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).