Interventional Treatment

Cardiac Cath

Cardiac catheterization, also known as coronary angiogram, or "heart cath," is a procedure in which the coronary arteries and heart muscle are directly imaged under x-ray using iodine contrast dye. Cardiac cath is the "gold standard" for diagnosis of coronary disease. The procedure is usually performed through the femoral artery in your groin but is sometimes performed through the brachial artery on the inner aspect of your elbow. During a cardiac cath, your cardiologist administers local anesthesia to numb the groin, then inserts a thin, hollow catheter into the femoral artery in the groin and advances it to the heart. Injection of contrast through the catheter under x-ray allows visualization of the coronary arteries. Blockages, or "stenoses" of the coronaries can be identified in this manner. Cardiac cath takes about one hour and can be done in an outpatient manner. However, if an angioplasty is performed at the same time as a heart cath, the patient is usually admitted to the hospital overnight for observation.

Pacemaker

A slow heart rhythm, or bradycardia, can be treated with a permanent pacemaker. This sophisticated device is only about the size of a silver dollar coin and is implanted beneath the skin in the upper chest. The procedure is done under local anesthesia. The pacemaker lies dormant as long as the heart is beating normally. However, if the heart should beat inappropriately slowly, the pacemaker "kicks in" and paces the heart.

Coronary Angioplasty Stent

Coronary angiography, described above, is a diagnostic procedure during which the coronary arteries are imaged in order to define their anatomy and identify stenoses, or blockages, within the arteries. Coronary angioplasty, or percutaneous transluminal coronary angioplasty (PTCA), is a therapeutic procedure geared toward treating coronary stenosis or occlusion. During this procedure, the cardiologist advances an angioplasty balloon into the coronary artery and, under x-ray guidance, positions the balloon over the site of the blockage, or stenosis. Inflation of the balloon stretches the artery, compressing the plaque against the artery wall, thereby enlarging the artery channel. While the balloon is inflated, it occludes the artery channel and blood cannot pass. During this time, the patient may experience chest discomfort, until the balloon is deflated. Following angioplasty, the artery channel is enlarged. However, since the artery contains elastic tissue, there is always some degree of "recoil" after the balloon is deflated. Over the ensuing weeks, as the artery heals, the recoil process may continue. In some cases (30-40%), severe recoil can cause "restenosis," or re narrowing of the arterial channel. This is a drawback to angioplasty. Fortunately, a device known as a "stent" has been developed that completely overcomes the recoil phenomenon.

Coronary stents are designed to be placed into the coronary arteries that lie on the surface of the heart and supply the heart with oxygen-fresh blood. A stent is mounted on an angioplasty balloon in its collapsed state. The stent/balloon assembly is then advanced into the coronary artery and positioned over the site of the coronary lesion. When the balloon is inflated, the stent becomes fully expanded and apposed against the coronary artery wall, "tacking up" the atherosclerotic lesion and buttressing the artery wall. The balloon is then removed but the stent remains in the coronary artery (forever). As a result of advancing stent design, more patients with more complex disease are candidates for stenting, which reduces the number of coronary artery bypass graft surgeries.

Stenting has been an important advance in balloon angioplasty. Before the introduction of stents, as many as half of all coronary arteries opened with a balloon-tipped catheter narrowed once again after the procedure(restenosis). In 2003, a major advancement in stenting was realized with the introduction of a new generation of stents. These stents, call "drug-eluting" stents, are covered with special drugs that reduced the restenosis rate to its current low level. Today, drug-eluting stents comprise the majority of stents in clinical use for coronary disease.

Following stenting, the patient is treated with aspirin in addition to blood thinner, in order to prevent blood clotting at the site of the stent. It is important for the patient to carefully follow their physician's orders regarding these medications, as well as practice healthy lifestyle behaviors, such as not smoking and lowering cholesterol levels. Stents are not affected by metal detectors or most mechanical equipment.

Defribillator / AICD

An automatic implantable cardiac defibrillator is a device capable of detecting a dangerous heart rhythm and applying an electrical shock to the heart in order to convert the rhythm back to normal. This device is implanted under the skin under local anesthesia, much like a pacemaker, in patients who have a predisposition to dangerous arrhythmias that could cause loss of consciousness. Following implantation, the device is checked at regular intervals several times a year, on an outpatient basis.

Electrophysiology Study

A study of the Heart's electrical system is know as an electrophysiology test. During this test, wire electrode catheters are advanced through a vein in the groin to various positions in the heart. The electrical activity of the heart is then examined and the conduction properties of the nerves in the heart are measured. The second part of this test involves electrical stimulation of various parts of the heart in an attempt to induce an abnormal heart rhythm. Identification of this abnormal rhythm allows specific treatment to be tailored towards it. Electrophysiology testing is usually performed on patients with symptoms of dizziness or fainting. In some instances, a Holter monitor may pick up an abnormal and potentially dangerous heart rhythm that is further investigated by elecrophysiology study.

Tilt Table Test

An automatic implantable cardiac defibrillator is a device capable of detecting a dangerous heart rhythm and applying an electrical shock to the heart in order to convert the rhythm back to normal. This device is implanted under the skin under local anesthesia, much like a pacemaker, in patients who have a predisposition to dangerous arrhythmias that could cause loss of consciousness. Following implantation, the device is checked at regular intervals several times a year, on an outpatient basis.