Cardiovascular Medicine

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Angioplasty and Stent Placement

A stent is a tiny mesh tube that doctors implant in an artery to prevent plaque from blocking the blood vessel. Stents are implanted in arteries in the heart (coronary arteries), neck (carotid arteries), or liver. Drug-eluting stents are coated with medication that is released over time to help prevent the artery from becoming blocked again. A coronary artery stent implant may lower the risk of heart attack. A carotid artery stent implant may lower the risk of stroke.

To perform this procedure a cardiologist or surgeon first opens a blocked artery by performing an atherectomy or a balloon angioplasty during a catheterization. During the catheterization, a thin flexible tube called a catheter is inserted through a blood vessel in the groin (or sometimes in the arm) and guided toward the blocked vessel. Dye injected through the catheter allows blood vessels to be shown on a monitor. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of an angioplasty. After clearing the blockage, the doctor uses a catheter to place the stent in the newly-opened artery. The stent helps hold the artery open so and reduces the change that plaque will block the artery again.

A stent implant is performed in a cardiac catheterization or endovascular lab where the patient lies on special table and an intravenous (IV) line is put into their arm. The IV line delivers fluids and medications. The area is numbed to minimize discomfort. The doctor makes a small incision for the catheter, and patients may feel pressure as the catheter is inserted. Most people recovery fairly quickly, but an overnight hospital stay may be required.

Cardioversion

Cardioversion is a medical procedure for treating an abnormally fast or irregular heartbeat. Most commonly used for atrial fibrillation, atrial flutter, or ventricular tachycardia, cardioversion sends an electrical impulse to the heart muscle, restoring normal heart rhythm.

Cardioversion is usually performed as a scheduled treatment. While blood pressure and heart rate are monitored, the patient is sedated with medications injected through an intravenous line (IV). An electrical shock, synchronized to the heart rhythm, is then delivered to the chest wall with paddles or small electrode pads. Because of the sedation, there is no discomfort. Blood thinners are often prescribed before and after the procedure.

If the heart rhythm does not return to normal with the use of an external shock, internal cardioversion may be considered. In this procedure, the electrical impulse is delivered directly to the heart muscle with soft wires inserted through a large vein in the leg, arm or neck.

Recovery from cardioversion takes several hours. Medications to maintain a regular heart rhythm may be prescribed. Cardioversion may be repeated if the abnormal heart rhythm returns.

Pacemaker and Implantable Cardioverter-efibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a small device surgically implanted in patients with serious heart issues, including ventricular tachycardia (VT) or ventricular fibrillation (VF).

During VT or VF, a disruption in the heart's electrical system causes a change in the heart's rhythm, leading to a high risk of sudden cardiac arrest (SCA) and sudden cardiac death (SCD). The ICD restores the heart to a normal rhythm. The system includes a small palm-sized device with electrical leads connecting to the heart.

The ICD surgical procedure is minimally invasive and usually requires only a local anesthesia. The electrical leads are guided to the heart through a small incision in the collarbone. The ICD is inserted near the collarbone.

Recovery is quick; though some patients may stay overnight.

Radiofrequency Ablation

For some heart arrhythmia conditions, doctors recommend a procedure called ablation. During an ablation procedure, small areas of the heart muscle are purposely destroyed to create scars -- called lesions – that improve the heart's function by correcting a faulty electrical process.

Catheter Ablation

Ablation is performed surgically or with a thin, flexible tube (catheter) that is inserted into a blood vessel.

By inserting a catheter into a blood vessel, usually in the groin or neck, and using a video monitor, doctors can guide the catheter to the heart. This allows them to work on the heart without making chest incisions.

The catheter has an electrode that measures the heart's electrical signals. This gives doctors the information needed to do an ablation.

The catheter is also used for the ablation, which is done either with intense cold (cryo-ablation) or with high-frequency energy (radio-frequency ablation).

Some patients require a pacemaker after an ablation is performed.

Surgical Ablation

Surgical ablation can be done with cryo-ablation, radio-frequency ablation, microwave ablation, ultrasound energy or laser energy.

There are two types of surgical ablation:

One type is a minimally invasive surgical ablation procedure in which doctors examine, test and ablate the heart through small chest incisions.

Another type can be done while other heart procedures are performed such as open-heart surgery. This combination of surgery and ablation procedure requires a longer incision down the middle of the chest.

Segmental Pressures Test

Segmental pressure testing is similar to ankle-brachial index (ABI) testing, but involves two or three additional blood pressure cuffs. These are placed just below the knee, just above the knee, and at the upper thigh. Blood pressure at each point is recorded. Significant drops between body segments may suggest blockages or narrowing in the arteries.

Segmental pressure testing is a non-invasive flow study (NIFS) used to diagnose claudication, experienced as pain while walking, may be caused by peripheral arterial disease (PAD). PAD, a form of atherosclerosis, causes arteries to narrow and leg muscles to receive less blood, and therefore less oxygen.

Diagnosing this condition is important, as it may precede cardiovascular issues, including heart attack or stroke.

The test takes 45 minutes to an hour. No special preparation is needed.

 

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