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Cardiac Treatments and Procedures

Ablation (also Radio-frequency or RF Ablation)

A Cardiac Ablation is a procedure where catheters are placed in the heart and RF energy is delivered through the catheter to abnormal heart tissue causing an irregular heartbeat. This neutralizes (ablates) the cardiac cells that are causing an arrhythmia, an abnormal heart rhythm, by creating a block that the electrical impulses can no longer cross. The treatment is used on abnormal heart tissue, sometimes referred to as 'hot spots', both in the atria or in the pulmonary veins. This restores the normal electrical pathways of your heart and allows it to beat normally again. The procedure is performed by a cardiac specialist called an Electrophysiologist. It is a widely used procedure, proven safe, effective, and long-lasting, although some arrhythmias are more easily treated with catheter ablation than others.

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Atrial Fibrillation Treatment

Atrial fibrillation (AF or A-Fib) is the most common abnormal heart rhythm. It is a fast, complex, and chaotic rhythm of the upper chambers, or the atria. During AF, the typical rhythm is between 350 and 600 times per minute. At that rate, the upper chambers are not contracting normally. At first they quiver, but eventually there is mechanical standstill. The lower chamber, or the ventricles, also have an irregular and fast rhythm during AF. The AV node (aventricular node) acts as a filter, resulting in a ventricular rate between 100-200 beats per minute. 

Because the upper chambers are not contracting normally, the blood pools in these chambers and clots. The result of a dislodged clot is a stroke. The American Heart Association (AHA) estimates that of the 700,000 strokes occurring each year in the U.S., 15 percent -- about 105,000 -- occur in people with atrial fibrillation. Apart from the major side effect, it can result in symptoms causing a fair amount of morbidity. 

AF has traditionally been treated with antiarrhythmic medications in conjunction with blood thinners. The most common blood thinner prescribed is coumadin or warfarin. Electrical cardioversion is another technique frequently used to temporarily correct this problem.

People diagnosed with AF can live with the condition for years, but should not consider this disease benign. Complications associated with AF can be life threatening. AF reduces the pumping efficiency of the heart, creating a five-fold increase in the risk of stroke, and doubles the risk of mortality. Essentially, the AF heart is overworked. Over time, this stress on the heart can lead to heart failure.

AF can affect persons of any age group; however, the prevalence increases with age. It is estimated that 1 in 4 persons will develop AF within their lifetime. Fortunately, treatment options for those who suffer from AF have never been better, and may include lifestyle changes, drug therapies, and surgery.

What are the different types of Atrial Fibrillation?

  • Paroxysmal AF
    • Recurrent episodes that end in less than one week;
  • Persistent AF
    • Recurrent episodes that last more than one week; or requiring cardioversion by medication or electrical shock;
  • Permanent AF
    • Recurrent episodes continuing long term.

(Although the above types of AF are acceptable, the categories continue to 
change and evolve based upon new observations and data gathering.)

What are some of the risk factors for developing Atrial Fibrillation?

Both cardiac and non-cardiac factors contribute to the occurrence of AF.

  • Cardiac Related
    • Pre-Existing Heart Disease
    • Hypertension (High Blood Pressure)
    • Coronary Artery Disease
    • Congestive Heart Failure
    • Diabetes
    • Post-Cardiac Surgery
  • Non-Cardiac Related
    • Stress (Emotional, Pain, Fatigue)
    • Drugs (Tobacco, Caffeine, Alcohol, Chocolate, Illegal Drugs, Medications)
    • Disease (Hyperthyroidism, Severe Infections)
    • Sleep Apnea
    • Idiopathic (No Known Cause) - Lone AFib

How is Atrial Fibrillation diagnosed?

Physicians at McLaren Greater Lansing (McLaren Greater Lansing) use a number of noninvasive options to diagnose AF. Blood tests help to rule out causes of AF such as thyroid or blood chemistry problems. Other tests, such as an electrocardiogram (ECG) that record the heart's electrical impulses or an echocardiogram that uses sound waves to produce a "heart-in-motion" video, can help direct a diagnosis when AF occurs often or regularly. Physicians may prescribe a Holter Monitor or event recorder for those persons who have only occasional AF symptoms. Both devices are worn by the patient for a period of a few days or up to a month, in order to record the heartbeat and AF symptoms.

What are the options for treating Atrial Fibrillation?

There are a variety of options for treating AF, and are based upon the diagnosis and needs of each patient individually. Some treatment options include:

- Medications to control heart rhythm, heart rate and blood clotting
- Device implants such as pacemakers
- Catheter ablation
- Surgical ablation, including new minimally-invasive surgery

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Cardiac Catheterization or Arteriography

Cardiac Catheterization (Coronary Arteriography)

Mapping of the coronary arteries is done using a procedure called cardiac catheterization. A doctor guides a thin plastic tube (called a catheter) through an artery in the arm or leg and leads it into the coronary arteries. Then, the doctor injects a liquid dye through the catheter. The dye is visible in X-rays which record the course of the dye as it flows through the arteries. By mapping the dye's flow, the doctor identifies blocked areas. Once the mapping is done, the doctor can decide the best course of action.

-- Many tests for diagnosing and treating coronary artery disease (angiography and electrophysiology studies) are performed during a process called cardiac catheterization. These tests are done in the hospital's cardiac catheterization labs. They are administered by our specially trained cardiologists.

About the procedure: During the procedure, cardiologists thread a long, thin tube (catheter) through an artery or vein in the leg, arm or wrist (transradial procedure) and into the heart. Dye is injected through the catheter to see the heart and its arteries. This test is called a coronary angiograph. In another type of test, electrical impulses may be sent through the catheter to study irregular heartbeats. These tests are called electrophysiology studies (EPS).

Prior to the procedure, the area where the catheter will be inserted is numbed using an anesthetic agent. The cardiologist locates the artery then gently threads the catheter through the artery and into the heart.

Once the catheter is in place, dye is injected and the catheterization team will take pictures of the coronary arteries (a coronary angiograph). This allows the cardiologist to see if there is blockage in the arteries and to determine the location of the blockage.

Transradial catheterization- Increasingly, specialists are using the transradial method to view the coronary arteries. This approach involves threading a small catheter through the radial artery of the wrist.

The transradial catheterization method has several benefits for the patient.

Radial artery access allows the patient to regain mobility faster after the procedure and has a lower risk of bleeding than the more traditional method of using an artery in the groin area. Not all patients are candidates for this procedure. The cardiologist will determine if the patient is able to undergo this type of catheterization.

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Cardiac Rehabilitation

The goal of the Cardiac Rehabilitation program is to provide cardiac patients with the education, experience and practical knowledge to return to full productive lives. This includes targeted exercise programming designed to reduce symptoms and improve quality of life.  Our program includes monitored, personalized exercise classes, and educational experiences to help the patient control their disease and make the necessary changes to reduce the chances of repeat events.

Cardiac Rehabilitation can benefit those individuals with conditions or procedures such as:

  • angina pectoris
  • myocardial infarction (heart attack)
  • coronary artery bypass graft surgery
  • valve repair or replacement
  • interventional procedures such as angioplasty and coronary stenting
  • post heart transplant patients
  • heart failure
  • arrhythmia
  • device implants, such as pacemakers or internal defibrillators
  • multiple cardiac risk factors (hypertension, hyperlipidemia, diabetes, and smoking)

Cardiac Rehab is divided into three phases.  Each phase is designed to provide you with the appropriate medical support and exercise training based on your own personal cardiac history.

Phase I:

The first phase of cardiac rehab begins in the hospital after a heart attack, heart surgery or other cardiac treatment.  This initial phase includes education about the event and new medications, and guidelines for home activities.  In some cases, it also includes small amounts of telemetry monitored exercise.

Phase II:

This phase begins two to six weeks after your cardiac event.  It includes continuous telemetry monitoring, 30 minutes of aerobic exercise divided into shorter segments on a variety of exercise equipment including treadmills, stationery bikes, rowers, and stair climbers.  All exercises are conducted at a safe and comfortable, yet effective, level for you.  Phase II also includes education on exercising safely and effectively, risk factor modification, dietary guidelines, and smoking cessation, as needed.

Phase III:

Cardiac rehab continues for as long as you like in Phase III.  This is a supervised aerobic and strength-building exercise class.  It provides medical supervision, including blood pressure and rhythm strip checks to monitor your cardiac health; and small group personal training to help you attain your health and fitness goals.  Risk factor education also continues in Phase III. 

What cardiac rehabilitation offers

  • A clinical evaluation for safe and optimal exercise prescription and goal-setting
  • Individualized exercise and activity program within a group setting
  • Monitoring and better control of:
    • Heart rate
    • Blood pressure
    • Blood oxygen levels
    • Cholesterol
    • Diabetes
  • Support and training to help you return to work or normal activities and manage your heart condition and other medical concerns
  • Opportunity to meet and share stories with other people like you

Benefits of cardiac rehabilitation

  • Regular physical exercise helps your heart and body get stronger and work more efficiently. It improves your energy level and lifts your spirits.
  • Regular exercise reduces your chances of future heart problems including heart attack.
  • Improves stamina and strength, which allows you to resume normal activities, including work, hobbies, and regular exercise.
  • Improves communication with your cardiologist, primary, or referring physician about your progress following your cardiac event.
  • Improves confidence and well-being

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Cardioversion

Cardioversion-- This procedure is done to convert an abnormal heartbeat (arrhythmia) to a normal rhythm. The technique is most often done by sending electrical shocks to the heart through electrodes placed on the patient's chest.

Cardioversion can correct a heartbeat that's too fast (tachycardia) or irregular (fibrillation). It is usually used to treat people who have atrial fibrillation or atrial flutter.

Occasionally, cardiologists may perform cardioversion using only medications to restore the heart's rhythm. For most people, cardioversion quickly restores a normal heart rhythm.

About the procedure: Electric cardioversion is usually done on an outpatient basis and the patient will be asleep under sedation. The patient should not eat or drink anything for 12 hours before the procedure. Ask your doctor beforehand whether you should take any of your regular medications before the procedure.

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Catheter Assisted Thrombolysis (EKOS)

Acute pulmonary embolism (PE) is a common and sometimes fatal disease with a highly variable clinical presentation. It is critical that therapy is administered in a timely fashion to prevent recurrent thromboembolism.

If your vascular doctor detects a blood clot such as Deep Vein Thrombosis (DVT) or pulmonary embolism you may be a candidate for catheter-based therapy to treat the problem.

During catheter-assisted thrombolysis treatment, a catheter is guided through blood vessels to the location of the blood clot. The catheter will deliver special clot dissolving medicine called thrombolytics to help dissolve the clot. The device, called EKOS is a cutting-edge technology that uses an ultrasound to deliver very low doses of a clot-dissolving drug directly into the clot through a catheter. The result is rapid clearance of the clot while at the same time significantly reducing the risk of bleeding. As ultrasound waves penetrate the clot, it causes the clot to become very porous so when a clot-dissolving drug is infused, it is rapidly absorbed into the clot. The dissolving process is significantly accelerated, resulting in rapid restoration of blood flow.

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Coronary Angiography

Coronary Angiography is a procedure used to visualize blood vessels of the heart. A catheter is used to inject a dye into the vessels; the vessels can then be seen by x-ray.

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Coronary Atherectomy

Coronary Atherectomy is a procedure where the cardiologist uses a catheter with a cutting device, such as a excimer laser or rotoblator, to shave the plaque accumulation in the artery and open the blockage. Because there is still plaque after this procedure, the doctor inserts a balloon catheter to compress the remaining plaque against the artery wall (angioplasty procedure).There are several variants on the atherectomy procedure due to the type of cutting device that is at the tip of the catheter.

Learn more about coronary atherectomy procedures

 

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Coronary Stenting

Coronary Stenting - About 80 percent of the time, patients who have balloon angioplasty will also have a stent placed in the artery. A stent is a small, mesh-like device made of metal. It is placed inside the artery (again through a small catheter tube) to act as a support and keep the vessel open. This improves the flow of blood to the heart muscle.

About the procedure: The procedure requires inserting a balloon catheter into the radial or femoral artery. When this catheter is positioned at the location of the blockage in the coronary artery, it is slowly inflated to widen that artery, and is then removed. The stent catheter is then threaded into the artery and the stent is placed around a deflated balloon. When this is correctly positioned in the coronary artery, the balloon is inflated, expanding the stent against the walls of the coronary artery. The balloon catheter is removed, leaving the stent in place to hold the coronary artery open. A cardiac angiography will follow to ensure that the stent is keeping the artery open.

The procedure usually takes 90 minutes to a little more than 2 hours and the patient may or may not spend the night in the hospital. Patients will feel sleepy until the sedative wears off.

Coated stents- Recently new types of stents have been introduced to help reduce the possibility of re-stenosis, the development of more blockages in the treated area. Some stents are coated with drugs that can help to keep the vessel from re-closing. The coated stents (also called drug-eluting stents) release their medicine into the tissue around the stent, which can slow down or stop re-stenosis.

Your cardiologist will determine the best type of stent to be used for your particular situation.

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Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention (PCI), also referred to as a coronary angioplasty or balloon angioplasty, is a procedure that opens narrowed or blocked blood vessels of the heart by compressing the fatty build-up against the artery wall.

About the procedure: Once the cardiologists know the location of the blockage, they thread a guide wire through that same artery and advance it across the blockage. This allows them to slip the balloon-tipped catheter over the guide wire and advance it to the blockage. Then they inflate the balloon at the site of the blockage inside the artery. This flattens or compresses the plaque against the artery wall and opens up the artery. Doctors may inflate and deflate the balloon a number of times. At the end of the procedure, they remove the catheter, wire and deflated balloon. The widening of the artery allows for increased blood flow to the regions of the heart served by the vessel.

 

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Peripheral Vascular Intervention Procedures

Peripheral Vascular Intervention Procedures are used to open blocked arteries in areas other than the heart.

Peripheral Procedures

Peripheral vascular disease can cause blocked or narrowed arteries in the neck, arms, legs and abdomen (peripheral arteries). This condition can cause strokes, leg pain, kidney problems and high blood pressure./p>

Peripheral catheterization

Just as the catheterization method is used to see inside the coronary arteries, the process also can be used (along with angiography) to see the vessels in the rest of the body (the peripheral arteries, or those outside of the heart).

Peripheral vascular specialists often use angiography to detect any problems in the vessels of the legs (peripheral angiogram) or kidneys (renal angiography). The angiography procedure for peripheral arteries is performed in a similar way as described above for cardiac catheterization.

Peripheral angiogram

This test is done to help the peripheral vascular specialist find narrowed or blocked areas in one or more of the arteries that supply blood to the legs. It can help to determine if the patient has peripheral artery disease or PAD. The procedure uses a catheter and the injection of dye into the leg artery so that X-ray images can be taken of the artery. The procedure is similar to the cardiac catheterization procedure described above.

Peripheral angiography can help determine if the patient requires an interventional treatment, such as peripheral angioplasty or the placement of a stent in the peripheral artery.

Renal angiography

This test is done to look at the blood vessels that feed the kidney. With this procedure, the specialist inserts a catheter, usually near the groin, to allow a dye to be injected. The dye flows through the catheter into the kidney artery so the specialist can take special X-ray images of the vessel. (The dye helps the arteries to show up better on the X-ray).

The test may show the presence of tumors, narrowing of the artery or aneurysms (widening of the artery), blood clots, fistulas or bleeding in the kidney.

Other peripheral diagnostic tests

Doctors also perform a test called carotid arteriography to look inside the vessels leading to the brain.

Intravascular Ultrasound

is also used to look inside the arteries and determine the blood flow within the vessel.

Peripheral Interventional Procedures

Peripheral angioplasty is a procedure similar to a cardiac angioplasty during which doctors may also use balloon angioplasty or stenting to open narrowed vessels in other (peripheral) parts of the body, such as the legs, arms or the carotid arteries in the neck that lead to the brain. Opening blocked carotid arteries can help prevent a stroke.

A peripheral vascular specialist can also use stents to repair blockages in the peripheral arteries in the legs, or int eh carotid arteries in the neck. To help relieve the pain involved with Peripheral Arterial Disease (PAD), doctors may use balloon angioplasty and stenting in methods that are similar to the interventional heart procedures described above.

Drug Coated Balloons (DCB) are a newer treatment option for peripheral artery disease that allows the artery to be expanded and treated by a balloon, while at the same time releasing a special medicine directly into the arterial wall that prevents a new blockage from forming, but does not leave any permanent material behind.

Arterial Thrombectomy is the process of removing a clot from an artery. Clots can occur suddenly in any of the arteries of the body due to sudden events within the artery, such as plaque rupture. When this occurs in a peripheral artery, such as a leg artery, the extremely will become acutely painful and discolored due to the sudden loss of blood flow. When this happens it is important to seek treatment immediately. The primary goal of treatment is to relieve the blockage, and restore blood flow. One way to do this is to use a special catheter that is placed directly at the site of the clot where it is aspirated and removed from the artery, restoring normal blood flow, and relieving pain.

For these interventional procedures, the patient usually receives a local anesthetic (injected at the site where the catheter is inserted) so he or she will not feel any pain.

Peripheral Atherectomy is a procedure that helps cut through plaque in the blood vessels outside of the heart (peripheral vessels). The plaque is reduced to particles smaller than red blood cells, which leaves the inner surface of the vessel smoother and more open so that blood can flow more freely through the vessel. Occasionally a laser catheter can also be used to treat the artery. This device vaporizes the plaque, and smooths the lining of the vessel, making it more amenable to additional interventions. This treatment options will usually be used together with a balloon to fully treat the blockage.

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Thrombectomy

Deep Vein Thrombosis (DVT) or Venous thromboembolism is a potentially deadly condition in which a person has deep vein thrombosis (DVT), where a blood clot develops in the deep veins, or a pulmonary embolism, which occurs when one or more arteries in the lungs is blocked, usually when part of a clot in the legs breaks off and travels to the lungs. When deep vein thrombosis is diagnosed, it is potentially life-threatening and requires immediate medical attention. Most importantly the medical team wants to stop the clot from getting bigger, keep the clot from breaking off and travelling into the lungs, and doing everything possible to keep another clot from forming.

Treatment for DVT

Specialists will determine the best treatment for you. Treatment may include:

  • Blood thinners to break up existing clots and prevent new ones.
  • Anticoagulants. For example, injectables such as heparin or low-molecular-weight heparin, or tablets such as apixaban, dabigatran and rivaroxaban, edaxaban and warfarin.
  • Equipment such as compression stockings and air compression cuffs and garments for the legs, calves, arms or chest that fill with compressed air and help increase blood flow.
  • Thrombolytic therapy using drugs such as a tissue plasminogen activator, which is a clot-dissolving enzyme.
  • Surgery may be needed when medication doesn't work. It may involve placing a filter in the body’s largest vein to prevent blood clots from traveling to the lungs or a procedure called a thrombectomy which involves removing a large blood clot from the vein or injecting clot-busting medicines.In some cases, a procedure to remove a large blood clot from the vein is performed using a device called an Angiojet is used.

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Transradial Coronary Angioplasty

Coronary Angioplasty, also referred to as a Percutaneous Coronary Intervention (PCI) or balloon angioplasty, is a procedure that opens narrowed or blocked blood vessels of the heart by compressing the fatty build-up against the artery wall.

Transradial Catheterization Coronary Angioplasty - Increasingly, specialists are using the transradial method to view the coronary arteries. This approach involves threading a small catheter through the radial artery of the wrist. Cardiologists at McLaren Bay Region are routinely using the transradial catheterization method because it has several benefits for the patient. Radial artery access allows the patient to regain mobility faster after the procedure and has a lower risk of bleeding than the more traditional method of using an artery in the groin area. Not all patients are candidates for this procedure. The cardiologist will determine if the patient is able to undergo this type of catheterization.

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Vascular Rehabilitation

"Healthy Living from Head-to-Toe"

"If exercise were a pill, it would be the most prescribed medication of all time!" - Covert Bailey

Vascular Rehabilitation is a non-invasive exercise program that improves maximal walking distance in patients with claudication, pain in the legs with activity that subsides with rest.

This supervised exercise program is designed to increase pain-free walking distance in patients with lower extremity peripheral arterial disease (PAD). The program uses a walk/rest interval training program to train the leg muscles to use oxygen more efficiently, therefore allowing patients to walk further without pain. Rehab combines exercise and comprehensive healthy lifestyle education for patients with PAD to enhance their overall cardiovascular health, promote functional independence, & improve quality of life.

Most patients with Claudication do not exercise or walk on their own as prescribed by most physicians. Vascular Rehab consists of a personalized exercise prescription that teaches and motivates a patient to walk at a level that will improve their pain free walking distance.

Program outline:

  • Supervised Exercise Program
  • Hourly exercise sessions 3 times/week
  • Individual exercise orientation & consultation
  • Individualized exercise prescription
  • Comprehensive Education
  • Outcome measurements

Vascular Rehabilitation is dedicated to improving the lives of people with intermittent claudication, one step at a time!

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