Cardiac Education
Are You at Risk?
Factors Affecting Heart Disease Risk
There are many factors-personal, lifestyle, hereditary, and medical-that can affect your risk for developing heart disease. Some
factors, such as smoking, are within your power to control. Others, such as a family history of heart disease, are risks that
you have to live with. But one thing is certain; by working to eliminate those risk factors that are controllable, and
by adopting a healthier lifestyle in general, you can greatly reduce your risk for heart disease.
Personal Risk Factors
Personal risk factors refer to your age, sex, and ethnic background. Women, as a group, have fewer heart attacks than men. Women
under the age 55 are at least risk, while men over the age of 65 are at greatest risk. Your ethnic background can also affect your
heart disease risk, since some ethnic groups have higher rates of medical conditions that can affect heart disease. African
Americans, for instance, have a greater incidence of hypertension, while Native Americans are more prone to diabetes.
Lifestyle Risk Factors
By lifestyle risk factors, we mean those risk factors that are a result of personal lifestyle choices. Smoking is the number one
risk factor for heart disease (as well as for stroke and many forms of cancer). High fat, high cholesterol diets also add to
your heart disease risk. Lack of exercise, inability to manager stress, and excessive use of alcohol (more than one to two
drinks daily) also raise your risk of developing heart disease.
Hereditary Risk Factors
Certain risk factors are hereditary. For instance, if one or more of your relatives died of a heart attack before age 60, you
are at greater risk than if no one in your family suffered a fatal heart attack before that age. If high blood pressure, high
cholesterol levels, or diabetes run in your family, there is a greater possibility that you may suffer from these heart-threatening
conditions.
Medical Risk Factors
Many medical conditions can affect your heart's health. Hypertension (high blood pressure), diabetes (both juvenile diabetes and
adult-onset diabetes), congenital heart disease (heart defects present at birth), rheumatic fever, and heperlipidemia (too much
fat and cholesterol in the bloodstream), are all examples of medical conditions that increase your disease risk.
Reducing Your Risk
Heart disease risk is cumulative. That means that the more risk factors you have, the greater your risk for heart disease. You
can begin to reduce your risk by managing those factors that are within your control. Personal, hereditary, and medical factors
aside, you can reduce your heart disease risk significantly by stopping smoking, eating a low fat, low cholesterol diet,
managing stress, exercising regularly, and following your doctor's advice regarding blood pressure control. Your heart will be
healthier, and so will you!
Angina
What is Angina?
The chest pain or discomfort that your doctor calls angina is caused when your heart cannot get the oxygen it needs.
For example, the chest discomfort you get when you run too fast or too long, makes you get out of breath. It is the same with
angina, except it is your heart that is not getting enough oxygen.
What causes Angina?
Your blood vessels carry blood to all parts of your body. The blood has first passed through the blood vessels in your
lungs and picked up oxygen to carry with it. When the blood vessels that feed your heart get smaller--or constrict--they can't
carry as much blood and oxygen as your body needs.
Is Angina dangerous?
Angina is often a warning sign. If you have angina, your risk for heart disease or a heart attack is higher. Your doctor may
give you medicine. Some medicine helps open up the blood vessels around your heart, or others reduce the work your heart
has to do. This lets more blood and oxygen flow to your heart and lessens the pain of angina attacks.
What can be done to help?
You can do things to help lower your risk if you have angina. Ask your doctor about ways you can help lower your blood pressure
if it is high. This may decrease your pain from angina. If you smoke, you should quit. Smoking has been shown to increase the
chance of high blood pressure and angina. If your angina is not too severe, even a little exercise could help. Ask your
doctor if he can give you exercises that would be right for you. Don't eat foods that are high in fat or cholesterol. Ask
your doctor to tell you what foods you should eat and which you should cut back on.
Coronary Artery Disease
Recognition, Treatment and Prevention
Coronary Artery Disease or CAD, is a disease that affects the blood vessels that nourish the heart muscle. CAD is actually a result
of atherosclerosis-a build-up of fatty substances on the inner walls of the coronary arteries. When the coronary arteries become
clogged or narrowed by these waxy "fats", blood flow is restricted and the heart muscle does not receive adequate oxygen which
can cause heart attack and even death. While the precise causes of CAD are not known, there are many factors that may contribute
to developing this disease. For your heart's health, recognize early "warning signs" of CAD, understand what can be done if you
suffer from the disease, and how you yourself may be able to prevent (or slow) its progress.
Recognize Warning Signs
In many cases, chest pain, (angina) may occur when the heart is not receiving enough oxygen. Angina may be worst during exercise
or stress when there are increased oxygen demands on the heart. Always see your doctor if you experience recurrent chest
pain. Your physician can check your blood pressure, cholesterol levels, and heart function, and advise you about how to
reduce your risk for heart attack. Unfortunately, for many people, the first "sign" of CAD is a heart attack. Everyone
should know about the common signs that may signal a heart attack: pain that spreads from the shoulders, neck or arms; pressure,
uncomfortable "fullness" in the chest; dizziness, nausea, and/or shortness of breath. If you experience any of these
warning signs, call for emergency medical help immediately.
Treatments for CAD
If you have CAD, your doctor may want to try one or more of the following methods of treatment. Medications can reduce blood
pressure, oxygen demand, and relieve excess strain on the heart, but they cannot clear an already blocked artery. Angioplasty
expands narrowed arteries by inflating a catheter-guided balloon in the area of the blockage. Bypass surgery improves
blood flow by grafting blood vessels (from your arm or leg) around the blocked coronary arteries.
Prevention
The single most important thing you can do to prevent heart disease is not to smoke, or if you do, to stop. You can also
follow the American Heart Association's guidelines for a healthy diet: limit dietary cholesterol to no more than 300 mg.
per day; limit your intake of fat of 30% or less of your daily calories; limit added salt and foods that are high in
sodium and eat plenty of complex carbohydrates. (Note: If you already suffer from CAD, high blood pressure, elevated
cholesterol your doctor may recommend limits lower than these general guidelines.) Regular aerobic exercise
(3-5 times a week for 20-30 minutes a session) will also strengthen your heart, improve oxygen supply, and
actually help control cholesterol. It is also important to have your blood pressure checked annually. Although
it is a leading risk factor for heart attack and stroke, high blood pressure can be controlled.
Living with CAD
Since many factors, like heredity, can affect your risk for developing CAD, not everyone will be able to prevent its occurrence.
If you have CAD, you can, however, slow its progress by using the guidelines above and following your physician's advice.
Heart Attack
Heart attacks result from heart disease — blood vessel disease in the heart. Coronary heart disease (C.H.D.), coronary artery
disease (C.A.D.) and ischemicheart disease are more specific names for heart disease.
What causes a heart attack?
The medical term for heart attack is myocardial infarction. A heart attack occurs when the blood supply to part of the
heart muscle itself — the myocardium— is severely reduced or stopped. This occurs when one of the arteries that supply blood to the
heart muscle (coronary arteries) is blocked by an obstruction. The blockage is sometimes from the buildup of plaque (deposits of
fat-like substances) due to atherosclerosis.
A heart attack also can be caused by a blood clot lodged in a coronary artery. Such an event is sometimes called a coronary
thrombosis or coronary occlusion. A myocardial infarction is the damaging or death of an area of the heart muscle resulting from
a reduced blood supply to that area.
If the blood supply is cut off severely or for a long time, muscle cells suffer irreversible injury and die. Disability or death
can result, depending on how much heart muscle is damaged.
Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of
the heart muscle decreases or even stops. What causes a spasm is unclear. But it can occur in normal-appearing blood vessels as
well as vessels partly blocked by atherosclerosis. If a spasm is severe, a heart attack may result.
IF YOU THINK YOU ARE HAVING A HEART ATTACK, CALL YOUR EMERGENCY MEDICAL SYSTEM IMMEDIATELY.
The American Heart Association says the body likely will send one or more of these "classic" warning signals of a heart attack:
- Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
- Pain spreading to the shoulders, neck or arms.
- Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
Less common warning signs of heart attack:
- Atypical chest pain, stomach or abdominal pain.
- Nausea or dizziness.
- Shortness of breath and difficulty breathing.
- Unexplained anxiety, weakness or fatigue.
- Palpitations, cold sweat or paleness.
Not all of these signs occur in every attack. Sometimes they go away and return. If some occur, get help fast. IF YOU NOTICE ONE OR
MORE OF THESE SIGNS IN ANOTHER PERSON, DON'T WAIT. CALL YOUR EMERGENCY MEDICAL SERVICES AND GET TO A HOSPITAL RIGHT AWAY!
How do I know if a heart attack has occurred?
The actual diagnosis of a heart attack must be made by a doctor who has studied the results of several tests. The doctor will:
- Review the patient's complete medical history.
- Give a physical examination.
- Use an electrocardiogram to discover any abnormalities caused by damage to the heart.
- Sometimes use a blood test to detect abnormal levels of certain enzymes in the bloodstream.
Mitral Valve Prolapse
Mitral valve prolapse is very common. Studies have shown that it occurs in 4 to 8 percent of the population.
The heart is a pump with four chambers. Two are filling chambers (atria) and two are pumping chambers (ventricles).
Blood that is circulated throughout your body enters your heart in the right atrium, then passes through your tricuspid valve
into your right ventricle. From there the blood is pumped through the pulmonary valve into your lungs, where it releases carbon
dioxide and picks up oxygen.
After that the oxygen-replenished blood returns to the heart, fills the left atrium, then flows through the mitral valve
to the left ventricle. Then it's pumped through the aortic valve into the aorta and on to the rest of the body.
How Does the Mitral Valve Work?
The mitral valve has two flaps or leaflets. They are shaped somewhat like a parachute and are attached to the supporting muscles
by strings. These strings help the flaps close evenly.
By opening and closing, the mitral valve ensures that the blood flows in just one direction-from the left atrium to the left
ventricle. When the mitral valve closes, it blocks blood from returning to the left atrium when the ventricle pumps. That ensures
that the blood goes through the aortic valve, into the aorta and on to the rest of the body.
What Is Mitral Valve Prolapse?
In mitral valve prolapse, one or both mitral valve leaflets are enlarged or their supporting strings are too long. As a result,
when the heart pumps, the mitral valve flaps don't close evenly. Instead, part of one or both flaps goes farther backward than normal
into the left atrium. This sometimes allows a small amount of blood to leak backward through the valve.
Is MVP Serious?
In general, the answer is no. It's extremely rare for mitral valve prolapse to be a serious or life-threatening problem. If any
problems, they are usually minor. As with most other heart valve abnormalities, antibiotics may be recommended before certain dental
and surgical procedures. These will prevent your valve from becoming infected with bacteria. Ask your doctor if you will need to
take antibiotics.
Some people with MVP may have abnormal heart rhythms. Usually no treatment is needed for this, although in some cases medication is
required. These rhythms are usually felt as heart palpitation or "skipped beats".
A very few people with MVP may tire easily, have chest pain or shortness of breath. These symptoms rarely require medication. If
you have these symptoms, it does not necessarily mean you have MVP or any form of heart disease. The vast majority of people with
MVP have few or no symptoms.
What Causes Mitral Valve Prolapse?
The exact cause of mitral valve prolapse is usually unknown. In most cases, no other heart disease is present.
A few other conditions are occasionally associated with MVP. These include atrial septal defect, coronary artery disease, disease of
the heart muscle, and disorders causing inflammation of the heart. Most often if these other diseases are present, they would
have been present with or without mitral valve prolapse.
In some cases mitral valve prolapse may be inherited.
How is MVP Diagnosed?
If you have mitral valve prolapse, your doctor will probably find evidence of it by listening to your heart with a stethoscope. Your
doctor will decide whether medications or special tests are needed. One test that may be done is an echocardiogram.
It is important to know if you have MVP, because taking medication you can usually prevent or control occasional problems that
might otherwise arise.
It is also important that MVP is not misrepresented as a more serious problem. Occasionally a person having an echocardiogram for
other reasons will be noted to have a valve that seems slightly prolapsed. Whether this is a true abnormality or just a variation
of normal remains controversial. No treatment is needed.
How is MVP Treated?
The majority of people with mitral valve prolapse have no symptoms, will have no problems and thus need no treatment. Those who have
leaky or regurgitant prolapsing valves are another story. They will need antibiotics to prevent their valve from becoming infected
during certain surgical or dental procedures that are likely to cause bleeding.
Typically this involves one dose of an antibiotic an hour before the procedure. In addition, medicine may be used in a small number of
MVP patients who have chest pain or abnormal heart rhythms.
Only in very rare cases is mitral valve prolapse serious or life-threatening. Most people with MVP enjoy active lives without any
restrictions. It is still a good idea to consult your physician about the activity level that is safest for you. Your doctor should
monitor your MVP, but it should not keep you from having a full and active life.
Cholesterol Management
Too much cholesterol in the blood can lead to heart disease-America's number one killer. Even though there's much you can do to lower
your cholesterol levels and protect yourself, half of all Americans still have levels that are too high (over 200 mg/dl).
You can reduce cholesterol in your blood by eating healthful foods, losing weight if you need to and exercising. Some people also
need to take medicine because changing their diet isn't enough. Your doctor and nurses will help you set up a plan for reducing your
cholesterol and keeping your heart healthy.
To control the amount and kind of fat, saturated fatty acids, and dietary cholesterol you eat:
- Eat up to 6 ounces (cooked) per day of lean meat, fish and skinless poultry.
- Try main dishes featuring pasta, rice, beans and/or vegetables. Or create "low-meat" dishes by mixing these foods with small amounts of lean meat, poultry or fish.
- The approximately 5 to 8 teaspoon servings of fats and oils per day may be used for cooking and baking, and in salad dressings and spreads.
- Use cooking methods that require little or no fat — boil, broil, bake, roast, poach, steam, sauté, stir-fry or microwave.
- Trim off the fat you can see before cooking meat and poultry. Drain off all fat after browning. Chill soups and stews after cooking so you can remove the hardened fat from the top.
- The 3 to 4 egg yolks per week included in your eating plan may be used alone or in cooking and baking (including store-bought products).
- Limit your use of organ meats such as liver, brains, chitterlings, kidney, heart, gizzard, sweetbreads and pork maws.
- Choose skim or 1% fat milk and nonfat or low-fat yogurt and cheeses.
To round out the rest of your eating plan:
- Eat 5 or more servings of fruits or vegetables per day.
- Eat 6 or more servings of breads, cereals or grains per day.
EKG
EKG, or electrocardiogram, is a test that measures your heart's electrical activity and thus helps your doctor determine your heart's health.
An EKG can assess heart damage and disease, and is almost routine in persons over 40.
How it works
The EKG is a test that records electrical signals from your heart onto a paper strip. The pattern of these signals can tell the physician whether your
heart is normal, under stress, or experiencing electrical problems, strain or damage.
Stress EKG
The stress EKG or stress test, conducted while you exercise on a treadmill or a stationary bicycle, measures your heart's health under the stress of physicial
activity. Your blood pressure and pulse are also monitored by a specially trained technician, an expert in using stress test equipment. The stress EKG aids in
determining in how fit you are and how safe an exercise program is for you, or if a heart problem exists. The stress EKG provides even more specific information
about how your heart and coronary artereries are functioning.
How it works
The stress EKG for your heart is like test driving a car before you buy it. You have to take it out on the road to see how it really performs. The stress
EKG does not always give 100% accurate information, but the doctor can usually determine the presence or absence of a heart problem. The stress EKG often detects
heart disorders missed by an EKG taken while you lie at rest. Blood pressure, when measured during exercise, helps determine your blood pressure pattern and how
well your heart is working.
Echocardiography
Echocardiogram (Echo) produces images of the heart by using sound waves. These images can help identify abnormalities of heart muscles or valves and fluid around the heart.
How it works
During an echo, harmless sound waves are bounced off your heart, then beamed back and converted to images on a screen. These images are used to see the structure
and movement of the heart's valves and chambers. A Doppler echo may be used in the same way, bouncing sound waves off heart chambers and blood vessels to view blood flow patterns and valves.
Stress Echocardiography
Stress echocardiography, or stress echo, is an exercise test that helps your doctor see how well your heart pumps when made to beat harder. Harmless sound waves bounce
off your heart. The sound waves show the structure and movement of your heart before and immediately after exercise. By comparing the images taken before and after exercise, your
doctor can see any changes in the way your heart muscle works when under the strain of exercise. This tells your physician whether your heart is getting enough blood to meet
its increased demand for oxygen.
How it works
During a stress echo, a transducer (a small device that produces sound waves) is placed on your chest before and immediately after you exercise. The sound waves bounce off your heart
and are changed into images on a video screen. The doctor compares the two images to detect any changes in the way your heart responds when you exert yourself.
Myocardial Perfusion Imaging (Nuclear Stress Test)
What is a Myocardial Perfusion Imaging Stress Test?
Myocardial Perfusion Imaging stress test is usually done at the Roswell office of Cardiovascular Physicians of North Atlanta or in Nuclear Medicine Departments at
area hospitals. The test involves an injection of a small amount of radioactive material which circulates in the bloodstream and shows if your heart muscle is receiving
adequate blood supply under stress and/or rest conditions. The radioactive injection is a clear liquid called Myoview (Tc99m Tetrofosmin for injection). Another material which
could also be used is called Thallium.
How safe is a Myocardial Perfusion Stress Test?
Any stress procedure may have some risks and you should consult your physician regarding the risks and benefits of this procedure. The radioactive materials, Myoview and
Thallium, have been shown to be safe with low incidence of adverse reactions. This test and materials are used routinely worldwide, under physician supervision, for myocardial
perfusion imaging. Neither Myoview nor Thallium are "dyes", and there should be no serious side effects from their injection.
Why would my doctor order a Myocardial Perfusion Imaging Stress Test instead of a regular stress test?
Under certain circumstances, a regular stress test may yield indeterminate results. To improve the diagnositc accuracy, your physician may request a myocardial perfusion stress test.
How is the test performed?
The test usually consists of two parts, after exercising and under resting conditions. There are many variations for performing the test, which depend on the department's routine
procedure. The entire test may completed in one day or in two separate days. You will be informed if the exercise or rest portion will be done first. Myoview will be administered by
injection during peak exercise and once again while you are at rest.
As in a regular stress test, ECG electrodes will be attached to your chest. This will allow the physician to monitor your heart rate before, during and after you have exercised. A
blood pressure cuff will be placed on your arm to monitor your blood pressure before, during and after you have exercise. Additionally, an IV line will be placed in your hand or arm
vein to allow for ease of the Myoview injection. The IV will be removed when the exam is completed.
The exercise part of the exam is usually done with a treadmill, very similar to one used at a healthclub. Exercising will begin slowly, and approximately every three minutes, the pace
will gradually increase. As you exercise, your heart rate and blood pressure will change. This is normal and remember, you are being closely monitored throughout the exam. At your peak
exercise, Myoview will be injected into the IV and you be asked to continue exercising for an additional one or two minutes.
Approximately fifteen minutes after the exercise is complete, pictures will be taken of your heart using a special camera able to trace either Myoview or Thallium that has localized
in your heart. You will be asked to lie down on a special table. The camera will rotate above and around your chest while special pictures are being taken, which will take approximately
20 to 30 minutes to complete. You may breathe normally while the pictures are being taken. It is very importan that you hold very still while the camera takes pictures of your heart. You
will not receive any radiation from the camera.
After 30 minutes or so, a second injection of Myoview will be given. The resting pictures are taken in the same manner as the exercise pictures. Remember, the order in which pictures are
taken depends on the department's routine imaging procedure. The total time needed for the test may take from two to five hours.
What happens if you are unable to exercise?
Some people, due to a variety of disabilities, are unable to exercise adequately enough on a treadmill machine to acheive a diagnositic test result. In these cases, the physician may decide
to use a drug to mimic the effect of exercise on the heart (pharmacologic stress).
Drugs that mimic exercise on a treadmill are commonly used for this purpose. If you notice any changes in the way you feel or experience any side effects, notify the individual who is
closely monitoring the test.
Are there any special preparations for the study?
Clothing
You should wear comfortable, loose-fitting clothing for exercise and comfortable shoes appropriate for walking.
Food
The physician will instruct you not to eat or drink anything 4 hours prior to the scheduled test time. Also, you should not have caffeine 12 hours prior to the study. If you are diabetic
or insulin-dependent, consult with the physician on such dietary restrictions and insulin use.
Medications
Consult with the physician regarding whether certain medications should be taken before, or held until after the test. Certain medications may interfere with the effectiveness of the
study. If you have high blood pressure, it is important to take your blood pressure medication.
Important Points to Remember
- There may be two parts of the exam. Return for the second part.
- You may receive an injection for both parts of the exam.
- The radioactive material is ordered especially for you. If you are unable to keep your appointment for any reason, notify the office before the exam.
- A written report of the test will be sent to your physician once it is interpreted.
- If you are pregnant or suspect you may be, notify your doctor before taking the test.
Transesophageal Echocardiography (TEE)
Transesophageal echocardiography (TEE) is a test that allows your doctor to record images of your heart from inside your esophagus, or food pipe. Since the esophagus lies just
behind the heart, TEE may produce clearer pictures of the heart's movement than would standard echocardiography taken from outside the chest. During TEE, harmless sound waves
bounce (echo) off your heart. These sound waves create images of your heart as it pumps blood through the valves and chambers. These images help your doctor identify and treat
problems such as infection, disease, or defects in your heart's walls or valves.
How TEE Works
A flexible tube about the size of your index finger is inserted into your mouth and down your esophagus. At the tip of the tube is a small probe that produces sound waves. The
sound waves bounce off your heart and are changed into pictures on a video screen. The doctor can move the probe up, down, and sideways to look at different parts of your heart
from different angles. Your throat is numbed, so you should feel little or no discomfort during the procedure.
Before The TEE
Do not eat or drink 4-6 hours before your exam. Take any prescribed medications with a sip of water only.
Arrange to have someone pick you up after the exam. Do not plan to drive yourself home, as you may be drowsy.
During The TEE
Your throat is sprayed with an anesthetic to numb it. You may be given a mild sedative through an IV line in your arm to help you relax. You may also be given oxygen. Then
you will be asked to lie on your left side.
The doctor gently inserts the probe into your mouth. As you swallow, the tube is slowly guided into your esophagus. The tube is lubricated to make it slide easily.
You may feel the doctor moving the probe, but it shouldn't be painful or interfere with your breathing. A nurse will monitor your heart rate, blood pressure, and
breathing during the test, which usually takes approximately 20-40 minutes.
Catheterization
What is Cardiac Catheterization?
Cardiac catheterization is a common, relatively painless, nonsurgical procedure that can help your physician diagnose a heart problem. In some cases, catherization can be used to
treat heart disease, as well. To perform the the procedure, the cardiologist inserts a long, flexible tube called a catheter into a blood vessel and gently guides it toward your
heart. Once the catheter is in place, x-rays and other tests are done to help your doctor evaluate how well your heart is working.
Why is Cardiac Catherization Done?
You may have had shortness of breath, angina, dizziness, palpitations, or other symptoms of heart trouble. Or, your doctor may have found signs of heart problems during a
physicial exam. You've probably been through a number of tests already, such as a treadmill test, an echocardiogram, and perhaps a nuclear scan. The next step may be cardiac
catheterization, which can help your doctor identify a heart problem more precisely. Cardiac catherization can show:
- If the blood vessels in your heart are clogged.
- If your heart is pumping normally and blood is flowing correctly.
- If you were born with any heart problems.
Understanding the Risks
The risks of catherization are farily low. They are usually outweighed by the benefit of knowing the exact condition of your heart. Your doctor will discuss any risks and side
effects with you.
Possible risks include:
- Bleeding or clotting
- Perforation of the heart muscle or blood vessel
- Arrhythmia (abnormal heartbeat)
- Allergic reaction to the x-ray-sensitive liquid
- Heart attack or stroke
Before the Procedure
The night before the catherization, you may be asked not to eat or drink anything after midnight. You will probably be admitted to the hospital on the day of the procedure. Before
cateterization begins, you may be given medication to help you relax. The skin where the catheter will be inserted may be shaved. Then you'll be taken to the catherization laboratory.
During the Procedure
Cardiac catheterization usually takes an hour or less. The area where the catheter is inserted is numbed with a local anesthetic. You remain awake during the procedure, because
your cooperation is needed from time to time. A local anesthetic is given by injection so you won't feel pain at the insertion site. The most common insertion site is a blood vessel
in your groin or arm. The injection feels like a bee sting and is probably the most uncomfortable part of the procedure. An introducing sheath is inserted into a blood vessel. You
may feel a little pressure when it is inserted, but this sensation should pass quickly. The diagnositc catheter is inserted throught the introducing sheath. While watching the
catheter's progresson an x-ray video monitor, your doctor gently guides it toward the heart. You should feel no pain as the catheter moves through your body and into your heart.
To conduct different tests in your heart and coronary arteries, your doctor inserts new catheters or changes the position of the catheter or x-ray equipment. During angiography and
ventriculography, x-ray contrast fluid is injected into your blood vessels or heart chamber. You may be asked to hold your breath, and you may feel a hot flush all over your body for
about 10 seconds. Your doctor will probably ask you to cough to help move the liquid through your heart. After the tests are finished, the doctor removes the catheter and introducing sheath.
After the Procedure
After the catheterization, you will need to remain lying down for 4 to 6 hours. If the catheter was inserted in your groin, you will be asked not to move your leg to prevent bleeding.
Most people have no pain after the procedure. Many patients go home from the hospital the same day, while others may stay overnight.
Angioplasty
What is Angioplasty?
Your doctor will talk to you about your heart problem and explain how angioplasty can help. Angioplasty relieves symptoms of coronary artery disease by improving blood flow to your
heart. During angioplasty, a catheter (a thin, flexible tube) with a balloon at the tip is inserted into your artery to widen the passageway. Then the catheter is removed.
Understanding Your Risks
The risks of angioplasty are fairly low and are usually outweighed by the benefits to your heart. Your doctor will explain the risks to you, then ask you to sign a consent form giving
permission to perform the procedure.
The risks of angioplasty include:
- Tearing or cracking of the artery lining, resulting in closure of the treated artery.
- Heart attack, stroke or death
- Rarely, a complication occurs that makes emergency bypass surgery necessary. Just in case, a cardiac surgery team stands by during the angioplasty.
Before the Procedure
The night before the angioplasty, you may be asked not to eat or drink anything after midnight. After you're admitted to the hospital, you may given routine blood tests, and EKG
(electrocardiogram), and a chest x-ray. A nurse prepares the patch of skin where the catheter is inserted. An IV line is inserted into your vein to give you fluids. You will also be
given medication to help you relax.
During the Procedure
The angioplasty procedure usually takes one to two hours. You are awake during the procedure. Several steps are necessary before the actual angioplasty is performed. First, the doctor
numbs the skin where the catheter will be inserted. An introducing sheath is inserted into the artery in your groin, or an incision is made in your arm. Then, the doctor inserts the guiding
catheter through the sheath or incision and moves it throught the blocked artery. X-ray constrast fluid is injected through the catheter to allow your doctor to see your artery on an
angiogram. The doctor may ask you to take a deep breath and hold it during the angiogram.
A guide wire is inserted through the guiding catheter and moved to the narrow spot in your arter. Your doctor tracks its movement on angiogram. A balloon-tipped catheter is inserted through
the guiding catheter and threaded over the guide wire. It is positioned at the narrow part of the artery. The balloon is then inflated and deflated several times to compress the plaque against
the artery wall. You may feel angina when the balloon is inflated. The balloon is deflated and the catheters and guide wire are removed. The artery is now open and blood flow to the heart
muscles increases.
After the Procedure
After angioplasty, you'll return to the cardiac care unit or a special recovery room. If there are no complications, you'll probably go home one to two days after the procedure. The
introducing sheath is left in place for several hours or overnight to prevent bleeding and to allow your doctor to check the treated artery. Your doctor gives you instructions on
medication and follow-up care. He may also schedule follow-up visits.