Cardiac catheterization

Coronary angioplasty (PTCA)

Coronary artery stenting

Coronary artery bypass grafting

Permanent pacemaker

Implantable cardioverter-defibrillator (ICD)

Heart valve replacement or repair

Heart transplant

 

Cardiac catheterization

During cardiac catheterization a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, doctors can perform diagnostic tests and treatments on your heart. 

 

For who?

Doctors may recommend this procedure for a number of different reasons. The most common reason is to evaluate chest pain. Chest pain can be a symptom of coronary artery disease (CAD), and cardiac catheterization can show whether plaque is narrowing or blocking your heart’s arteries.

 

You also may have cardiac catheterization to help your doctor figure out the best treatment for your CAD if you:

 

• Recently recovered from a heart attack, but are having chest pain
• Had a heart attack that caused major damage to your heart
• Had an EKG (electrocardiogram), stress test, or other test with results that suggested heart disease

 

You also may need cardiac catheterization if your doctor suspects you have a heart defect or if you’re about to have heart surgery. The procedure shows the overall shape of your heart and the four large spaces (heart chambers) inside it. This inside view of the heart will show certain heart defects and help your doctor plan your heart surgery.

 

Sometimes your doctor may do a cardiac catheterization to see how well the valves at the openings and exits of the heart chambers are working.

 

Other important notes

 

• It may not be safe to drive right after the procedure. If your doctor says you can go home the same day, you should arrange for a ride home from the hospital.
• During cardiac catheterization, you’re kept on your back and awake. That way you can follow your doctor’s instructions during the procedure. You’re given medicine to help you relax.
• After the procedure, you will be moved to a special care area, where you will rest for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the catheter was inserted.
• A small bruise may develop at the site where the catheter was inserted. That area may feel sore or tender for about a week. You need to let your doctor know if you have a lot of bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the procedure.
• Cardiac catheterization is a common medical procedure that rarely causes serious complications. The risk of complications is higher in people with diabetes and kidney disease, and in older people and women.

 

Coronary angioplasty (PTCA)

Coronary angioplasty is a medical procedure in which a balloon is used to open a blockage in a coronary artery narrowed by atherosclerosis. This procedure improves blood flow to the heart. Angioplasty is a common medical procedure. It may be used to:

 

• Improve symptoms of CAD, such as angina and shortness of breath.
• Reduce damage to the heart muscle from a heart attack. A heart attack occurs when blood flow through a coronary artery is completely blocked. Angioplasty is used during a heart attack to open the blockage and restore blood flow through the artery.
• Reduce the risk of death in some patients.

 

Other important notes

Although angioplasty is normally safe, there is a small risk of serious complications, such as:

 

• Bleeding from the blood vessel where the catheter was placed.
• Damage to blood vessels from the catheter.
• An allergic reaction to the dye given during the angioplasty.
• An arrhythmia (irregular heartbeat).
• The need for emergency coronary artery bypass grafting during the procedure (2–4 percent of people). This may occur when an artery closes down, instead of opening up.
• Damage to the kidneys caused by the dye used.
• Heart attack (3–5 percent of people).
• Stroke (less than 1 percent of people).

 

As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than 2 percent of people die during angioplasty.

 

Sometimes chest pain can occur during angioplasty because the balloon briefly blocks off the blood supply to the heart.

The risk of complications is higher in:

 

• People aged 75 and older
• People who have kidney disease or diabetes
• Women
• People who have poor pumping function in their hearts
• People who have extensive heart disease and blockages

 

Research on angioplasty is ongoing to make it safer and more effective, to prevent treated arteries from closing again, and to make the procedure an option for more people.

 

Stenting

A stent is a small mesh tube that’s used to treat narrowed or weakened arteries in the body.  You may have a stent placed in an artery as part of an angioplasty procedure. Angioplasty can restore blood flow through narrowed or blocked arteries, while stents help prevent arteries from becoming narrowed or blocked again in the months or years after treatment with angioplasty. You may also have a stent placed in a weakened artery to improve blood flow and to help prevent the artery from bursting.

 

To place a stent, your doctor makes a small opening in a blood vessel in your groin (upper thigh), arm, or neck. Through this opening, a flexible, plastic tube (catheter) with a collapsed balloon and stent on the end is threaded up to the area of the artery that needs treatment. The balloon is then expanded, which widens the narrowed artery and pushes the stent into place.

The placement of a stent only takes a few hours.

 

Angioplasty and stents are often used to relieve chest pain and minimize damage to the heart due to narrowed or blocked heart arteries. They also are used in other arteries in the body to prevent loss of blood flow to the limbs, and to prevent weakened arteries from bursting.

 

Other important notes

 

• Stents are usually made of metal mesh, but sometimes they’re made of fabric. Fabric stents, also called stent grafts, are used in larger arteries.
• You may have to stay in the hospital for up to 3 days, depending on which artery was treated. You may feel some pain when the balloon is expanded to push a stent into place.
• To prevent blood clots, you will probably take blood-thinning medicines for at least a few months after having a stent placed. Developing a blood clot at the stent site is the main risk of having a stent. Blood clots can cause heart attack, stroke, and other serious problems. This risk is greatest during the first few months after the stent is placed in the artery. Taking blood-thinning or anticlotting medicines can decrease the risk for a blood clot. There also are risks related to angioplasty and to the placement of the stent.
• Patients with drug-releasing stents are usually advised to take aspirin and an anticlotting drug, such as clopidogrel, for months to years to lower the risk of blood clots.
• Vigorous exercise and heavy lifting should be avoided for a short time after a stent procedure. Your doctor will discuss with you when you can resume normal activities.

 

Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting (CABG) is a type of surgery called revascularization , used to improve blood flow to the heart in people with severe coronary artery disease (CAD), when the arteries that supply blood to the heart muscle become blocked due to the buildup of plaque on the inside of the blood vessels. If the blockage is severe, chest pain (also called angina), shortness of breath, and, in some cases, heart attack can occur.

 

CABG is one treatment for CAD. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked portion of the coronary artery. This new passage routes oxygen-rich blood around the blockage to the heart muscle. As many as four major blocked coronary arteries can be bypassed during one surgery.

 

For who?

Coronary artery bypass grafting (CABG) is only used to treat people who have severe coronary artery disease (CAD) that could lead to a heart attack. Your doctor may recommend CABG if other treatments, such as lifestyle changes or medicines, haven't worked. He or she also may recommend CABG if you have severe blockages in the large coronary arteries that supply a major part of the heart muscle with blood-especially if your heart's pumping action has already been weakened. CABG also may be a treatment option if you have blockages in the heart that can't be treated with angioplasty.

 

Your doctor will determine if you're a candidate for CABG based on a number of factors. These include the presence and severity of CAD symptoms, the severity and location of blockages in your coronary arteries, your response to other treatments, your quality of life, and any other medical problems you may have.

 

Other important notes

 

• Although the surgery is usually done on an elective (scheduled) basis, it may need to be performed in an emergency, such as pending or during a heart attack.
• Although complications are rare, risks of CABG include infection at the incision site, bleeding, reactions to the anesthesia, fever and pain, stroke, heart attack, or even death.
• Recovery may take 6 to 12 weeks or more. Most people can get back to their normal activities about 6 weeks after the surgery.
• Care after surgery may include followup visits with doctors, lifestyle changes to prevent further progression of CAD, and taking medicines as prescribed.

 

Permanent pacemaker

A pacemaker is a small device that's placed under the skin of your chest or abdomen to help control abnormal heart rhythms.

A pacemaker uses low-energy electrical pulses to correct faulty electrical signaling in the heart causes arrhythmias. Pacemakers can:

 

• Speed up a slow heartbeat
• Help end an abnormal and fast rhythm (only in implantable cardioverter defibrillator/pacemaker combination devices)
• Make sure the ventricles contract normally if the atria are in a state of atrial fibrillation
• Coordinate the electrical signaling between the upper and lower chambers of the heart
• Coordinate the electrical signaling between the ventricles (cardiac resynchronization therapy used in heart failure)
• Monitor and record your heart's electrical activity and the rhythm of your heartbeat. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors and adjust your heart rate to changes in your activity.

 

A pacemaker consists of a battery, a computerized generator, and wires with electrodes on one end. The battery powers the generator, and a thin metal box surrounds both it and the generator. The wires connect the generator to the heart.

The pacemaker's generator sends the electrical pulses that correct or set your heart rhythm. A computer chip figures out what types of electrical pulses to send to the heart and when those pulses are needed. To do this, the computer chip uses the information it receives from the wires connected to the heart. It also may use information from sensors in the wires that detect your movement, blood temperature, breathing, or other factors that indicate your level of physical activity. That way, it can make your heart beat faster when you exercise.

The computer chip also records your heart's electrical activity and heart rhythms. Your doctor will use these recordings to set your pacemaker so it works better at making sure you have a normal heart rhythm. Your doctor can program the computer in the pacemaker without having to use needles or directly contacting the pacemaker.

 

For who?

A pacemaker may be helpful if:

 

• Aging or heart disease damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can make your heart beat too slow, or it can cause long pauses between heartbeats. The damage also can cause your heart rhythm to alternate between slow and fast.
• You need to take certain heart medicines (such as beta blockers), but these medicines slow down your heartbeat too much.
• The electrical signals between your heart's upper and lower chambers are partially or completely blocked or slowed down (this is called heart block). Aging, damage to the heart from a heart attack, or other heart conditions can prevent electrical signals from reaching all the heart's chambers.
• You often faint due to a slow heartbeat.
• You need help regulating your heartbeat after having a medical procedure to treat atrial fibrillation.
• You have heart muscle problems that cause electrical signals to travel through your heart muscle too slow. (Your pacemaker will provide cardiac resynchronization therapy for this problem.)

 

To decide whether a pacemaker will benefit you, your doctor will consider any symptoms you have of an irregular heartbeat, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests. A pacemaker won't be recommended unless your heart tests show that you have irregular heartbeats.

 

Other important notes

 

• Pacemaker surgery is usually done in a hospital or special heart treatment laboratory. You will be given medicine to help you relax. The surgery takes just a few hours, but you will stay in the hospital overnight so your doctor can monitor your heart rhythm and make sure your pacemaker is working properly.
• Problems from pacemaker surgery are rare. Most people can return to normal activities within a few days.
• Your doctor may ask you to avoid any vigorous exercise or heavy lifting for a short period after your surgery. After you have fully recovered from surgery, discuss with your doctor how much and what kinds of physical activity are safe for you.
• Once you have a pacemaker, you have to avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. You also need to avoid certain medical procedures that can disrupt your pacemaker.
• Let all of your doctors, dentists, and medical technicians know that you have a pacemaker.
• Have your pacemaker checked regularly. Some pacemaker functions can be checked remotely through a telephone call or a computer connection to the Internet. Your doctor may ask you to come to his or her office to check your pacemaker.
• Pacemaker batteries have to be replaced every 5 to 15 years, depending on how active your pacemaker is. The wires of your pacemaker also may need to be replaced eventually. Your doctor can tell you whether you need to replace your pacemaker or its wires.

 

Implantable cardioverter-defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a small device that's placed in your chest or abdomen. This device uses electrical pulses or shocks to help control life-threatening, irregular heartbeats (ventricular arrhythmias) especially those that could lead the heart to suddenly stop beating (sudden cardiac arrest). If the heart stops beating, blood stops flowing to the brain and other vital organs. This usually causes death if it's not treated in minutes.

 

When these ventricular arrhythmias occur, the heart can't effectively pump blood, and a person will pass out within seconds and die within minutes if not treated. To prevent death, the condition must be treated right away with an electric shock to the heart. This treatment is called defibrillation.

 

An ICD has wires with electrodes on the ends that connect to the chambers of your heart. The ICD will continually monitor your heart rhythm. When the device detects that you're having an irregular rhythm in your ventricles, the ICD will use low-energy electrical pulses to restore a normal rhythm. If this doesn't restore your normal heart rhythm, or if your ventricles start to quiver rather than contract strongly, the ICD will switch to high-energy electrical pulses for defibrillation.

 

For who?

You may need an implantable cardioverter defibrillator (ICD) if you're at risk for certain life-threatening ventricular arrhythmias, such as ventricles that beat too fast or that quiver. For example, you may be considered at high risk for a ventricular arrhythmia if you:

 

• Have had a ventricular arrhythmia before
• Have had a heart attack that has damaged the electrical system in your ventricles
• An ICD is often recommended for people who have survived sudden cardiac arrest

 

Other important notes

 

• An ICD is notthe same as a pacemaker. A pacemaker can only give off low-energy electrical pulses to correct certain irregular heartbeats. An ICD can give off the high-energy electrical pulses needed to correct dangerous arrhythmias in the lower chambers of the heart (ventricles).
• Your doctor may recommend an ICD if he or she sees signs of an irregular ventricular arrhythmia (or heart damage that would make one likely). He or she also may recommend an ICD if you survive sudden cardiac arrest.
• Surgery to place an ICD usually takes a few hours. After this minor surgery, you may have mild pain; over-the-counter medicines can usually relieve it. Consult your doctor before taking any pain medicine.
• The most common problem with ICDs is that they give pulses too often or when they aren't needed. Doctors can reprogram ICDs or prescribe medicines so the pulses occur less often. There are other rare risks linked to the ICD surgery, such as infection and bleeding.
• Once you have an ICD, you have to avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. You also need to avoid medical procedures that can disrupt your ICD.
• Let all of your doctors, dentists, and medical technicians know that you have an ICD.
• Your doctor may ask you to avoid any vigorous exercise or heavy lifting for a short period after your surgery. After you have fully recovered from surgery, discuss with your doctor how much and what kinds of physical activity are safe for you.
• Have your ICD checked regularly. Some ICD functions can be checked remotely through a telephone call or computer connection to the Internet. Your doctor may ask you to come to his or her office to check your ICD.
• ICD batteries have to be replaced every 5 to 7 years. The wires of your ICD also may have to be replaced eventually. You doctor can tell you whether you need to replace your ICD or its wires.

 

Heart valve replacement or repair

Having heart valve repair or replacement depends on a number of factors, including:

 

• How severe your valve disease is.
• Your age and general health.
• Whether you need heart surgery for other conditions, such as bypass surgery to treat CAD. Bypass surgery and valve surgery can be done at the same time.

 

When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk for endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives. However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic or pulmonary valves often have to be replaced.

 

Repairing Heart Valves

Heart valves can be repaired by:

 

• Separating fused valve flaps
• Removing or reshaping tissue so the valve can close tighter
• Adding tissue to patch holes or tears or to increase the support at the base of the valve

 

Replacing Heart Valves

Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made valve or a biologic valve. Biologic valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so no medicines are needed to stop the body from rejecting the valve.

 

Man-made valves are more durable than biologic valves and usually don't have to be replaced. Biologic valves usually have to be replaced after about 10 years, although newer biologic valves may last 15 years or longer. Unlike biologic valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk for endocarditis.

 

Heart transplant

A heart transplant is an operation in which the diseased heart in a person is replaced with a healthy heart from a deceased donor. Transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed. Because donor hearts are in short supply, patients who need a heart transplant go through a careful selection process. They need to be sick enough to need a new heart, yet healthy enough to receive it.

 

For who?

Most patients referred to a heart transplant center have end-stage heart failure. Of these patients, close to half have heart failure as a result of coronary artery disease. Others have heart failure caused by hereditary conditions, viral infections of the heart, or damaged heart valves and muscles due to factors such as the use of certain medicines and alcohol, and pregnancy.

Most patients considered for a heart transplant have exhausted attempts at less invasive treatments and have been hospitalized a number of times for heart failure.

 

Patients who are eligible for a heart transplant are placed on a waiting list for a donor heart. Policies on distributing donor hearts are based on the urgency of need, the organs that are available for transplant, and the location of the patient who is receiving the heart. Organs are matched for blood type and size of donor and recipient.

 

Other important notes

 

• Heart transplant surgery usually takes about 4 hours.
• The amount of time a heart transplant recipient spends in the hospital will vary with each person.
• Once home, patients must carefully check and manage their health status. Patients will work with the transplant team to protect the new heart by watching for signs of rejection, managing the transplant medicines and their side effects, preventing infections, and continuing treatment of ongoing medical conditions.
• Risks of heart transplant include failure of the donor heart, complications from medicines, infection, cancer, and problems that arise from not following lifelong health care plans.
• Lifelong health care includes taking multiple medicines on a strict schedule, watching for signs and symptoms of complications, keeping all medical appointments, and stopping unhealthy behaviors such as smoking.
• Survival rates for people receiving a heart transplant have improved over the past 5–10 years—especially in the first year after the transplant. About 88 percent of patients survive the first year after transplant surgery.
• After the surgery, most heart transplant recipients (about 90 percent) can come close to resuming their normal daily activities.

 

 

Source: "Heart and Vascular Diseases." Disease and Conditions Index. The National Heart, Lung, and Blood Institute. The National Institutes of Health.