What is Angioplasty?
Angioplasty is a procedure during which a person's coronary artery is widened to increase blood flow to the heart muscle tissue (this procedure is also called percutaneous transluminal angioplasty or PCTA). Angioplasty uses a catheter to reach the coronary artery and is less invasive and has a shorter recovery time than bypass surgery, which requires open-heart surgery.
During an angioplasty, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided into the narrowed coronary artery. Once the catheter reaches the narrowed portion of the artery, a small balloon at the end of the tube is inflated. The balloon may remain inflated from 20 seconds to three minutes and is then deflated and removed. The pressure from the inflated balloon presses the plaque against the wall of the artery, creating more room for blood to flow.
A small, expandable wire tube called a stent is often permanently inserted into the artery during angioplasty. The balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall. Because the stent is mesh like, the cells lining the blood vessel grow through and around the stent to help secure it.
This procedure is designed to:
- Open up the artery and press the plaque against its walls, thereby improving blood flow
- Keep the artery open after the balloon is deflated and removed
- Seal any tears in the artery wall
- Prevent the artery wall from collapsing or closing off again
- Prevent small pieces of plaque from breaking off that might cause a heart attack
What to Expect After TreatmentAfter angioplasty, you will be moved to a recovery room or to the coronary care unit. Your heart rate, pulse and blood pressure are closely monitored and the catheter insertion site is checked for bleeding.
You usually can start walking within 12 to 24 hours after angioplasty. The average hospital stay is one to two days for uncomplicated procedures. You may resume exercise and driving after several days.
You are usually given aspirin after angioplasty and stenting to help prevent the formation of blood clots. When a stent is also used, you are given aspirin and usually another anti-platelet medication (such as ticlopidine [Ticlid] or clopidogrel [Plavix]). You will usually take the aspirin long-term; the second antiplatelet medication is usually only given for a two- to four-week period after the stent is placed.
Why It Is DoneAlthough many factors are involved, angioplasty is most often used if you have:
- Frequent or severe chest pain (angina) that is not responding to medication
- Evidence of severely reduced blood flow (ischemia) to an area of heart muscle caused by one or more narrowed coronary arteries
- The artery can be treated successfully with angioplasty
- The region of narrowing in the coronary artery does not involve the left main coronary artery or the proximal portion of the left anterior descending artery
- You are in good enough health to undergo the procedure
What is cardiac catheterization?
Cardiac catheterization (kath-uh-ter-I-za-shun) is one of the common tests used to diagnose a heart problem. During the procedure, a long, bendable tube is inserted into a blood vessel in the groin. It is then gently guided to your heart under X-rays.Click here to see before and after videos of a heart.
Why should I have this test?
Your doctor has told you that you may have coronary artery disease. This means that the blood vessels within your heart may be narrowed or blocked. Angina (an-gin-uh) is the term doctors and nurses use to describe the symptoms when your heart is not receiving enough oxygen. Your doctor may also check on how well the valves are opening and closing. If the valves do not work properly, blood can back up into the chambers and makes the heart work harder. Because the heart is working harder it becomes larger. As it becomes larger over time, the heart does not pump blood well to the entire body. Some patients experience chest discomfort and/or trouble breathing.
You may have one or more of the following symptoms:
- Chest tightness, fullness, heaviness, numbness, squeezing, aches and pain
- Ache in the jaw, neck, and arm, in the back or between the shoulder blades
- Shortness of breath
- Indigestion, heartburn or feeling sick to your stomach
- Weakness or generalized fatigue
Your doctor is suggesting a procedure to assess the pumping function of the heart and to examine the coronary arteries. Your doctor may also examine the heart's valves.
The cardiac rehabilitation programs at each of the Maine Heart Center hospitals provides you an opportunity to learn how to take charge of you life by better understanding how your lifestyle and daily habits affect your heart health. The programs are open to people who have had a heart attack, heart surgery or angioplasty, and focus on helping you change your lifestyle to prevent a second occurrence. We provide nutrition counseling, graduated exercise training, stress reduction education and more.
The talented staff at each program will teach you that through better nutrition, exercise, lowering the "bad" cholesterol, managing stress and stopping smoking, future heart trouble may be prevented. Adopting a healthy lifestyle can even reverse some effects of heart disease. The talented, professional staff includes physicians, nurses and healthcare specialists. Your personal physician will be involved in all aspects of your care. Working as a team, a plan will be developed which will continuously monitor your progress. The program's nutritionist will demonstrate how to cook delicious, heart-healthy meals. Qualified staff will help to develop a program to quit smoking and manage stress. Others will work to incorporate exercise into a daily routine. Family members are encouraged to participate in the promotion of healthy habits.
Cardiac rehabilitation services are available at:
- Healthy Heart Program at Southern Maine Medical Center, (207) 283-7773
- Cardiac Rehabilitation Program at Mid Coast Hospital, (207) 373-6360
- Cardiac Rehabilitation Program at St. Mary's Regional Medical Center, (207) 753-3259
- Turning Point, Cardiac Rehabilitation Program of Maine Medical Center, 96 Campus Drive, Scarborough, ME (207) 396-8700 or toll free (866) 556-2550
- A Change in Heart Works, the Cardiac Rehabilitation Program at Maine General Medical Center Augusta, (207) 626-1529, Waterville (207) 872-1353
The heart has four chambers. At each squeeze, the valves open to let blood pass to the next chamber; then the valves close to prevent blood from moving backwards.
If a valve doesn't completely open, less blood must pass through a narrower opening. With a condition called " stenosis, " the valve may become difficult to open because it has become hardened with deposits or scarring. Conversely, if a valve doesn't tightly close, blood may move backwards. The valve or its supportive structures may have become worn. In either case, the heart has to work harder to pump the same amount of blood.
During heart valve surgery, one or more heart valves can be repaired or replaced. If a valve is repaired, it is made to work more efficiently. If it is replaced, a new valve replaces the defective one. If a valve is repaired, parts of a valve that are stiff or hardened are altered to help them open more widely. Parts of a worn valve may be strengthened to help the valve close more tightly. If a valve can't be repaired, it may be replaced with a prosthesis (a synthetic substitute for a valve). Two kinds of prosthetic heart valves are available: mechanical valves that are created from man-made materials and biological valves that are taken from animal or human donors.
Coronary Bypass Surgery
Coronary bypass surgery is performed to bypass blockages in the coronary arteries that feed the heart muscle. The number and areas of blockages are identified prior to surgery by cardiac catheterization. In order to bypass the blocked section of coronary artery, the surgeon actually reroutes the blood flow through a new section of blood vessel. This new vessel is usually taken from an internal mammary artery (which delivers blood to the shoulders and arms), an artery in the wrist or a vein of the leg. When these vessels are removed for bypass surgery, other vessels will take over their original function.
When the operation begins, two surgeons work on the patient. The first surgeon opens the chest, while the second surgeon harvests the saphenous vein. The length of the section of the vein or artery to be removed is determined by the number of bypasses to be performed. Once the vein has been successfully harvested, the leg incision is closed. The second surgeon then assists the remainder of the operation. The harvested artery of vein is now used to enable the blood to circumvent the blocked pathways.
For over 10 years, Maine Heart Center physicians have been implanting coronary stents into small arteries on the surface of the heart to improve blood flow and relieve symptoms of angina pectoris (chest pain).
What is a stent?
Stents are small metal mesh tubes that are expanded by a balloon at the site of blockage and act as scaffolding to keep the artery open and maximize blood flow to the heart muscle. Over 2,300 patients underwent this procedure at MHC last year.
In early 2003, the FDA approved a new heart stent (Cypher, Cordis/JNJ) that has had a major favorable impact on how well patients do after stent implantation. These stents have been coated with a drug that dramatically reduces any reblockage of the stent. By inhibiting scar tissue formation within the stent, the medicated stent reduces the chance a patient will need to return for a reblockage of the implanted stent by 75%.The cardiology clinical research group at MMC continues to play a major role in multiple clinical trials evaluating new drug-eluting stent technology.
What is an Echocardiogram?
An echocardiogram, or echo of the heart, is a painless test that uses high-frequency sound waves (ultrasound) to get a picture of the heart. The sound waves bounce back from the heart chambers and valves, producing images and sounds that detect damage and disease.
The procedure is noninvasive and painless. A conductive gel is applied to the chest. The technician then moves a small device called a transducer to the appropriate points and a picture of the area is transmitted to a video monitor. It may be saved on tape or stored in a computer.
There are many different types of echocardiograms, including:
- Doppler ultrasound, which computes the blood's velocity in the heart. A Doppler adds color in order to perceive the flow patterns more clearly
- Stress echocardiogram, which is performed while the patient exercises on a treadmill or stationary bicycle. This may reveal an inadequate blood supply to selected areas of the heart muscle
- Chemical stress echocardiogram, which is used with patients who are unable to perform physical activity. Although the patient is lying down for this procedure, the drug causes the heart to react as if the person were exercising
An electrocardiograph (ECG or EKG) is a graphical representation of the electrical currents produced by the heart while it beats. In a 12-lead ECG the patient, who is sitting or lying down, has twelve stick-on electrodes attached to the skin to detect these electrical impulses. In turn, these leads are connected by wires to a printer which records the heart's pattern of electrical activity.
A normal heartbeat produces a specific pattern of waves. Different kinds of cardiac damage and disease result in other configurations. Hence, an ECG is a diagnostic tool that can pinpoint the location and extent of an injury to the heart. It can also show how the heart is responding to treatment.
What is a Stress EKG or EKG?
A stress ECG is taken while a patient is exercising on a treadmill or bicycle. This shows whether the heart is receiving an ample supply of oxygen as the demand on the heart increases. If the quantity of oxygen decreases while the demand increases, the ECG will change in predictable ways. If someone is unable to exercise, then a drug may be administered to simulate such activity.
Some of the most common reasons why such tests are done include the following:
- To see if an asymptomatic person has silent coronary artery disease, such as blockages or hardening of the arteries of the heart.Here the cardiologist hopes to detect a problem before the usual symptom of a heart attack or even death.
- To determine if a person's symptoms (such as chest discomfort or difficulty breathing) are due to heart disease rather than another problem.
- To see if the treatment being given to a patient for blocked arteries is working properly. To assess a person's exercise tolerance before beginning an exercise or cardiac-rehabilitation program.
- To determine if exercise causes an abnormal heart rhythm.
What is an Electrophysiology (EP) Study?
A cardiologist may recommend an electrophysiology (EP) study when standard tests cannot provide enough information to evaluate an abnormal heart rhythm or arrhythmia. It offers more detailed information about the electrical activity in the heart than other tests because electrodes are placed directly on the heart. This allows the physician to pinpoint the location of an arrhythmia and to correct it.
Both the EP study and the catheter ablation are low-risk procedures. Two or more catheters are inserted into a vein in the groin. Using X-rays, the catheters are moved to specific locations in the heart. Electrodes are usually placed at the end of the catheters, which have the ability to send and receive electrical signals to and from the heart. First, the electrodes are positioned to receive signals from inside the heart's chambers, allowing measurements of the electrical impulses in the patient's heart. Next, the electrodes are used to stimulate the heart. The EP team tries to induce the arrhythmia. When it is successfully induced and if it is determined that it can be treated with catheter ablation, a cardiac mapping is done to locate the abnormal pathway. When this is located, the ablating electrode catheter is positioned and energy is delivered through the electrode to destroy the tissue in this area. The treatment is usually considered a cure.
Cardiothoracic surgery remains the cornerstone of treatment for infants and children with structural heart disease. Improved pre- and post-operative care, combined with advancements in intra-operative technique, continue to lower mortality rates and broaden the therapeutic possibilities for patients with complex lesions.
The Congenital Heart Surgical program at Maine Heart Center utilizes highly trained individuals from the fields of cardiology, anesthesiology, nursing, perfusion and intensive care to bring comprehensive expertise to the care of each child who undergoes cardiac surgery. "Perhaps no other surgical patient requires the coordinated effort of so many sub-specialized disciplines," says Reed Quinn, M.D., director of the Division of Pediatric Cardiothoracic Surgery.
Maine Heart Center offers all types of curative and palliative surgery for infants, children and adults with congenital heart disease, except for cardiac transplantation. Being the only surgical program in the state translates into an experienced surgical team with a quality of care that is among the best in the country.
Recent developments in cardiac ultrasound have transformed the practice of pediatric cardiology. Advances in transducer design and data processing have made it possible for the first time to image the beating heart in three dimensions, providing the surgeon with a 3-D model of the heart prior to surgery.
"There is simply no substitute for being able to non-invasively look inside the patient's heart and thoroughly understand the problem before the surgeon makes an incision," says Aurelio Reyes II, M.D., director of the Pediatric Echocardiography Laboratory.
Transesophageal echocardiography also provides crucial information during cardiac interventions to provide the best possible procedural outcomes. In addition to performing 3,387 transthoracic and 176 transesophageal studies last year, the Division of Pediatric Cardiology also provides the primary fetal echocardiography service in the state, allowing time for both parents and physicians to plan for the birth of a child with congenital heart disease.
Cardiac MRI is quickly becoming an essential non-invasive imaging modality for the assessment of cardiac function and vascular anatomy. Dr. Adrian Moran, who received his training at Boston Children's Hospital, is the first and only cardiologist in Maine with expertise in cardiac MRI. "Magnetic resonance imaging overcomes some of the shortcomings of ultrasound by enabling the physician to image two-dimensional slices of the heart from any angle. Using complex, post-processing algorithms, the cardiologist can then construct a three-dimensional model of the heart which can be viewed from all sides, as if you were holding a plaster model," says Dr. Moran.
The electrophysiology (EP) services at MHC provide expert care for rhythm disorders in patients from fetal life through adulthood. All diagnostic and therapeutic modalities are available including rhythm surveillance, exercise testing, tilt-table evaluation, pacemaker and defibrillator implantation and follow-up, transesophageal and intracardiac EP testing, and radiofrequency ablation.
"Children are not just small adults" says Michael Epstein, M.D., Maine 's first and only pediatric electrophysiologist. "Issues of small size and patient growth play a vital role in the diagnosis and management of rhythm disorders in kids." In addition to caring for the very young, one of the great challenges faced by pediatric EP is the care of adults with repaired or palliated congenital heart disease. As more patients with complex disease survive into adulthood, rhythm abnormalities have become a common and serious morbidity. Pediatric electrophysiologists, because of their unique knowledge of structural heart disease, are best equipped to manage these difficult problems.
Dr. Epstein is a graduate of Harvard Medical School and performed his residency, fellowship and EP training at Boston Children's Hospital.
Catheter-based intervention is becoming increasingly utilized as a curative therapy for simpler, more common forms of congenital heart defects. Many congenital lesions, such as atrial septal defects or patent ductus arteriosus, can be closed with special devices delivered through catheters that are smaller than a drinking straw.
Similarly, congenitally obstructed blood vessels, such as coarctation of the aorta or pulmonary artery stenosis, can be completely opened with current stent technology. "It is exciting to be able to completely fix a patient's heart defect with no surgical incisions and essentially no recovery time," says Jon Donnelly M.D., director of the Pediatric Catheterization Laboratory. "Our efforts continue to be in collaboration with our surgical colleagues as many of the emerging catheter interventions take place in the operating room to augment a complex surgical repair."
The Pediatric Catheterization Laboratory at the Congenital Heart Center of Maine offers all FDA-approved procedures and devices used to treat children and adults with congenital heart disease. Being the only pediatric catheterization lab in the state helps ensure a sizeable volume and variety of procedures, which translate into experienced operators and quality care for the patient. A recent review of the last 1,000 cases revealed a mortality rate of 0.2% and major complication rate of 1.8%, both of which are well below the national average.
Precious Heart Support Group
Find out about Precious Heart Support Group for families with congenital heart defects.
Pam Schlichting, BSN, RN
22 Bramhall Street
Portland, ME 04102
Phone (207) 662-2273
Click here for Barbara Bush Children's Hospital Pediatric Cardiology Services.
MaineGeneral Medical Center
Maine Medical Center, Portland
207-662-0111 / 1-877-339-3107
Mid Coast Hospital, Brunswick
St. Mary's Regional Medical Center, Lewiston
Southern Maine Health Care, Biddeford
Physician DirectoryMaine Medical Partners
Scarborough: (207) 885-9905, Portland: (207) 774-2642
Augusta: (207) 430-4321
Waterville: (207) 872-1800
Lewiston: (207) 777-5300
Oakland: (207) 873-1715
Rockport: (207) 596-6410
Maine Centers for Healthcare
Maine Medical Partners
Mid Coast Cardiology
Pediatric Cardiology Associates
Southern Maine Healthcare
Spectrum Medical Group - Northeast Anesthesia Division