (a heart tracing that tells me about the electrical activity of your heart) and a chest x-ray (can detect an enlarged heart and/or fluid in the lungs). If I feel its necessary I may also order a stress test and/or an echocardiogram, which is an ultrasound of the heart that can tell me a lot about the structure and function of your heart.

I will explain the tests to you, including the reason I am ordering them and what I expect the test to tell me. If any results are abnormal, I promise to explain them to you in terms that you can understand. If necessary, I will refer you to a cardiologist, a physician who specializes in the heart.

How is CHF treated?

Many people with congestive heart failure can be managed with medications, including:

  • antihypertensives (medications to lower blood pressure)
  • diuretics (medications that help your body rid itself of excess fluids)
  • medications such as digoxin, which help the heart to beat more strongly

Some people with severe CHF may require surgery to put in a pacemaker or surgery to unblock clogged arteries. If you need surgery, I can work with you and your surgeon during and after recovery to follow his/her recommendations.

Lifestyle changes are an important part of managing CHF. You may be asked to:

  • restrict your daily fluid intake to less than 2 liters a day from all sources
  • monitor your blood pressure, pulse and weight regularly at home
  • exercise in moderation
  • quit smoking
  • eat a heart-healthy diet
  • increase the fiber in your diet
  • decrease the amount of sodium you consume
  • avoid excess caffeine and alcoholic beverages
  • get lots of rest and sleep
  • protect yourself from preventable disease by getting a flu shot and the pneumococcal vaccine
  • take your medications on time as prescribed

If you are diagnosed with congestive heart failure, your life will change. With proper treatment, you may find that you feel better and have more energy; however, CHF is a chronic condition that requires careful monitoring for the rest of your life. If you think you might have CHF, or you have already been diagnosed and need a physician who can partner with you to help you lead the best life possible, make an appointment to see me. I can help you manage your condition so that you can enjoy good quality of life.

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How I Diagnose and Treat Irregular Heartbeat (Palpitations, Arrhythmias)

Posted by on July 6th, 2013

Dr. Bella Zimilevich, MD

“Experiencing an irregular heartbeat can be frightening. Your heart may pound, skip beats or beat very quickly, which can definitely make you feel anxious! If you experience an irregular heartbeat, especially if it is happening for the first time or is happening frequently and you have risk factors for heart disease, such as a family history of heart disease, hypertension or diabetes, I want to see you. Although occasional palpitations can be normal, they can also signal a heart problem”.

-Dr. Zimilevich, MD

Most of us, if not all of us, have felt our heart skip a beat, a fluttering sensation in our chest or the sensation that our heart is turning over. Palpitations (rapid, fluttering, skipped or irregular heartbeats) are not uncommon as we age. When they occur rarely and stop almost before they start, they are probably nothing to worry about. However, some irregular heartbeats can be dangerous and there is no way you can tell if the weird sensation you are experiencing is benign or a symptom of a serious problem. That’s why it’s best to come and see me if you are experiencing palpitations.

Symptoms of an arrhythmia

The term arrhythmia (sometimes called dysrhythmia) refers to a change in the way your heart normally sends electrical impulses that result in contraction of your heart muscle. Electrical impulses may happen too slowly, too quickly or very irregularly. When the heart doesn’t beat normally, it may not pump blood efficiently to the rest of your body, resulting in abnormal symptoms. If your heart fires prematurely, you may notice a skipped beat. Premature beats that occur rapidly and in succession may cause a fluttering sensation in your chest. When an arrhythmia continues for more than a few beats you may experience:

  • dizziness/lightheadedness
  • rapid heartbeat or a pounding in your chest
  • sweating (diaphoresis), cool clammy skin
  • chest pain or shortness of breath (which may be more pronounced if you have underlying heart disease)
  • tiredness or fatigue
  • fainting or near-fainting spells (known as syncope or near syncope)
  • cardiac arrest or collapse, depending on the arrhythmia

What are risk factors for  irregular heartbeats?

  • older individuals- the incidence of palpitations increases with age, even in the absence of heart disease
  • prior heart attack- the scar tissue that forms after a person has suffered a heart attack can make them more prone to conduction abnormalities
  • electrolyte imbalances- the heart depends on potassium, sodium, magnesium and calcium to function properly. When levels of electrolytes are too high or too low, the heart may beat too slowly, too quickly or irregularly
  • chemicals- caffeine, alcohol, recreational drugs and certain medications (including heart medications) may cause an abnormal heart rhythm
  • chronic health conditions- heart failure, diabetes, high blood pressure, lung disease and congenital heart defects may cause rhythm abnormalities

How are abnormal rhythms diagnosed?

When you come in to see me complaining or an irregular heartbeat, I will ask you about your health history, including any history of heart disease in your family. I will ask in detail about the symptoms you have been experiencing- when you noticed them, how long episodes last and the symptoms you have experienced. I will perform a physical exam (you may need to change into a gown for this), listening to your heart and lungs, checking pulses in different areas and looking for abnormal swelling in your legs and feet. I may order blood work or other diagnostic tests such as an ECG, which provides a detailed tracing of your heart and can detect rhythm abnormalities. Depending on what I find, I may prescribe medication or refer you to additional doctors if necessary. It’s important to add that if you are experiencing severe chest pain or shortness of breath, you should go to the nearest emergency room, preferably by ambulance.

If you have been experiencing irregular, rapid or skipped heart beats frequently and you are concerned, it’s best to make an appointment to come in and see me. Although the occasional skipped beat is generally nothing to worry about, irregular heartbeats can be serious and should be investigated.

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Heart Health At Mill Basin Medical: Meet Dr. Zimilevich

Posted by on May 30th, 2013

Dr. Bella Zimilevich, MD

Cardiovascular disease is very prevalent in our society, and no one is immune. If you have chest pain, unexplained weight gain over a short period of time, high blood pressure, high cholesterol or a family history of heart disease,  I want to see you so that we can work together to minimize your risk of  serious complications, such as a heart attack or heart failure, and improve your heart health”.

Dr. Bella Zimilivich, MD

About Heart Disease

Heart disease is the leading cause of death in the United States for both men and women. Although more than half of the deaths from heart disease every year occur in men, women are rapidly catching up to men in this regard. Coronary artery disease, or CAD, is the most common type of heart disease, responsible for approximately 385,000 deaths every year (CDC, 2012).

What are the risk factors for heart disease?

Risk factors for heart disease include:

  • obesity or overweight
  • smoking
  • sedentary lifestyle/lack of exercise
  • inadequate diet
  • family history of heart disease

How I can help

As an internal medicine physician, I have seen my fair share of patients with heart conditions. Whether you are at risk for heart disease due to family history or lifestyle factors, or you already have heart disease, I can help you to identify ways to reduce your risk of suffering a serious complication. I can’t change your gender, family history or age (known as modifiable risk factors), but I can help you to reduce certain risk factors such as weight, hypertension and high cholesterol.

Many patients come to me complaining of chest discomfort or pain, which can be caused by many conditions such as heart attack, acid reflux or musculoskeletal injury. If you experience chest pain, I can order appropriate blood work, an ECG (which takes a tracing of your heart rhythm),  and many other tests that may be necessary to rule out a heart attack and help me get to the root of your chest pain. As an internal medicine physician, I am able to manage most heart-related conditions, so seeing a specialist is not always necessary, but if a specialist’s opinion is needed, I can certainly refer you. (Note: if you experience severe or sudden chest pain that lasts longer than a few minutes, is associated with shortness of breath, sweating, nausea or radiates to your jaw or arms you should go to the nearest ER, rather than coming to the clinic).

Of course, we see many other conditions besides chest pain. At Mill Basin Medical we treat a wide variety of cardiovascular symptoms, including:

  • high blood pressure
  • high cholesterol (particularly LDL cholesterol)
  • congestive heart failure (CHF)
  • leg or ankle swelling
  • pain, weakness or discoloration of the lower legs
  • rapid changes in weight from day to day
  • shortness of breath
  • weakness and/or dizziness
  • abnormal fatigue at rest or with exercise
  • irregular heart beat, fast or abnormally slow heart rate
  • chest pain or discomfort [Note: if you are experiencing severe chest pain that lasts longer than 2 minutes, please go to the nearest emergency]

Whether you are young or old, healthy or struggling to become healthy, I want to see you. If you do not have heart disease, I will work to maintain your heart health. If you have risk factors for heart disease, I will work with you to decrease or eliminate your personal risk for heart disease. If you have already been diagnosed with cardiovascular disease, I will work with you to manage your condition so that your condition does not worsen. Don’t delay- make an appointment today.

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High Blood Pressure /Hypertension

Posted by on May 1st, 2013

Dr. Bella Zimilevich, MD

“Often called the “silent killer” because it causes no or few attention-getting symptoms, untreated high blood pressure causes damage to your arteries that can’t be undone. If you have hypertension, we’ll work closely together to control your blood pressure to avoid serious complications”.

-Dr. Bella Zimilevich, MD

What exactly is blood pressure?

In simplest terms, blood pressure is the force of circulating blood against the walls of arteries. (Arteries are the vessels that carry blood away from your heart to supply the rest of your body with oxygenated blood.) During each heartbeat, blood pressure varies between a maximum
(systolic) and a minimum (diastolic) amount of force.

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About Cholesterol

Posted by on April 30th, 2013

“High cholesterol is a risk factor for atherosclerosis, or hardening of the arteries. Can’t tell the difference between “good” cholesterol and “bad” cholesterol? This is where I come in- I can explain cholesterol clearly and help you to manage your cholesterol levels”.

-Dr. Bella Zimilevich, MD

What is cholesterol?

Cholesterol is a fatty substance that occurs naturally in the blood. We often hear about how bad cholesterol is, but cholesterol is not all bad. In fact, we wouldn’t be able to live without it! Cholesterol performs important functions in the body, including playing an important role in tissue and hormone formation. It also protects nerves, and it aids digestion. Cholesterol helps form the structure of every cell in the body.

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Our Location

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6301 Mill Lane, Brooklyn, NY 11234.

718-942-4600

We are not a hospital/urgent care facility. Our urgent care services are offered during normal business hours only.
Mill Basin Clinic Location

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