A cardiac catheterization or angiogram is a procedure that identifies possible problems with the heart or its arteries. During a catheterization, a thin plastic tube, called a catheter, is inserted into a blood vessel in the groin or arm. The catheter is guided up toward the heart. A special dye is injected into the catheter so x-rays can identify any artery blockage or other heart problems. This comprehensive test shows narrowing in the arteries, overall heart size and pumping ability of the heart. If a narrowing of a heart artery is found, this can usually be treated with balloon angioplasty and stenting, including the drug coated stents. This is usually performed on an outpatient basis with an overnight stay needed after an angioplasty or stenting.
Minimally invasive treatments include;
- Balloon Angioplasty- PTCA
Angioplasty is the technique of mechanically widening narrowed or obstructed arteries, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for the improved flow, and the balloon is then deflated and withdrawn. A stent may or may not be inserted at the time of ballooning to ensure the vessel remains open.
- Coronary Stents
- Bare Metal Stents
A bare metal stent (BMS) is a coronary stent (a scaffold) placed into narrowed, diseased coronary arteries that slowly releases a drug to block cell proliferation. This prevents fibrosis that, together with clots (thrombus), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the coronary artery by an Interventional cardiologist during an angioplasty procedure.
- Drug-eluting Stents
A drug-eluting stent (DES) is a coronary stent (a scaffold) placed into narrowed, diseased coronary arteries that slowly releases a drug to block cell proliferation. This prevents fibrosis that, together with clots (thrombus), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the coronary artery by an Interventional cardiologist during an angioplasty procedure.
- Electrophysiology (testing and treating of heart rhythm disorders)
Electrophysiology testing involves placing a special catheter in the low pressure side of the heart that relate to the electrical pathway or the conduit of the heart.Mapping is done and pts receive ablation or burning of the specific areas causing irregular heart rhythms to bring them back to a regular heart rhythm.
- Permanent Pacemaker
Your doctor has recommended a pacemaker because there are signs that your heart is not beating fast enough or there is a problem with the normal electrical signal which causes your heart to beat. A permanent pacemaker consists of a generator and leads which are usually implanted into the upper chest through a small incision. The generator is a metal case containing the power source and a timer that regulates how often the pacemaker sends out electrical signals. The generator life is usually 7 to 10 years. The leads allow the pacemaker to monitor your heart rhythm and to send out electrical signals to make your heart beat when needed.
- Intra-aortic balloon pump
The Intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery
- Internal Cardiac Defibrillators
An AICD is a device that monitors a person's heart rate. They are generally implanted into heart failure patients. The device is programmed to perform the following tasks; speed up or slow down your heart, depending upon the heart rate. The AICD gives your heart a shock if you start having life threatening arrhythmias or an abnormally high heart rate. Arrhythmias occur when your heart does not beat normally. Some arrhythmias can cause the heart to completely stop beating. The shock given by the AICD can make the heart start beating normally again. An AICD can also make your heart beat faster if your heart is not beating fast enough. There are different kinds of AICDs, but they all have 2 parts: electrodes (thin flexible wires) and a generator. The electrodes or "leads" sense or watch the heart's electrical activity. The generator is the battery power source and the "brains" of the AICD. It is a small metal can about the size of a deck of cards. The generator stores information about any arrhythmias you have. The generator also keeps track of how often it needs to give your heart a shock. Some AICDs also function as pacemakers for heart rates that are too slow or too fast.
- Intravascular Ultrasound
An invasive procedure, performed along with cardiac catheterization; a miniature sound probe (transducer) on the tip of a coronary catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the interior walls of the arteries. Where angiography shows a two-dimensional silhouette of the interior of the coronary arteries, IVUS shows a cross-section of both the interior, and the layers of the artery wall itself.
- Left-Ventricular assist device (Impella)
The Impella catheter procedure is an assist device that is placed in the main pumping chamber of the heart to use as an extra help in difficult procedures.It allows patients to have their cardiac output increased to withstand an exam that would otherwise go to the operating room.
- PFO Closure (Patent Foramen Ovale)
Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between two compartments of the heart called the left and right atria. Normally, the right and left atria are separated by a septum called the interatrial septum. If this septum is defective or absent, then oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart, or vice versa. This can lead to lower than normal oxygen levels in the arterial blood that supplies the brain, organs, and tissues. However, an ASD may not produce noticeable signs or symptoms, especially if the defect is small.
- Rotational atherectomy
A rotational athrectomy is a type of interventional coronary procedure to help open coronary arteries blocked with more calcified material and restore blood flow to the heart. This procedure utilizes a high speed rotational "burr" that is coated with microscopic diamond particles. It rotates at high speed (approximately 200,000 rpm), breaking up blockages into very small fragments (smaller than red blood cells) which can pass, harmlessly, into the circulation. Often angioplasty/stent is performed after rotational atherectomy to improve the results.