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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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Cardiovascular Rehabilitation

When cardiovascular health is compromised or if the patient has experienced a serious incident, a structured rehabilitative program is in order. Individualized rehabilitation strategies are developed through consultation with physicians, exercise specialists, and nurses maximize the health benefits and progress of each patient. 

A significant part of cardiovascular rehabilitation is conducted in classes, three days per week, for varying periods of time depending on the patient's specific condition. Instructor-led and video classes, support and social groups, and individual and group exercise routines speed recovery.

Diagnosis Types:

  • Heart attack
  • Heart failure
  • Angina (chest pain)
  • Angioplasty (with or without a stent)
  • Abnormal heart rhythms
  • Peripheral artery disease
  • Cardiovascular risk factors: smoking, obesity, elevated cholesterol, and a sedentary lifestyle

Therapy Strategies:

  • Goal setting
  • Counseling
  • EKG-monitored exercise
  • Monitored heart rate and blood pressure
  • Individualized exercise prescription
  • Assessments and screenings

The goal of the Cardiovascular 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.

Cardiovascular 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 Cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, and smoking)

Cardiovascular Rehabilitation 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 Cardiovascular history.

Phase I:

The first phase of Cardiovascular Rehabilitation begins in the hospital after a heart attack, heart surgery or other Cardiovascular 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:

Cardiovascular Rehabilitation 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 Cardiovascular health; and small group personal training to help you attain your health and fitness goals.  Risk factor education also continues in Phase III. 

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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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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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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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Structural Heart Disease Clinic

With a team of dedicated physicians, nurses, and support staff, the Structural Heart Disease Clinic provides patients with the optimal treatment option for heart disease and vascular conditions.Using highly innovative technologies, with the least invasive approaches, our team is a leader is treating heart disease.

Through the Structural Heart Disease Clinic, the patient is seen and evaluated by both an interventional cardiologist and a surgeon. The appropriate diagnostic testing is typically performed on the same day to determine the best treatment plan.

Patient Experience - our team is dedicated to your health and the experience you have.

Our team is dedicated to our patient's health, and that starts with the experience they have from start to finish. Rest assured that when you come to the structural heart disease clinic, that our team will make sure you understand every test, visit you receive and how it will benefit the final treatment that your specialist recommends.

Conditions Treated:

Aortic Stenosis occurs when the heart's aortic valve narrows. This obstructs blood flow into the aorta, and into the rest of the body, causing the heart to work harder. Eventually the heart muscle weakens and symptoms develop. Left untreated aortic stenosis can lead to serious heart problems.

    Symptoms: Chest discomfort (pain may get worse with activity), cough (possibly bloody), breathing problems when exercising, becoming easily tired, feeling the heart beat, fainting, weakness, or dizziness with activity.
    Treatment Option - See TAVR
    Tests You will need: See Cardiac Catheterization, CT Scan, Echocardiogram (TTE and TEE), Carotid Ultrasound, Laboratory tests, Physical Exam, Frailty Testing, Pulmonary Functional Testing, Arterial Blood Gases, Breathing Test.

Mitral Valve Regurgitation diagram of heart occurs when the heart's mitral valve does not close tightly, allowing blood to flow backward in the heart, and then preventing it from moving efficiently through the heart and the rest of the body. If left untreated, this condition can lead to congestive heart failure, irregular heartbeat, and endocarditis (infection of inner lining of the heart).

    Symptoms: often times there are no symptoms and they gradually occur. They may include cough, fatigue, exhaustion, rapid breathing, sensation of feeling the heart beat, shortness of breath that increases with activity and when lying down, urination.
    Treatment Option - see Mitral Valve Repair Procedures
    Tests you will need: Aww Cardiac Catheterization, Echocardiogram, Carotid Ultrasound, Laboratory Tests, Physical Exam, Frailty Testing, Pulmonary Functional Testing.

     

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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 Oakland 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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