Eat Healthy to Help Prevent Heart Disease

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You can lower your chances of getting heart disease by eating healthy. For a healthy heart, eat:

• Less Fat
• Less Sodium
• Fewer Calories
• More Fiber

Eat less fat
Some fats are more likely to cause heart disease. These fats are usually found in foods from animals, such as meat, milk, cheese, and butter. They also are found in foods with palm and coconut oils. Eat less of these foods.
Eat less sodium
Eating less sodium can help lower some people's blood pressure. This can help reduce the risk of heart disease. Sodium is something we need in our diets, but most of us eat too much of it. Much of the sodium we eat comes from salt we add to our food at the table or that food companies add to their foods. So, avoid adding salt to foods at the table.
Eat fewer calories
When we eat more calories than we need, we gain weight. Being overweight can cause heart disease. When we eat fewer calories than we need, we lose weight.
Eat more fiber
Eating fiber from fruits, vegetables and grains may help lower your chances of getting heart disease. To learn more visit the fiber article.
Diet Tips for a Healthy Heart

• Eat a diet low in fat, especially animal fats and palm and coconut oils. (These foods contain saturated fat and cholesterol. Saturated fat and cholesterol can cause heart disease.)
• Choose a diet moderate in salt and sodium.
• Maintain or improve your weight.
• Eat plenty of grain products, fruits and vegetables.
• Choose milk with 1% fat or skim milk instead of whole milk.
• Eliminate fried foods and replace them with baked, steamed, boiled, broiled, or microwaved foods.
• Cook with oils which are low in fat and saturated fat like corn, safflower, sunflower, soybean, cottonseed, olive,canola, peanut and sesame oils. Stay away from oils and shortenings that are high in fat and saturated fat.
• Smoked, cured, salted and canned meat, poultry and fish are high in salt. Eat unsalted fresh or frozen meat, poultry and fish.
• Replace fatty cuts of meat with lean cuts of meat or low-fat meat alternatives.
• In recipes requiring one whole egg try two egg whites as a lower fat alternative.
• Replace sour cream and mayonnaise with plain low-fat yogurt, low-fat cottage cheese, or low-fat sour cream and mayonnaise.
• Substitute hard and processed cheeses for low-fat, low-sodium cheeses.
• Use herbs and spices as seasoning for vegetables and potatoes instead of salt and butter.
• Replace salted crackers with unsalted or low-sodium whole-wheat crackers.
• Substitute canned soups,bouillons and dry soup mixes which are high in salt for sodium-reduced soups and bouillons.
• Replace white bread, white rice, and cereals made with white flour with whole-wheat bread, long-grain rice, and whole-grain cereals.
• Substitute snacks high in salt and fat with low-fat, low salt snacks. Cut-up vegetables and fruits are a quick healthy snack.

Read the Food Label
The food label can help you eat less fat and sodium, fewer calories and more fiber.
Look for certain words on food labels. The words can help you spot foods that may help reduce your chances of getting heart disease.
Words to Look For:

• Fat-free Saturated fat-free
• Low-fat
• Low saturated fat
• Reduced or less fat
• Reduced or less saturated fat
• Cholesterol-free
• Low-cholesterol
• Reduced or less cholesterol
• Lean
• Extra lean
• Healthy
• Sodium-free
• Low-sodium
• Light in sodium
• Lightly salted
• Reduced or less sodium
• Salt-free
• Unsalted
• Light
• Calorie-free
• Low-calorie
• Reduced or fewer calories
• High-fiber
• More or added fiber

Read the Food Label
Look at the side or back of the package. Here, you will find "Nutrition Facts." Look for these words:

• Total fat
• Saturated fat
• Cholesterol
• Sodium

Look at the %Daily Value listed next to each term. If it is 5% or less for fat, saturated fat, cholesterol, and sodium, the food is low in these nutrients. That's good. It means the food fits in with a diet that is heart healthy and may help reduce your chance of developing heart disease.
For additional information visit:

Sacred Heart Diet

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sacred-heart-dietThe Sacred Heart Diet is a fad diet that has been circulating for many years. The diet was supposedly thought to come from the cardiology department at Sacred Heart Memorial Hospital where it was used for overweight heart patients. However, like most of these diets – this is an urban myth.

The Sacred Heart Diet has been called a number of different names (such as the Spokane Heart Diet, the Cleveland Clinic Diet, Sacred Heart Memorial Hospital Diet and the Miami Heart Institute Diet). The diet also bears a striking resemblance to the cabbage soup diet.

Background of the Diet

The Sacred Heart diet is a soup-based diet, and claims that you will lose 10-17 pounds in the first week. This may be true, but most of the weight will tend to be water – and will be gained right back very soon after the diet.

This diet is very clearly an unsustainable fad diet, but is not as nutritionally unsound as similar diets. Most of these diets claim some magical fat-burning science is involved, or that there is something special about the combination of foods. This is simply untrue – it is nothing more complex than a reduction in calories!

7 Day Diet Plan

This diet is not recommended

* The Sacred Heart Hospital in Montreal Canada (Hôpital Sacre Coeur) issued a press release in 2004 stating that “no nutritionist at the Hospital took part in the development of this diet”.

* The American Heart Association have claimed that the diet is phony (ref).

* The Sacred Heart Medical Center also disclaim any association with the diet (ref).

Day 1

Any fruit (except bananas). Cantaloupes and watermelon are lower in calories than most other fruits. Eat only soup and fruit today.

Day 2

All vegetables. Eat until you are full with fresh raw, cooked or canned veggies. Try to eat green leafy veggies and stay away from dry beans, peas or corn.

Eat veggies along with the soup.

A baked potato and dinner time with butter.

Don’t eat any fruits through today.

Day 3

Eat all the soup, fruit and veggies you want. Do not have a baked potato.

Day 4

Bananas and skim milk: Eat at least 3 bananas and drink as much milk as you can today, along with the soup.

Day 5

Beef and tomatoes: you may have 10 to 20 ounces of beef and a can of tomatoes, or as many as 6 tomatoes on this day. Eat the soup at least once today.

Day 6

Beef and veggies, eat to your heart’s content of the beef and veggies today. You can even have 2-3 steaks if you like with green leafy veggies but no baked potato. Be sure to eat the soup at least once today.

Day 7

Brown rice, unsweetened fruit juice and veggies, until full (and eat the soup).

You can add cooked veggies to your rice if you wish.

Drinks Allowed

* Unsweetened juices

* Tea (also herbal)

* Coffee

* Cranberry juice

* Skim milk

* Lots of water

Soup Recipe

* 1 or 2 cans of stewed tomatoes

* 3 plus large green onions

* 1 large can of beef broth (no fat)

* 1 pkg. Lipton Soup mix (chicken noodle)

* 1 bunch of celery

* 2 cans green beans

* 2 lbs. Carrots

* 2 Green Peppers

Season with salt, pepper curry, parsley, if desired, or bouillon, hot or Worcestershire sauce. Cut veggies in small to medium pieces. Cover with water. Boil fast for 10 minutes. Reduce to simmer and continue to cook until vegetables are tender.

The soup can be eaten at any time.

Variations

Here is a different version of the diet – alleged to have come from Lehigh Valley Hospital, Pennsylvania.

“Follow the daily plan for 2 consecutive weeks, then take the following week off. You can repeat the cycle for as long as you like or until you achieve your weight loss goal.”

MONDAY

Eat SOUP and all the FRESH FRUIT that you want. Nothing else. (no bananas)

TUESDAY

Eat SOUP and all the FRESH VEGETABLES that you want. Nothing else. (no corn or beans).

WEDNESDAY

Eat SOUP and BOTH FRUIT & VEGETABLES, all you want. Nothing else.

THURSDAY

Eat SOUP all day and 3 BANANAS. 1 GLASS OF SKIM MILK. Nothing else.

FRIDAY

Eat SOUP, up to 8 TOMATOES and ALL the skinless CHICKEN, lean BEEF & FISH that you want. Nothing else.

SATURDAY

Eat SOUP, ALL the skinless CHICKEN, lean BEEF & FISH that you want… nothing else.

SUNDAY

Eat SOUP and all the BROWN RICE that you want. Nothing else.

SOUP Ingredients

Soup to be eaten ALL DAY as much and as often as you can

* 2 – 11oz. cans chicken noodle soup (Campbell Healthy)

* 5 stalks of celery

(diced)

* 1 lb. pack frozen string beans

* 4 carrots (diced)

* 4 potatoes (diced)

* ½ green pepper (diced)

* 2 onions (diced)

Carotid Endarterectomy

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Page Content

 

What is carotid endarterectomy?

Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.
Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to enter the base of your skull. These important arteries supply blood to your brain.
Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.
To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid endarterectomy. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.

How do I prepare?

Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.
Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. It can also determine the location and degree of narrowing in your carotid artery. Other tests your vascular surgeon may use include:

• Computed tomography (CT) scan
• Computed tomographic angiogram (CTA)
• Magnetic resonance angiography (MRA)
• Angiography (or arteriography)

Am I eligible for carotid endarterectomy?

You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing TIAs and are in reasonably good health otherwise. You may be eligible, but at a relatively increased risk, if you have:

• Had a large stroke without recovery
• Widespread cancer with a life expectancy of less than two years
• High blood pressure that has not been adequately controlled by lifestyle changes or medications
• Unstable angina (chest pains)
• Had a heart attack in the last six months
• Congestive heart failure
• Signs of progressive brain disorders, such as Alzheimer's disease

Am I at risk for complications during a carotid endarterectomy?

Having had a stroke in the past increases your chances for complications to a varying degree depending upon its severity, how recently it occurred, and the degree of recovery. Other factors that may increase your chances for problems during a carotid endarterectomy, in addition to those conditions listed above, include:

• The presence of a serious disease, such as severe heart or lung disease
• Plaque your surgeon cannot reach through surgery
• Severe blockage in other blood vessels that supply blood to your brain, such as the carotid artery on the other side
• Having a new blockage in a previous carotid endarterectomy on the same side (recurrence)
• Diabetes
• Cigarette smoking

What happens during a carotid endarterectomy?

You may either be put to sleep or, alternatively, your anesthesiologist or surgeon can numb your neck area and keep you awake so you can communicate with the surgeon during the operation. By staying awake, you may help your physician monitor your brain's reaction to the decreased blood supply. Once you are either asleep or the area around your neck is completely numb, your surgeon will shave the skin on your neck where he or she is going to make an incision, to help prevent infections. Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery. Next, your surgeon temporarily clamps your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck. Alternatively, your surgeon can insert a shunt to detour the blood around the artery that is being repaired.
After your surgeon clamps your carotid artery, he or she makes an incision directly into the blocked section. Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque. After removing the plaque, your surgeon stitches your artery, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Often, a patch is used to widen the artery as part of the procedure. The patch material used can be your own vein, usually from the leg, or a variety of synthetic materials depending upon your particular circumstance. The procedure takes about 2 hours to perform but may seem slightly longer depending upon the anesthetic and preparation time.

What can I expect after a carotid endarterectomy?

After surgery, you may stay in the hospital for 1 to 2 days. During this time, your physician will monitor your progress. Initially, during your recovery, you will receive fluid and nutrients through a small, thin tube called an intravenous (IV) catheter. Because the neck incision is so small, you may not feel significant pain.
After you go home, your physician may recommend that you avoid driving and limit physical activities for several weeks. You can usually begin normal activities again several weeks after the operation.
If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately.

Are there any complications?

You may have complications following any surgical procedure. A stroke is one possible complication following a carotid endarterectomy. This risk is very low, ranging between 1 and 3 percent. Another unusual complication is the re-blockage of the carotid artery, called restenosis, which may occur later, especially if you continue to smoke cigarettes. The chance of developing a restenosis severe enough to require another carotid endarterectomy is usually about 2 to 3 percent. Temporary nerve injury, leading to hoarseness, difficulty with swallowing, or numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn't require any treatment. However, the chance of any of these unusual complications is much less than the risk of stroke if a significant carotid blockage is not adequately treated.

What can I do to stay healthy?

Although a carotid endarterectomy can reduce your risk of stroke by removing the offending plaque, and although the procedure is quite durable, it does not completely stop plaque from building up again in susceptible individuals. To minimize the chance of hardening of the arteries occurring again, you should consider the following changes:

• Eat foods low in saturated fat, cholesterol, and calories
• Exercise regularly, especially aerobic exercises such as walking
• Maintain your ideal body weight
• Avoid smoking
• Discuss cholesterol-lowering medications and antiplatelet therapy with your physician

Valve Repair or Replacement

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Blood is pumped through your heart in only one direction. Heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close tightly to prevent a backflow of blood.

There are 4 valves in the heart:

• Tricuspid valve
• Pulmonary valve
• Mitral valve
• Aortic valve

Diastole: blood is pumped from the atria into the ventricles.

Systole: Blood is pumped out of the ventricles to the lungs and the body.

In the United States, surgeons perform about 99,000 heart valve operations each year. Nearly all of these operations are done to repair or replace the mitral or aortic valves. These valves are on the left side of the heart, which works harder than the right. They control the flow of oxygen-rich blood from the lungs to the rest of the body.

See also on this site: Valve Disease

If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed.

What is valve repair?

Valve repair can usually be done on congenital valve defects (defects you are born with) and has a good success record with treating mitral valve defects.

Here are some procedures surgeons may use to repair a valve:

• Commissurotomy, which is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
• Valvuloplasty, which strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
• Reshaping, where the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
• Decalcification, which removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.
• Repair of structural support, which replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.
• Patching, where the surgeon covers holes or tears in the leaflets with a tissue patch.

What is valve replacement?

Severe valve damage means that the valve will need to be replaced. Valve replacement is most often used to treat aortic valves and severely damaged mitral valves. It is also used to treat any valve disease that is life-threatening. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.

There are 2 kinds of valves used for valve replacement:

• Mechanical valves, which are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines (called anticoagulants) for the rest of their lives.
• Biological valves, which are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft). Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.

You and your doctor will decide which type of valve is best for you.

During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine. Because the heart or the aorta must be opened, heart valve surgery is open heart surgery.

What to Expect

The operation will usually be scheduled at a time that is best for you and your surgeon, except in urgent cases. As the date of your surgery gets closer, be sure to tell your surgeon and cardiologist about any changes in your health. If you have a cold or the flu, this can lead to infections that may affect your recovery. Be aware of fever, chills, coughing, or a runny nose. Tell the doctor if you have any of these symptoms.

Also, remind your cardiologist and surgeon about all of the medicines you are taking, especially any over-the-counter medicines such as aspirin or those that might contain aspirin. You should make a list of the medicines and bring it with you to the hospital.

It is always best to get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect when you have valve repair or replacement surgery.

Before the Hospital Stay

Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery.

The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin. After you are admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.

A medicine (anesthetic) will make you sleep during the operation. This is called "anesthesia." Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon.

If you smoke, you should stop at least 2 weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.

Day of Surgery

Before surgery, you may have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health. You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room.

Small metal disks called electrodes will be attached to your chest. These electrodes are connected to an electrocardiogram machine, which will monitor your heart's rhythm and electrical activity. You will receive a local anesthetic to numb the area where a plastic tube (called a line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in a vein. The IV line will be used to give you the anesthesia before and during the operation.

After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called a respirator, which will take over your breathing. Another tube will be inserted through your nose and down your throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so you will not feel sick and bloated when you wake up. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation.

A heart-lung machine is used for all valve repair or replacement surgeries. This will keep oxygen-rich blood flowing through your body while your heart is stopped. A perfusion technologist or blood-flow specialist operates the heart-lung machine. Before you are hooked up to this machine, a blood-thinning medicine called an anticoagulant will be given to prevent your blood from clotting. The surgical team is led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist, and surgical nurses.

After you are hooked up to the heart-lung machine, your heart is stopped and cooled. Next, a cut is made into the heart or aorta, depending on which valve is being repaired or replaced. Once the surgeon has finished the repair or replacement, the heart is then started again, and you are disconnected from the heart-lung machine.

The surgery can take anywhere from 2 to 4 hours or more, depending on the number of valves that need to be repaired or replaced.

Recovery Time

You can expect to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU).

Recovery after valve surgery may take a long time, depending on how healthy you were before the operation. You will have to rest and limit your activities. Your doctor may want you to begin an exercise program or to join a cardiac rehabilitation program.

If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.

Life After Valve Replacement

Most valve repair and replacement operations are successful. In some rare cases, a valve repair may fail and another operation may be needed.

Patients with a biological valve may need to have the valve replaced in 10 to 15 years. Mechanical valves may also fail, so patients should alert their doctor if they are having any symptoms of valve failure.

Patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives. Because these medicines increase the risk of bleeding within the body, you should always wear a medical alert bracelet and tell your doctor or dentist that you are taking a blood-thinning medicine.

Even if you are not taking a blood-thinning medicine, you must always tell your doctor and dentist that you have had valve surgery. If you are having a surgical or dental procedure, you should take an antibiotic before the procedure. Bacteria can enter the bloodstream during these procedures. If bacteria get into a repaired or artificial valve, it can lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.

Patients with mechanical valves say they sometimes hear a quiet clicking sound in their chest. This is just the sound of the new valve opening and closing, and it is nothing to be worried about. In fact, it is a sign that the new valve is working the way it should.

Minimally Invasive Valve Surgery

Minimally invasive heart valve surgery is a technique that uses smaller incisions to repair or replace heart valves. This means there is less pain. Minimally invasive surgery also reduces the length of the hospital stay and the recovery time.

Minimally invasive valve surgery can only be done in certain patients. This type of surgery cannot be done in patients

• With severe valve damage
• Who need more than one valve repaired or replaced
• Who have clogged arteries (atherosclerosis)
• Who are obese

In some cases, minimally invasive valve surgery can be done using a robot. Robotic surgery does not require a large incision in the chest. It is not available at all hospitals, and patients with severe valve damage cannot have the procedure. The Texas Heart Institute has a robot.

With robotic surgery, the surgeon has a control console, a side cart with 3 robotic arms, a special vision system, and instruments. A computer translates the surgeon's natural hand and wrist movements made on the control console to instruments that have been placed inside the patient through small incisions. The robot's controls can read even the tiniest of movements the surgeon makes.

Robotic surgery can reduce the time it takes to do valve surgery, as well as shorten the hospital stay and recovery time.

Pacemaker

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A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.

Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that's too slow is called bradycardia (bray-de-KAR-de-ah).

During an arrhythmia, the heart may not be able to pump enough blood to the body. This may cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.

A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.

Understanding the Heart's Electrical System

Your heart has its own internal electrical system that controls the rate and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.

Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity.

First, the heart's two upper chambers, the atria (AY-tree-uh), contract. This contraction pumps blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat.

For more information on the heart's electrical system and detailed animations, go to the Diseases and Conditions Index How the Heart Works article.

Overview

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

• Speed up a slow heart rhythm.
• Help control an abnormal or fast heart rhythm.
• Make sure the ventricles contract normally if the atria are quivering instead of beating with a normal rhythm (a condition called atrial fibrillation).
• Coordinate the electrical signaling between the upper and lower chambers of the heart.
• Coordinate the electrical signaling between the ventricles. Pacemakers that do this are called cardiac resynchronization therapy (CRT) devices. CRT devices are used to treat heart failure.
• Prevent dangerous arrhythmias caused by a disorder called long QT syndrome.

Pacemakers also can monitor and record your heart's electrical activity and heart rhythm. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors and adjust your heart rate to changes in your activity.

Pacemakers can be temporary or permanent. Temporary pacemakers are used to treat temporary heartbeat problems, such as a slow heartbeat that's caused by a heart attack, heart surgery, or an overdose of medicine.

Temporary pacemakers also are used during emergencies. They're used until a permanent pacemaker can be implanted or until the temporary condition goes away. If you have a temporary pacemaker, you'll stay in a hospital as long as the device is in place.

Permanent pacemakers are used to control long-term heart rhythm problems. This article mainly discusses permanent pacemakers, unless stated otherwise.

Doctors also treat arrhythmias with another device called an implantable cardioverter defibrillator (ICD). An ICD is similar to a pacemaker. However, besides using low-energy electrical pulses, an ICD also can use high-energy electrical pulses to treat certain dangerous arrhythmias.

Bypass Surgery

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Surgery Overview

During a coronary artery bypass graft (CABG), blood flow is rerouted through a new artery or vein that is grafted around diseased sections of your coronary arteries to increase blood flow to the heart muscle tissue. This procedure is also called coronary artery bypass surgery. A bypass typically requires open-chest surgery and the use of a heart-lung bypass machine to circulate the blood and add oxygen.

There are several newer, less invasive techniques for bypass surgery that can be used instead of open-chest surgery in some cases. In some procedures, the heart is slowed with medicine but is still beating during the procedure. For these types of surgery, a heart-lung bypass machine is not needed.

Other techniques use keyhole procedures or minimally invasive procedures instead of open-chest surgery. Keyhole procedures use several smaller openings in the chest and may or may not require a heart-lung machine. Although these techniques are growing in popularity, they have not been well studied and may not be available in all medical centers.

This information will focus on traditional open-chest bypass surgery.

For the bypass grafts, your surgeon will use either an artery or a vein from your body.

• A vein may be removed from your leg. One end of it is attached to the aorta and the other end to the diseased coronary artery just past the blocked area.
• One end of a mammary artery or another artery in the chest may be detached and reattached to the coronary artery just past the blocked area.
• A portion of the radial artery in your forearm may be used.

In any case, blood is redirected through the artery or vein graft, detouring the blocked or narrowed artery and increasing blood flow to that region of the heart.

What To Expect After Surgery

After surgery, there will be a short stay (1 to 2 days if there are no complications) in the intensive care unit (ICU). In the ICU, you will likely have:

• Continuous monitoring of your heart activity.
• A tube to temporarily help with breathing.
• A central line, which is a thin plastic tube inserted into a vein in the neck and threaded down into the heart and pulmonary artery. It is used to monitor pressures and blood flow within the heart.
• A tube to remove stomach secretions until you start eating again.
• A tube (catheter) to drain the bladder and measure urine output.
• Tubes connected to veins in the arms (intravenous, or IV, lines) through which fluids, nutrition, and medicine can be given.
• An arterial line to measure blood pressure. An arterial line is a short, soft, plastic tube (a catheter) that is placed directly into an artery. The arterial line leads to a monitor, which continuously displays your blood pressure.
• Chest tubes to drain the chest cavity of fluid and blood (which is temporary and normal) after surgery.

Recovery includes physical therapy, respiratory therapy, occupational therapy, and diet counseling. You will typically stay in the hospital from 3 to 8 days after open-chest bypass surgery. The amount of time you stay varies and will depend on your health before bypass surgery and whether complications develop from the surgery.

Your doctor may have you take aspirin right after your surgery. Starting aspirin therapy shortly after having this procedure can help prevent complications that can affect the heart, brain, kidneys, and intestines.

After you are released from the hospital, your recovery at home takes 4 to 6 weeks. Exercise and driving may be resumed after about 2 to 3 weeks. People who are able to return to work can usually do so within 1 to 2 months, depending on the type of work they do. Some people find that they experience heightened emotions (such as a greater tendency to cry or otherwise show emotion in ways that are unusual compared with before the procedure) for up to a year following the surgery.

Why It Is Done

Bypass surgery is usually performed for heart attack only when other treatments, such as medicine and angioplasty with or without stenting, are not useful because of the location or extent of the blockage. See a picture of the coronary arteries .

Although new techniques have allowed doctors to use angioplasty and/or stenting increasingly over bypass surgery, some types of heart attack may not be effectively treated with angioplasty with or without stenting. Bypass may be a better option for people with diabetes or with two or more blocked coronary arteries. It may also be a better option when certain areas of the heart are damaged or when angioplasty is not possible for technical reasons.

How Well It Works

Although the immediate risks of coronary artery bypass graft surgery are greater than those of angioplasty, long-term outcomes are similar for both procedures. CABG surgery may offer the advantages of greater durability and more complete revascularization. Generally, the greater the extent of coronary atherosclerosis, the greater the benefits of bypass surgery over angioplasty.

Bypass surgery may be considered a better option for some people who have:

• Diabetes.
• Disease of the left main coronary artery.
• Weakened heart muscle.
• Valve disease and need surgery.

Bypass surgery often relieves symptoms of chest pain (angina), improves exercise performance, and reduces the risk of a future heart attack.

People with severe coronary artery disease (CAD) have an increased risk of death within a year when they are treated with bypass surgery rather than medicines alone. But 5 to 10 years after bypass surgery, the risk of death from CAD is less for those who had surgery compared with those treated with medicine. Factors that affect these results include the number of coronary arteries that are diseased, the severity of the disease, and the location of the plaque in the coronary arteries.

Risks

The most common problem after surgery is the return of chest pain (angina). Severe angina may return shortly after bypass surgery in about 4 out of 100 people. Surgery is usually less successful when it is repeated.

After 5 years, about 4 out of 100 people need another operation. After 10 years, about 12 out of 100 people need another surgery.

Other risks of bypass surgery may include:

• Risks associated with anesthesia.
• Death.
• Heart attack.
• Stroke.
• Excessive bleeding.
• Infection.
• Subtle problems in long-term memory, comprehension, calculation skills, and concentration.

What To Think About

When bypass surgery is clearly needed, surgery improves symptoms and in some cases prolongs life. But in many situations the reasons for doing bypass surgery rather than other treatments are less clear.

People are encouraged to ask their doctors what they can expect from bypass surgery compared with other forms of treatment. Bypass surgery does not cure coronary artery disease and does not affect the process of hardening and narrowing of the arteries (atherosclerosis). A person can still develop blockages in the new blood vessels that are used to bypass blocked arteries or in the original coronary arteries. Reducing risk factors and slowing the rate of atherosclerosis are vital to successful long-term results. Lowering cholesterol when it is high, quitting smoking, and controlling high blood pressure and diabetes are important in anyone who receives bypass surgery.

In each case, the cardiac surgeon or cardiologist should be able to clearly explain why bypass surgery is preferred over medicine or angioplasty. Sometimes a second opinion can be helpful when it is not clear that surgery needs to be done.

Atherectomy

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A procedure for opening up an artery by removing the plaque (atheroma) produced by the build-up of cholesterol and other fatty substances in the inner lining of the artery from atherosclerosis ("hardening of the arteries"). Atherectomy is done most often in major arteries -- such as the coronary arteries within the heart muscle and the carotid and vertebral arteries leading up to the head and brain -- that have experienced the occlusive effects of atherosclerosis.

Atherectomy can be done by various means, including a conventional surgical incision to open up the vessel or a catheter inserted into the artery the same way as in angioplasty. The catheter may have a laser that vaporizes the plaque, a rotating shaver (a "burr" device) on the end of the catheter, or a dissectional device that shaves off the plaque. Balloon angioplasty or stenting may then be done after the atherectomy.

In the US, atherectomy is also called the "Rotorooter" procedure (after the name of a company that reams out drainage pipes).

Angioplasty

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For certain people, heart disease treatment can be achieved without surgery. Angioplasty is a non-surgical procedure that can be used to open blocked heart arteries. Stent placement is another option that can be done during angioplasty.

The procedure is performed in the cardiac catheterization laboratory (or cath lab) by a specialized cardiologist and a team of cardiovascular nurses and technicians

What Happens During Angioplasty?

First, a cardiac catheterization is performed during angioplasty. You will receive medication for relaxation, and then the doctor will numb the site with local anesthesia.
Next, a sheath (a thin plastic tube) is inserted into an artery -- usually in your groin, but sometimes in the arm. A long, narrow, hollow tube, called a catheter, is passed through the sheath and guided up the blood vessel to the arteries surrounding the heart.
A small amount of contrast material is injected through the catheter and is photographed as it moves through the heart's chambers, valves, and major vessels. From the digital pictures of the contrast material, the doctors can tell whether the coronary arteries are narrowed and/or whether the heart valves are working correctly.
Once the catheter engages the artery with the blockage, the doctor will perform one of the interventional procedures described below.
The procedure usually lasts about 1 1/2 to 2 1/2 hours, but the preparation and recovery time add several hours. You may stay in the hospital overnight to be observed by the medical staff.

What Types of Interventional Procedures Are Used in Angioplasty?

There are several types of interventional procedures which your doctor may use when performing angioplasty. They include:

• Balloon angioplasty. During this procedure, a specially designed catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to compress the fatty matter into the artery wall and stretch the artery open to increase blood flow to the heart.
• Stent. A stent is a small metal mesh tube that acts as a scaffold to provide support inside your coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed while the stent stays in place permanently. Over a several-week period, your artery heals around the stent. Stents are commonly placed during interventional procedures such as angioplasty to help keep the coronary artery open. Some stents contain medicine and are designed to reduce the risk of reblockage (restenosis). The doctor will determine if this type of stent is appropriate for your type of blockage.
• Rotoblation. A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing in your coronary artery. The tip spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen. This process is repeated as needed to allow for better blood flow. This procedure is rarely used today because balloon angioplasty and stenting have much better results and are technically easier for the cardiologist to perform.
• Atherectomy. The catheter used in this procedure has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is inserted into the narrowed artery, the balloon is inflated, pushing the window against the fatty matter. A blade (cutter) within the cylinder rotates and shaves off any fat that protruded into the window. The shavings are caught in a chamber within the catheter and removed. This process is repeated as needed to allow for better blood flow. Like rotoblation, this procedure is rarely used today.
• Cutting Balloon. The cutting balloon catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon compresses the fatty matter into the artery wall.

What Can I Expect Before an Angioplasty?

Before an angioplasty, most people will need to have a routine chest X-ray, blood test, electrocardiogram and urinalysis. These tests may require separate appointments and are usually scheduled the day before the procedure.
You will not be able to eat or drink after midnight the evening before the procedure.
If you normally wear dentures or a hearing assistive device, plan to wear them during your angioplasty to help with communication. If you wear glasses, bring them also.
Please tell your doctor or nurse if you are taking Coumadin (warfarin), diuretics (water pills), or insulin. Also let them know if you are allergic to anything, especially iodine, shellfish, X-ray dye, latex or rubber products (such as rubber gloves or balloons), or penicillin-type medications.
You will need to take aspirin before the procedure. Please tell your doctor or nurse if you did not take aspirin.
You will remain awake during an angioplasty, but you are given medication to help you relax.

What Happens After an Angioplasty?

After your angioplasty, you will have to lay flat (without bending your legs) while the groin sheath is in place. A sheet may be placed across your leg with the sheath to remind you to keep it straight.
After the groin sheath is removed, you must lay flat for about six hours to prevent bleeding, but your nurse can raise your head (about two pillows high) after two hours. Your nurse will tell you when you can get out of bed with assistance six to eight hours after the groin sheath is removed (or sooner if a collagen "plug" was placed in your artery).
You should not eat or drink anything except clear liquids until the groin sheath is removed because nausea can occur during this time. Once you are allowed to eat, you will be advised to follow a low-cholesterol and low-salt diet. You may be admitted to the hospital overnight for observation after the procedure.
Notify your doctor or nurse immediately if you develop a fever or experience chest pain, swelling, or pain in your groin or leg. If you experience bleeding from your groin site after you return home, call 9-1-1 and lie down immediately. Remove the dressing and push down on your pulse in the affected area.
If a stent was placed during the angioplasty procedure, you will need to take platelet-blocking medications to reduce the possibility of a blood clot forming near the newly implanted stent.
When you have recovered sufficiently from the procedure and have talked with your doctor about your follow-up care, you will be able to go home.
You will need to take it easy for a few days after an angioplasty. You may climb stairs, but use a slower pace. Do not strain during bowel movements.
Gradually increase your activities until you reach your normal activity level by the end of the week.

Can Angioplasty Cure Coronary Artery Disease?

While procedures performed during coronary angioplasty will open a blocked artery, they will not cure coronary artery disease. Lifestyle factors that can worsen coronary artery disease, such as smoking and diet, will still need to be modified. An exercise program will also be prescribed to improve your cardiac health.

Carotid Artery Disease

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What are the carotid arteries?

Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. The carotid arteries can be felt on each side of the lower neck, immediately below the angle of the jaw.
The carotid arteries supply blood to the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside.
The vertebral arteries run through the spine and supply blood to the back part of the brain (the brainstem and cerebellum).

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, is the narrowing of the carotid arteries, usually caused by atherosclerosis. Atherosclerosis is the buildup of cholesterol, fat and other substances traveling through the bloodstream, such as inflammatory cells, cellular waste products, proteins and calcium. These substances stick to the blood vessel walls over time as people age, and combine to form a material called plaque.
Plaque buildup can lead to narrowing or blockage in the carotid artery which, when significant, can put an individual at increased risk for stroke.

What are the risk factors for carotid artery disease?

The risk factors that have been linked to the development of atherosclerosis include:

• Family history of atherosclerosis (either carotid artery disease or coronary artery disease or elsewhere in the vascular system)
• Age: In general, the risk of atherosclerosis increases as we age, and in particular, men under age 75 have a greater risk of developing carotid artery disease than women, but after age 75, women have a greater risk than men
• High levels of low density lipoprotein (LDL, bad cholesterol) and triglycerides in the blood. However, this link is not as strong as it is for coronary artery disease
• Smoking
• High blood pressure (hypertension)
• Diabetes
• Obesity
• Sedentary lifestyle

Typically, the carotid arteries become diseased a few years later than the coronary arteries. People who have coronary artery disease, and atherosclerosis elsewhere (such as peripheral artery disease or PAD) have a higher risk of developing carotid artery disease.

What are the symptoms?

There may not be any symptoms of carotid artery disease. However, there are warning signs of a stroke. A transient ischemic attack (also called TIA or "mini-stroke") is one of the most important warning signs of a stroke. A TIA occurs when a blood clot briefly blocks an artery that supplies blood to the brain. The following symptoms of a TIA, which are temporary and may last a few minutes or a few hours, can occur alone or in combination:

• Sudden loss of vision or blurred vision in one or both eyes
• Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body 
• Slurred speech, difficulty talking or understanding what others are saying
• Loss of coordination
• Dizziness or confusion
• Difficulty swallowing

A TIA is a medical emergency, since it is impossible to predict if it will progress into a major stroke. If you or someone you know experiences these symptoms, get emergency help (Call 9-1-1 in most areas). Immediate treatment can save your life or increase your chance of a full recovery.
TIAs are strong predictors of future strokes; a person who has experienced a TIA is 10 times more likely to suffer a major stroke than someone who has not experienced a TIA.

What is a stroke?

A stroke, or "brain attack," occurs when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing surrounding nerve cells to be cut off from their supply of nutrients and oxygen. When tissue is cut off from its supply of oxygen for more than 3 to 4 minutes, it begins to die.
A stroke can occur if:

• The artery becomes extremely narrowed by plaque
• A piece of plaque breaks off and travels to the smaller arteries of the brain
• A blood clot forms and blocks a narrowed artery

A stroke also can occur as a result of other conditions, such as sudden bleeding in the brain (intracerebral hemorrhage), sudden bleeding in the spinal fluid space (subarachnoid hemorrhage), atrial fibrillation, cardiomyopathy, or blockage of the tiny arteries inside the brain.

How is carotid artery disease diagnosed?

There may not be any symptoms of carotid artery disease. If you are at risk, it is important to have regular physical exams
A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (pronounced BROO-ee), may indicate carotid artery disease. However, bruits are not always present when there are blockages, and may be heard even when the blockage is minor.
Diagnostic tests include:

• Carotid duplex ultrasound: An imaging procedure that uses high-frequency sound waves to view the carotid arteries to determine if there is narrowing. This is the most common test utilized to evaluate for the presence of carotid artery disease.
• Carotid angiography (carotid angiogram, carotid arteriogram, carotid angio): During this invasive imaging procedure, a catheter (thin, flexible tube) is inserted into a blood vessel in the arm or leg, and guided to the carotid arteries with the aid of a special X-ray machine. Contrast dye is injected through the catheter while X-rays of the carotid arteries are taken. This test may be performed to evaluate or confirm the presence of narrowing or blockage in the carotid arteries, determine the risk for future stroke and evaluate the need for future treatment, such as carotid stenting or surgery.
• Magnetic resonance angiogram (MRA): MRA is a type of magnetic resonance image (MRI) scan that uses a magnetic field and radio waves to provide pictures of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from an X-ray, ultrasound, or computed tomography (CT) scan. This test can provide important information about the carotid and vertebral arteries and the degree of stenosis.
• Computerized tomography (CT Scan): a CT of the brain may be performed if a stroke or TIA is suspected to have already occurred. During a CT scan, X-rays pass through the body and are picked up by detectors in the scanner, which produce three-dimensional (3D) images on a computer screen. Depending on the type of scan you need, a contrast material might be injected intravenously (into a vein) so the radiologist can see the body structures on the CT image. This test may reveal areas of damage in the brain.
• Computed tomography angiogram (CTA): A test that uses advanced CT technology, along with intravenous (IV) contrast material (dye), to obtain high-resolution, 3D pictures of the carotid arteries. CTA images enable physicians to determine the degree of stenosis in the carotid and vertebral arteries and can also assess leading to these arteries as well as the blood vessels in the brain.

How is carotid artery disease treated?

Carotid artery disease is treated by:

• Making lifestyle changes
• Taking prescribed medications
• Having procedures as recommended

Lifestyle changes

To prevent carotid artery disease from progressing, these lifestyle changes are recommended by your doctor and the National Stroke Association:

• Quit smoking and using tobacco products.
• Control high blood pressure, cholesterol, diabetes, and heart disease.
• Have regular checkups with your doctor.
• Have your doctor check your lipid profile and get treatment, if necessary to reach a lipid goal of LDL less than 100 and HDL greater than 45 (your doctor may adjust these goals based on additional risk factors and/or medical history).
• Eat foods low in saturated fats, cholesterol, and sodium.
• Achieve and maintain a desirable weight.
• Exercise regularly - at least 30 minutes of exercise most days of the week.
• Limit the amount of alcohol you drink. Excessive alcohol use is defined as drinking more than three drinks per day. (One drink equals 12 ounces of beer or wine cooler, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.)
• Manage other risk factors:
  • Find out if you have heart rhythm problems, such as atrial fibrillation, which increases the risk of blood clots that can lead to stroke. If you have atrial fibrillation, you should take anticoagulant (blood-thinner) medications as prescribed.
  • Talk to your doctor about circulation problems that can increase your risk for stroke.

Medications

Anti-platelet medications: All patients with carotid artery disease should take an anti-platelet medication to reduce the risk of stroke and other cardiovascular disease complications. The most commonly used anti-platelet medication is aspirin.
Other drugs that work to keep platelets from "sticking together" include clopidogrel (Plavix) and dipyridamole (Persantine), which may be prescribed alone or in combination with aspirin to reduce your risk of stroke. In some cases, the anticoagulant medication warfarin (Coumadin) may be prescribed to thin your blood and reduce the risk of blood clots.
Tissue plasminogen activator (t-PA): A clot-dissolving medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of strokes caused by blood clots (ischemic strokes). Eighty percent of all strokes are ischemic. T-PA only works if it is given within three hours of the start of stroke symptoms.

Treatment procedures

If there is severe narrowing or blockage in the carotid artery, a procedure may be necessary to open the artery and increase blood flow to the brain, to prevent a future stroke.
If you have symptoms related to carotid artery narrowing, you will likely need to have either carotid endarterectomy or carotid stenting to correct the narrowing in the artery and reduce your risk of stroke.  Your vascular specialist will evaluate you to recommend the best treatment for your situation.
If you have carotid narrowing without symptoms, your vascular specialist will evaluate your test results and risk status to make a recommendation as to whether medical therapy, carotid stenting or carotid endarterectomy would be the best option.
Carotid endarterectomy is the traditional surgical treatment for carotid artery disease. Carotid endarterectomy has been proven to be beneficial for symptomatic patients with a 50 percent or greater carotid stenosis (blockage) and for asymptomatic patients with a 60 percent or greater carotid stenosis.
Carotid endarterectomy can be performed under general anesthesia (the patient is asleep) or local anesthesia with intravenous sedation. During the procedure, an incision is made in the neck at the site of the carotid artery blockage. The surgeon removes the plaque from the artery and when the plaque removal is complete, the surgeon stitches the vessel closed. Blood flow to the brain is restored through its normal path.
Carotid angioplasty and stenting has been FDA-approved as a treatment option for some patients with carotid artery disease. Please talk to your doctor to determine if you are eligible.
The carotid angioplasty and stenting procedure is performed while the patient is awake, but sedated. During the procedure, a balloon catheter is inserted through a sheath in a blood vessel. With X-ray guidance, the catheter is placed through the blood vessel and directed to the carotid artery at the site of the blockage or narrowing. A specially designed guidewire with a filter is placed beyond the area of blockage or narrowing.
Once in place, the balloon tip is inflated for a few seconds to open or widen the artery. The filter (called the embolic protection device) collects any debris that may break off of the blockage. A stent (a small mesh tube) is placed in the artery and opens to fit the size of the artery. The stent stays in place permanently and acts as a scaffold to support the artery walls and keep the artery open. After several weeks, the artery heals around the stent.
Research has shown that carotid stenting, when used with the embolic protection device, was as safe and effective as carotid endarterectomy in high-risk surgical patients.
Recovery from both the carotid endarterectomy and carotid angioplasty and stenting procedures generally requires a one-night hospital stay. Patients often return to regular activities within one to two weeks after these procedures.

Follow-up care

Your doctor will want to see you on a regular basis for a physical exam and possibly to perform diagnostic tests. Your doctor will use the information gained from these visits to monitor the progress of your treatment. Check with your doctor to find out when to schedule your next appointment.

Cardiac Catheterization

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What Is Cardiac Catheterization?

Cardiac catheterization (KATH-e-ter-i-ZA-shun) is a medical procedure used to diagnose and treat certain heart conditions.

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 do diagnostic tests and treatments on your heart.

For example, your doctor may put a special dye in the catheter. This dye will flow through your bloodstream to your heart. Once the dye reaches your heart, it will make the inside of your coronary (heart) arteries show up on an x ray. This test is called coronary angiography (an-jee-OG-ra-fee).

The dye can show whether a substance called plaque (plak) has narrowed or blocked any of your coronary arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in your blood.

Plaque narrows the inside of the arteries and, in time, may restrict blood flow to your heart. When plaque builds up in the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.

Blockages in the coronary arteries also can be seen using ultrasound during cardiac catheterization. Ultrasound uses sound waves to create detailed pictures of the heart's blood vessels.

Doctors may take samples of blood and heart muscle during cardiac catheterization and do minor heart surgery.

Cardiologists (heart specialists) usually do cardiac catheterization in a hospital. You're awake during the procedure, and it causes little to no pain. However, you may feel some soreness in the blood vessel where the catheter was inserted. Cardiac catheterization rarely causes serious complications.

Who Needs Cardiac Catheterization?

Cardiac catheterization is used to diagnose and/or treat many heart conditions. Doctors may recommend this procedure for various reasons. The most common reason is to evaluate chest pain.

Chest pain may be a symptom of coronary heart disease (CHD). Cardiac catheterization can show whether plaque is narrowing or blocking your heart's arteries.

Doctors can treat CHD during cardiac catheterization with a procedure called angioplasty (AN-jee-oh-plas-tee). During angioplasty, a tiny balloon is put through the catheter and into the blocked artery. When the balloon is inflated, it pushes the plaque against the artery wall. This creates a wider pathway for blood to flow to the heart.

Sometimes a stent is placed in the artery during angioplasty. A stent is a small mesh tube that's used to treat narrowed or weakened arteries in the body.

Most people who have heart attacks have partly or completely blocked coronary arteries. Thus, cardiac catheterization may be done on an emergency basis while you're having a heart attack. When used with angioplasty, the procedure allows your doctor to open up blocked arteries and prevent more damage to your heart.

Cardiac catheterization also can help your doctor figure out the best treatment for your CHD 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 doctors do cardiac catheterization to see how well the valves at the openings and exits of the heart chambers are working. Valves control the flow of blood in the heart.

To check your valves, your doctor will measure blood flow and oxygen levels in different parts of your heart. Cardiac catheterization also can check how well a man-made heart valve is working and how well your heart is pumping blood.

If your doctor thinks you have a heart infection or tumor, he or she may take samples of your heart muscle through the catheter. With the help of cardiac catheterization, doctors can even do minor heart surgery, such as repair certain heart defects.

What To Expect During Cardiac Catheterization

Cardiac catheterization is done in a hospital. During the procedure, you'll be kept on your back and awake. This allows you to follow your doctor's instructions during the procedure. You'll be given medicine to help you relax, which may make you sleepy.

Your doctor will numb the area on the arm, groin (upper thigh), or neck where the catheter will enter your blood vessel. A needle is used to make a small hole in the blood vessel. Through this hole your doctor will put a tapered tube called a sheath.

Next, your doctor will put a thin, flexible wire through the sheath and into your blood vessel. This guide wire is then threaded through your blood vessel to your heart. The wire helps your doctor position the catheter correctly. Your doctor then puts a catheter through the sheath and slides it over the guide wire and into the coronary arteries.

Special x-ray movies are taken of the guide wire and the catheter as they're moved into the heart. The movies help your doctor see where to position the tip of the catheter.

When the catheter reaches the right spot, your doctor will use it to do tests or treatments on your heart. For example, your doctor may do angioplasty and stenting.

The animation below shows the process of cardiac catheterization. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

The animation shows the step-by-step process your doctor will follow to perform cardiac catheterization.

The animation shows the step-by-step process your doctor will follow to do cardiac catheterization.

During the procedure, your doctor may put a special dye in the catheter. This dye will flow through your bloodstream to your heart. Once the dye reaches your heart, it will make the inside of your heart's arteries show up on an x ray called an angiogram. This test is called coronary angiography.

Coronary angiography can show how well blood is being pumped out of the heart's main pumping chambers, which are called ventricles (VEN-trih-kuls). When the catheter is inside your heart, your doctor may use it to take blood samples from different parts of the heart or to do minor heart surgery.

To get a more detailed view of a blocked coronary artery, your doctor may do intracoronary ultrasound. For this test, your doctor will thread a tiny ultrasound device through the catheter and into the artery. This device gives off sound waves that bounce off the artery wall (and its blockage) to make an image of the inside of the artery.

If the angiogram or intracoronary ultrasound shows blockages or other possible problems in the heart's arteries, your doctor may use angioplasty to open the blocked arteries.

After your doctor does all of the needed tests or treatments, he or she will pull back the catheter and take it out along with the sheath. The opening left in the blood vessel will then be closed up and bandaged. A small weight may be put on top of the bandage for a few hours to apply more pressure. This will help prevent major bleeding from the site.

What To Expect After Cardiac Catheterization

After cardiac catheterization, you will be moved to a special care area. You will rest there for several hours or overnight. During that time, your movement will be limited to avoid bleeding from the site where the catheter was inserted.

While you recover in this area, nurses will check your heart rate and blood pressure regularly. They also will check for bleeding from the catheter insertion site.

A small bruise may develop on your arm, groin (upper thigh), or neck at the site where the catheter was inserted. That area may feel sore or tender for about a week. Let your doctor know if you develop problems such as:

• A constant or large amount of bleeding at the insertion site that can't be stopped with a small bandage
• Unusual pain, swelling, redness, or other signs of infection at or near the insertion site

Talk to your doctor about whether you should avoid certain activities, such as heavy lifting, for a short time after the procedure.

What Are the Risks of Cardiac Catheterization?

Cardiac catheterization is a common medical procedure that rarely causes serious problems. However, complications can include:

• Bleeding, infection, and pain where the catheter was inserted.
• Damage to blood vessels. Rarely, the catheter may scrape or poke a hole in a blood vessel as it's threaded to the heart.
• An allergic reaction to the dye used.

Other, less common complications of the procedure include:

• Arrhythmias (irregular heartbeats). These often go away on their own, but may need treatment if they persist.
• Damage to the kidneys caused by the dye used.
• Blood clots that can trigger stroke, heart attack, or other serious problems.
• Low blood pressure.
• A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with cardiac catheterization.

The risk of complications with cardiac catheterization is higher if you have diabetes or kidney disease, or if you're aged 75 or older. The risk of complications also is greater in women and in people having cardiac catheterization on an emergency basis.

Key Points

• Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions. 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 do diagnostic tests and treatments.
• Cardiac catheterization most often is used to evaluate chest pain. It also may be done during a heart attack to identify narrowed or blocked coronary arteries. You also may need this procedure if other tests suggest you have coronary heart disease (also called coronary artery disease).
• Before having cardiac catheterization, discuss with your doctor how to prepare for the test and any special steps you need to follow. It may not be safe to drive after the procedure, so you must arrange for a ride home.
• Cardiac catheterization is done in a hospital. During the procedure, you'll be kept on your back and awake. This allows you to follow your doctor's instructions during the procedure. You'll be given medicine to help you relax.
• After the procedure, you'll be moved to a special care area. You will rest there 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 who have diabetes and kidney disease, and in older people and women.