Patient Education

Basic information about the human heart and procedures performed at Cardiology Associates are described below. Click on a topic for more details. If additional information is desired, please contact us.

• Warning Signs of a Cardiac Emergency
  

  Some of the symptoms of a cardiac emergency are:
  
  

  • Chest pain which lasts for more than a few minutes
  • Pain which spreads to the arms, neck, or shoulders
  • A feeling of "fullness or squeezing" in the chest
  • Fainting, sweating, nausea, or shortness of breath

  In emergency situations, please call our regular office number, day or night: (806) 792-5105 After office hours, our answering service will notify your doctor or the doctor on call. Time counts! If you have any of the warning signs of a cardiac emergency, do not delay! Call EMS or 911 and get to a hospital as soon as possible.

  
  
• How the Heart Works
  

  The heart is a muscular, hollow organ that constantly pumps blood throughout the body. It is made up of strong muscle tissue, called heart muscle. The heart has four chambers. The two upper chambers (atria) receive and collect blood. The two lower chambers (ventricles) pump blood. The left ventricle is the heart's main pumping chamber. The four heart chambers work together to contract and pump blood. As it circulates, blood delivers oxygen and nutrients throughout the body.

  The Coronary Arteries:
  In order to keep pumping blood throughout the body, the heart must have a continuous supply of oxygen. The coronary arteries are the vessels that carry oxygen-rich blood to the heart muscle. As blood leaves the left ventricle, it is forced into the body's main artery, the aorta. At the very beginning of the aorta, near the top of the heart, emerge the two coronary arteries. They are referred to as the "left" and "right" coronary arteries. The first segment of the left coronary artery is called the left main artery. It is about as wide as a drinking straw, and less than an inch long. The left main artery then branches into two slightly narrower arteries—the left anterior descending, which travels down the front side of the heart; and the left circumflex, which circles around the left side and then to the back of the heart. The right coronary artery comes from the aorta, circles around the right side, and then to the back of the heart. The coronary arteries travel on the surface of the heart and divide into smaller branches. They then penetrate deep into the heart muscle, carrying oxygen-rich blood to the cells.

  
  
• Coronary Artery Disease
  

  The inside walls of arteries are normally smooth and flexible, allowing blood to flow through them easily. Over the years, the inside of an artery’s wall may become plugged with fatty deposits.

  When this process (which is called atherosclerosis) involves the coronary arteries the result is coronary artery disease. As these fatty deposits, known as plaques, continue to build up, they narrow the arteries and can reduce the flow of blood. These plaques may sufficiently reduce blood flow in the coronary arteries to cause angina or heart attack.

  Angina is a pain or discomfort in the chest, arm, neck, or jaw that occurs when narrowed or blocked coronary arteries do not allow sufficient blood flow to the heart muscle. Angina typically occurs during physical exertion or emotional stress, when the heart works harder and needs more oxygen. It usually lasts for only a few minutes and is relieved by resting.

  In a heart attack, a blood clot usually forms in the narrow portion of the artery, sealing the passageway. This cuts off the supply of oxygen-rich blood to the heart muscle and leads to permanent damage to a portion of the heart muscle. As opposed to angina pain, the pain of a heart attack usually lasts for more than 15 minutes and does not go away with rest.

  
  
• Cardiac Catheterization (Angiogram)
  

  

  If your doctor suspects you have coronary artery disease, he or she may recommend that you undergo cardiac catheterization (also called an angiogram). During catheterization, x-ray dye is injected into the coronary arteries and pictures are taken. In patients with coronary artery disease, the pictures show the actual blockages and their severity.

  Treatment Options: Several options are available for treating patients with coronary artery disease.

  Medications can help reduce symptoms of angina either by improving the supply of oxygen to the heart muscle and/or by reducing the heart's need for oxygen. Although they are frequently prescribed to patients with heart disease, drugs do not eliminate existing coronary blockages.

  Bypass surgery is an operation in which surgeons create a bypass (detour) to allow blood to go around blockages in the coronary arteries. To accomplish a bypass, surgeons use a graft — a blood vessel from the leg or chest. With the graft in place, blood can now flow freely to the heart muscle, bypassing the blocked or narrowed section of the artery. A week's stay in the hospital is usually necessary after the surgery. It may take up to three months to fully recover after this type of surgery.

  Coronary angioplasty is a technique used to open narrowed arteries without surgery. A special catheter (a long, flexible tube) with a small balloon at its tip is passed into the narrowed artery. The balloon is inflated, compressing the fatty plaque against the artery’s walls. The larger opening allows better blood flow to the heart muscle. Although angioplasty is successful in most cases, it also has limitations. In particular, the blockage in the artery may recur. To help prevent the artery from closing off, doctors may decide to implant a coronary stent.

  A coronary stent is a small metal coil, slotted tube, or mesh structure that is placed in an artery to keep it open. The stent is mounted on a balloon catheter and delivered to the site of the blockage. When the balloon is inflated, the stent expands and is pressed against the inner wall of the coronary artery. After the balloon is deflated and removed, the stent remains in place, keeping the artery open.

  
  
• Coronary Angioplasty
  

  Preparing for Angioplasty

  Unless you are already hospitalized, you probably will be admitted to the hospital on the day of the procedure or the night before. Several routine tests will be performed, including an ECG and blood tests. (Blood tests may be done one or two days before the procedure.) The doctor will explain the technique, its purpose, potential benefits, and possible risks. This is a good time to ask questions and, most importantly to share any feelings or concerns you may have about angioplasty. You will then be asked to sign a consent form. A nurse will shave and cleanse the area where the catheters will be inserted. In most cases, this will be the groin; in some cases, the arm. Shaving and cleansing makes it easier to insert the catheters and helps to avoid infection. A small intravenous needle ("IV line") will be inserted into a vein in your arm. It allows drugs to be injected directly into the vein, if needed. You may also be given a sedative to help you relax.

  During the Procedure

  You'll be transported to the cath lab on a movable bed, then transferred to an x-ray table. The table has a large camera above it and television screens close by. The equipment in the cath lab also includes heart monitors and various instruments and devices. The cath lab team generally includes a cardiologist, an assistant (usually a doctor), one or two nurses, and technicians. After being positioned on the x-ray table, you'll be connected to a variety of monitors and covered with sterile sheets. The staff will be wearing sterile gowns, masks, and gloves.

  How Is Angioplasty Done?

  The site where the catheters will be inserted, usually the groin, is cleansed with an antiseptic solution. A local anesthetic is then injected into the skin with a tiny needle, to numb the area. This may cause a stinging sensation. A small incision is made in the skin, and a needle is used to puncture the artery. A guide-wire (a long, flexible wire) is inserted into the artery. A short plastic tube, called an introducer sheath, is slipped over the guide-wire and into the artery. Doctors then insert a guiding catheter through the introducer sheath. With the help of an x-ray camera, the guiding catheter is directed toward the opening of the diseased artery. Contrast dye may be injected into the vessel to get pictures of the obstruction. Next, doctors insert a balloon catheter through the guiding catheter. It has a small balloon at its tip that is used to open or widen the narrowed artery. The balloon catheter is threaded into the artery and then advanced across the narrowed area. Once in position, doctors slowly inflate the balloon. This stretches the artery and flattens the plaque against the artery's wall. The balloon is then deflated and pulled out. The larger opening in the artery now allows improved blood flow.

  What You Can Expect

  You will be awake during the procedure, although medication may be given to help you relax (it is not uncommon to doze off during the procedure). The staff will be monitoring your progress constantly. You may be asked to take a deep breath and hold it, to prevent blurring of the pictures. You may also be asked to cough forcefully several times to help move the dye through the heart. The procedure usually is not painful, although you may feel some pressure in the groin area during the insertion of the catheters. You may experience some chest discomfort during the inflation of the balloon. Also, you may feel tired and uncomfortable from lying still for a long time. The angioplasty procedure generally lasts from one to two hours, occasionally longer.

  The Results

  Angioplasty is considered "successful" when the narrowed artery has been opened wide enough to allow adequate blood flow. Angioplasty sometimes fails to open the artery. This may occur, for example, when the artery is curved and the narrowed area is located beyond sharp bends. Also, in patients with long-standing disease, the plaque may have hardened to such a degree that it cannot be flattened.

  Is Angioplasty Safe?

  In the majority of cases, angioplasty is successful and no problems occur. However, as with any other "invasive" procedure that requires the insertion of a catheter into the body, there are some risks. Risks associated with the catheterization (which is part of the angioplasty procedure) may include nausea and vomiting, allergic skin rash, abnormal heart rhythms, and damage to blood vessels. Less frequently, angioplasty may be associated with more serious complications. These include tearing or cracking of the artery lining, bleeding at the site of insertion, heart attack, and stroke. Rarely, a complication occurs that makes emergency bypass surgery necessary. Deaths are very rare. Although most patients who undergo angioplasty do not experience complications, you should be aware of the risk. To learn about your particular risk, discuss the matter with your doctor.

  The Obstruction May Recur

  During angioplasty, the balloon stretches the artery's wall and may cause some injury to it. In some cases, this may cause the artery to close off abruptly during or soon after the procedure. In about one-third of initially successful angioplasty procedures, a blockage slowly recurs at the same site. This renarrowing or reclosure of the artery is called a restenosis. When restenosis occurs, it usually does so within the first six months after the procedure. Should the artery close off, it may be possible to re-open it with a repeat angioplasty. In some cases, doctors may recommend a coronary stent. During catheterization, x-ray dye is injected into the coronary arteries and pictures are taken. In patients with coronary artery disease, the pictures show the actual blockages and their severity.

  
  
• Coronary Stents
  

  In some cases, a coronary stent may be implanted following balloon angioplasty. A stent may be needed, for example, when angioplasty fails to open the artery sufficiently. Other times, a stent may be implanted to help reduce the chance of restenosis. Because a stent implant has risks as well as benefits, it is not for everyone. Your doctor will decide if a stent is the right treatment for you.

  How Is a Stent Implanted?

  A variety of stent designs have been developed. The Palmar-Shatz stent, the most widely used of these devices, is a small slotted, stainless-steel tube. It is about half an inch long, is as narrow as a piece of spaghetti, and weighs as little as a straight pin. The stent is mounted on a balloon catheter. It is inserted into the artery and is positioned at the site where the plaque was compressed. When the balloon is inflated, the stent expands and presses against the inner wall of the coronary artery. Another balloon may be used to fully expand the stent. After the balloon is deflated and removed, the stent remains in place, keeping the artery open. One or more stents may be used in the artery to span the length of the blockage. The stent is a permanent implant that will remain in your artery. Within weeks, new tissue will slowly grow over the stent and completely cover it.

  After the Procedure

  After the procedure, you'll be taken to the recovery area or to a special cardiac care unit, where you'll be monitored closely. The introducer sheath is usually left in the groin for several hours or overnight. When your condition is stable, the sheath is removed and pressure is applied to the insertion site until bleeding has stopped. After the sheath is removed, you'll lie flat on your back for six hours, sometimes longer. During that time, do not bend or lift the leg where the catheters were inserted. To relieve stiffness, you may move your foot and wiggle your toes. The nurses will monitor your heart rhythm and blood pressure very closely and will keep checking the insertion site for bleeding. When you return to your room, you may eat and drink, and family can visit.

  
  
• Cardiac Pacemaker
  

  A cardiac pacemaker is an electronic device that is implanted in the chest to permanently regulate heartbeat rhythms. The pacemaker monitors the heartbeat to make sure it is not beating too slowly, and when necessary transmits electric pulses to the heart to increase the heartbeat pace. Pacemakers are periodically replaced every several years when the battery runs out. Routine check-ups should follow implantation of a pacemaker as recommended by your physician. People with pacemakers should avoid strong electrical or magnetic fields.

  
  
• Cardiac Defibrillator
  

  A cardiac defibrillator is an electronic device that is implanted in the chest to prevent sudden cardiac arrest due to heartbeat rates that are too rapid. The defibrillator monitors the heartbeat rhythm and takes no direct action when the heart is beating normally. However, if the heart deviates into a life-threatening pace, the defibrillator sends electrical stimulation to the heart to stop the dangerously fast rate and return the heartbeat to a normal speed. Routine check-ups should follow implantation of a defibrillator as recommended by your physician. People with defibrillators should avoid strong electrical or magnetic fields.

  
  

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