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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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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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