What is Coronary Artery Disease?
Coronary artery disease occurs when blood flow to the heart muscle is restricted. It may; result from a build up of cholesterol inside the inner lining of the blood vessels that carry blood to the heart muscle call atherosclerosis. Atherosclerosis can cause angina (hear pain), arrhythmia (irregular heartbeats), as well as other problems including heart attack, damage to the heart muscle, and heart failure.
Often, lifestyle changes-smoking cessation, exercise, nutrition and medications can help manage risk factors that increase a person’s risk of heart attack, stroke, and other complications. However, when evidence of coronary artery disease is detected, cardiac catheterization is used to determine how ;your heart is functioning, and in many cases non-surgical interventional cardiac procedures can be used to treat the condition.
How is Coronary Artery Disease Treated?
Cardiac Catheterization involves inserting a catheter into your heart with the aid of a special X-ray machine. After sedation, the doctor numbs the site and a thin flexible tube (catheter) is inserted through an artery in your groin or arm and carefully guided up the aorta into the coronary artery. Contrast dye is injected through the catheter so that X-ray movies of your coronary arteries, can be created. This procedure can confirm the presence of heart disease, evaluate the heart muscle function, and determine the need for further treatment, such as angioplasty.
Angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a common procedure used to open clogged arteries and increase blood flow to the heart muscle tissue. Angioplasty is less invasive and has a shorter recovery time than open-heart surgery.
Stents are permanently inserted into the artery during angioplasty. A balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall. The stent will open the artery and improve blood flow to the heart. Stents are generally of the new type called coated or drug eluting:
- Coated stents: coated with a medication that prevents the growth of new tissue that often causes the treated artery to close up again (restenosis).
- Coronary Rotoblation: Physicians may; elect to remove plaque with a technique called rotoblation, which requires a special catheter with a football shaped diamond-coated tip that spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed safely away in your bloodstream and filtered out by your liver and spleen.
What are Electrophysiology (EP) Studies?
If you have experienced symptoms of arrhythmias (irregular heartbeats) or have had arrhythmias, your doctor may order tests to look at the electrical function of your heart. EP studies help to evaluate arrhythmias and the effect they; may; have on future health. An EP study, considered by many medical professionals to be the most accurate and reliable method of evaluating heart rhythms, will help you physician determine the treatment option that is most appropriate for you.
Electrophysiologists are cardiologists who have had additional training, especially in the science of electrical functions of the heart. EP studies are performed in a laboratory with specialized diagnostic equipment and heart monitoring devices. These highly trained physicians are assisted by EP trained nurses and technicians, who will monitor your hear and blood pressure, administer medications, and record data pertaining to your EP study.
How does electricity affect my heart?
Your heart is able to beat because the body naturally produces electricity that travels across the heart muscle and stimulates it to contract or beat, thereby pumping blood to and from other parts of your body. The electrical signal comes from a small area in the upper right chamber or right atrium called the sinoatrial nod (SA node).
Certain conditions can cause the heart’s electrical system to make the heart beat too slow, too fast, or in an uncoordinated fashion. These arrhythmias can occur in any of the four chambers of the heart.
What is the procedure like?
In order to measure how the electrical impulses flow through your heart during a heartbeat, the electrophysiologist must place two or more temporary pacemaker catheters into your heart. These catheters are usually inserted through veins in the upper leg, neck or arm areas. All of the catheters are usually removed when the EP study is completed.
An intravenous (IV) line will be started at the beginning of the procedure to administer medications, an automatic blood pressure cuff will be placed on your arm, and an oximeter clip will be placed on you finger to measure your blood’s oxygen content. You should feel no discomfort from any of these.
A numbing medicine will be used wherever the pacemaker catheters are to be inserted. There may be a slight burning sensation when the medicine is introduced, but the area will become numb immediately. The pacemaker catheters will be guided to your heart with the use of a fluoroscope (similar to a large x-ray machine or camera).
Once inserted, some of the wires deliver tiny electrical impulses to you heart, called “pacing”. The other wires sense your heart’s normal electrical impulses. During the test, the physician will send different types of impulses to your heart and you may feel your heat flutter, race or skip beats. This is normal and most people do not feel discomfort from it.
An EP study is an “invasive” procedure and involves some risk – but the risk is small. Some patients may develop bleeding at the insertion point, local swelling and/or a bruise at the insertion point. In rare cases, the procedure can lead to damage to the heart and blood vessels, formation of blood clots or infection.
How is arrhythmia treated?
Arrhythmia may stop simply when the doctor tries to “pace” you out of your arrhythmia by changing the electrical impulses going on to your hear. Some patients need to be “shocked” out of an arrhythmia with a defibrillator-a machine that produces an electrical shock to stop an abnormally fast heart rhythm. There are times when a prescription medicine is tested during the procedure to see if it prevents an arrhythmia.
Catheter Ablation/Radio-Frequency Ablation is a technique doctors use to ablate (destroy) parts of the abnormal electrical pathway that is causing rapid heart rhythm problems (tachycardias), which is usually done during the EP study. A special electrode catheter is inserted into the heart, close to the abnormal pathway. The doctor passes radio-frequency energy through it, the tip of the catheter heats up and destroys the small area of the heart tissue that contains the abnormal pathway.
Permanent Pacemakers are used to treat arrhythmias in a heart rhythm that’s too slow, called bradycardia. This is a small electronic device that is implanted in the chest near the right or left shoulder, or occasionally in the abdomen. It stimulates the heart muscle with precisely timed electrical impulses that keep the heart beating at the proper rate.
A local anesthetic is injected to numb the area and an incision is made below the collarbone. A “pocket” is created under the skin where the pulse generator will be placed. The lead is inserted into a vein, and with the help of an x-ray camera, the lead is passed through the vein and placed inside the heart. If a second lead is needed (dual-chamber pacemaker), this process is repeated. The lead(s) are attached to the pulse generator, which is placed in the pocket in your chest. The device is tested, the incision is closed, and covered with a sterile dressing. Most patients stay in the hospital overnight, some for an extra day.
Defibrillators (ICDs) can be used to treat tachycardias – rapid heart beats. ICDs automatically detect and treat life-threatening rapid heart rhythms, and can effectively stop a dangerous arrhythmia once it has started. The procedure is very similar to the pacemaker implantation explained above.
Bi-Ventricular PPM/Defibrillator significantly improves the condition of a patient whose heart is unable to pump sufficient amounts of blood into the body due to the heart beating in an irregular, uncoordinated manner. Unlike other pacemaker devices that connect to a wire in the right side of the heart only, the bi-ventricular pacemaker provides an additional wire that is used to send electrical signals to the left chamber at the same time as the right chamber, providing a normal electrical sequence. The implant is usually conducted under local anesthesia with the patient sedated. Early studies have shown that with this new device, patients experience improved activity levels and reduced hospitalization.
What will life be like after EP procedures?
A few days after any of these implant procedures, you’ll probably be able to go back to most of your daily activities; however, it may take a few weeks for the wound to heal completely. You may feel numbness or fullness around the incision and you may be aware of the pulse generator under the skin, but you’ll adjust to it.
Here is a summary of important things to remember:
- Resume daily activities gradually.
- Inform other healthcare providers of the ICD.
- Call your doctor as instructed.
- Schedule and keep appointments for follow-up visits.
- Plan for emergencies.
- Carry your ID card and wear you medical jewelry at all times.
- Take your medications as directed by your doctor.
- Follow precautions for avoiding electromagnetic interference (EMI). Microwaves do not affect device.
- Use cell phones on opposite side of device.
You’ll be given specific discharge instructions upon leaving the hospital:
- Keep the incision site completely dry for a week to help prevent an infection.
- For about 4 to 6 weeks, do not raise your arm on the pacemaker or ICD side above shoulder level.
- Avoid lifting anything heavier than 20 pounds.
- Avoid excessive pushing, pulling, or twisting.
Call your doctor if:
- The incision site shows signs of infection (pain, redness, swelling), there is drainage from the incision, or you develop a fever over 100?F.
- Your symptoms recur, or if you experience light-headedness, chest pain, or shortness of breath.
- You aren’t certain about medications-which ones to continue and which to stop.