Interventional Cardiology
Cardiac Catherization
Cardiac Catheterization is a common treatment used for people suffering from various heart conditions. During this procedure, a catheter (a thin, long tube) is passed through a blood vessel in the arm, leg, or neck, and into your heart. This helps your doctor perform diagnostic tests, including collecting blood samples, measuring blood pressure in the heart’s chambers, assessing the flow across heart valves, and looking for the presence of blockages in the Coronary Arteries.
Cardiac Catheterizations are performed for various diseases and disease screenings. Cardiac catheterization is typically a low risk, minimally invasive procedure that can sometimes be performed in under an hour. Patients typically can go home the same day, but sometimes have to spend one night in the hospital.
Coronary Artery Disease
A combination of elevated cholesterol, inflammation, and blood vessel injuries can lead to an increase in deposits of fat and cholesterol in the walls of the arteries of the heart. These blockages, or atheromas, are typically asymptomatic as they grow larger, often being found in people many years before they ever have symptoms. As the atheromas grow, the blood vessels accommodate by dilating, until they are unable to stretch any further. Then, the artery begins to get blocked by the increasing amount of cholesterol pushing in from the outside. This process is referred to as “stenosis.” As the stenosis increases, the artery eventually becomes unable to maintain enough blood flow during exercise, and the patient can develop chest pain or angina.
With angina, the heart suffers during exertion or stress, and the patient develops chest pain or pressure, shortness of breath, or fatigue. If these symptoms cannot be managed with medications that are meant to improve the blood flow through the arteries, a catheterization can determine the location of any blockages, and using extremely fine wires as guides, the artery can be opened by a procedure called Angioplasty (balloon dilation of an artery) and Stenting (insertion of a metal scaffold to keep the artery open).
Heart Attack/Myocardial Infarction
Typically, the progression of Coronary Artery Disease occurs in a continuous manner, but sometimes, the process can accelerate rapidly under conditions of stress, illness, or an increased workload on the heart. In these situations, the patient’s angina will not come on predictably, but can occur suddenly, even when sleeping. The sudden decrease in blood flow to the heart due to a ruptured cholesterol plaque, a blood clot, or rapid worsening of the stenosis is called a Myocardial Infarction, or Heart Attack. In this situation, a part of the heart muscle is severely deprived of blood and Oxygen, which causes damage to part of the heart muscle. This can be detected by an EKG and by blood testing.
When a patient suffers a Myocardial Infarction, they are at risk for weakening of the heart muscle, dangerous heart rhythm disturbances, further episodes of chest pain, and repeated Heart Attacks. These patients often benefit from a Cardiac Catheterization, along with blood thinning medications, which allow the doctor to restore blood flow to the damaged areas of the heart, while protecting the areas that are still healthy. Most often, stents are used to keep the arteries from clogging up again, called Restenosis. This procedure can effectively prevent repeated events, and many times, can prolong a patient’s life.
Heart Failure
The most important job of the heart is to function as a pump, delivering blood and oxygen to the body. When a patient is suffering from Heart Failure, the heart is unable to function effectively to deliver the Oxygen to every organ. The symptoms can include shortness of breath, fatigue, swelling, nausea, bloating, coughing, weight gain, and abdominal discomfort. The Heart Failure is frequently caused by a weakened heart muscle, but almost half of the time, it is caused by an inability of the heart to relax well, despite squeezing normally. These two problems can be due to blockages in the arteries, inflammatory diseases, rhythm disturbances, high blood pressure, kidney disease, and many other diseases.
A heart catheterization that involves measuring the pressures inside all of the heart chambers, as well as the oxygen levels in multiple blood samples, can help your doctor to determine the precise cause of your Heart Failure. With improved information comes the ability to tailor the medical therapy to each individual patient, allowing for more precise treatment of your individual cause of Heart Failure.
Heart Valve Disease
The heart has four chambers and four valves, which prevent blood from flowing backward during each heartbeat. These valves are paper-thin and are designed to open and close between 60 and 100 times per minute, for your entire life. After years of movement, combined with high blood pressure, inflammation, and multiple other reasons to take damage, the valves can break down over the years. Some valves can become stenotic, or too tight, and other valves can become Regurgitant, or leaky. In either situation, the valves do not function properly, and blood can be prevented from flowing in a normal manner. This can lead to Heart Failure, cough, shortness of breath, rhythm disturbances, passing out, and eventually to death, in some situations.
Using our noninvasive tests, like Echocardiograms and EKGs, your doctor can start to determine which patients have valve disease. In most situations, these valve problems can be better diagnosed by directly measuring the pressure and flow across the valves using a Catheterization. In many of these situations, there are minimally invasive procedures that can allow patients to have thorough treatment of their valve disease without the risks of Open Heart Surgery. These procedures, the TAVR, MitraClip, and Valvuloplasty, are among the most advanced procedures performed in medicine and can be performed with relative ease and great safety in a Cardiac Catheterization Lab.
Pulmonary Hypertension
The heart and lungs work together throughout your life to provide oxygen to the body and to remove waste products, including Carbon Dioxide. In the same way that your doctor checks the blood pressure in your body, the blood pressure in the arteries of the lungs can be measured using fine catheters. The pressure in the Pulmonary Arteries can be elevated for many reasons, including Heart Failure, Valve Disease, Lung Diseases, Chronic Infections, Congenital Heart Disease, and diseases of the Arteries themselves.
Through the procedure of catheterization, the pressure in the Pulmonary Arteries can be measured directly, and different medications can be used to determine the precise cause of the elevated pressures. The results of this test can allow your doctor to provide a more complete diagnosis, leading to a medication regimen tailored to your specific cause of Pulmonary Hypertension.