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Cardiac Treatments and Procedures

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-- 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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Carotid Artery Stenting (CAS)

Every year, more than 300,000 people in the United States are diagnosed with blockages, or plaques, in their carotid artery. If left untreated, these blockages can slow or even stop blood flow to the brain, causing a potentially disabling stroke, also known as a "brain attack."

Carotid Artery Stenting (CAS) - Carotid angioplasty begins with a needle puncture into the femoral artery in the groin. A thin tube called a catheter is gently pushed into the artery and maneuvered up through the aorta into the narrowing in the carotid artery. An umbrella-shaped filter is placed beyond the narrowing to catch any dislodged plaque or debris. Once everything is in place, a balloon on the catheter is inflated, mashing the plaque into the artery wall and expanding a stent. The balloon is deflated; the catheter and filter are removed, leaving the stent in place to hold the artery open.

Cardiac Clinical Trials - Some hospitals are participating in cardiac clinical trials of new procedures that also help unblock the carotid artery.

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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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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. 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.

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.

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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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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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