Heart Disease

What is heart disease?

The term heart disease refers to a number of conditions that result in the heart not being able to work properly. Examples of heart disease include:

Coronary artery disease (CAD)
Arrhythmias (abnormal heart rhythms)
Heart failure
Heart valve disease
Heart muscle disease
Congenital heart disease

The heart is a muscle that pumps oxygen-rich blood and nutrients to the rest of the body. Heart disease may occur when the heart muscle itself does not receive enough oxygen-rich blood, causing problems such as angina (chest pain) and heart attack. It can also involve arrhythmia, which is when the heart beats irregularly or abnormally. Changes in the function or structure of the heart muscle or heart valves can also cause heart problems.

The good news is that some types of heart disease can be prevented! Speak with your doctor for more information on heart disease prevention strategies. Refer to the Doctor Discussion Guide for more information and questions you might want to ask your doctor about heart health.

Types of Heart Disease

Although coronary heart disease (CAD) is the most common type of heart disease, there are several other types. Some of the other more common types of heart disease include abnormal heart rhythms (arrhythmias), heart failure, heart valve disease, heart muscle disease, and congenital heart disease.

Coronary artery disease (CAD) is the most common type of heart disease. In CAD, the arteries carrying blood to the heart muscle (the coronary arteries) become lined with plaque, which contains materials such as cholesterol and fat. This plaque buildup (called atherosclerosis) causes the arteries to narrow, allowing less oxygen to reach the heart muscle than it needs to work properly. When the heart muscle does not receive enough oxygen, chest pain (angina) or heart attack can occur.

Heart failure (congestive heart failure, or CH) occurs when the heart is not able to pump sufficient oxygen-rich blood to meet the needs of the rest of the body. This may be due to lack of force of the heart to pump or as a result of the heart not being able to fill with enough blood.Some people have both problems.

Heart valve disease occurs when one or more of the four valves in the heart are not working properly. Heart valves help to ensure that the blood being pumped through the heart keeps flowing forward. Disease of the heart valves (e.g., stenosis, mitral valve prolapse) makes it difficult for the heart to work efficiently.

Heart muscle disease (cardiomyopathy) causes the heart to become enlarged or the walls of the heart to become thick. This causes the heart to be less able to pump blood throughout the body and often results in heart failure.

Congenital heart disease is a type of birth defect that causes problems with the heart at birth and occurs in about one out of every 100 live births. Some of the most common types of congenital heart disease include:

atrial septal defects (ASD) and ventricular septal defects (VSD), which occur when the walls that separate the right and left chambers of the hearts are not completely closed

Patent ductus arteriosus (PDA), which occurs when the ductus arteriosis doesn’t close properly after birth

Causes of Heart Disease

The causes of heart disease are as varied as the types of heart disease. Some of the most common causes of heart disease include atherosclerosis (“hardening of the arteries”), changes in the electrical activity of the heart, birth defects, and infections. Here are some common types of heart disease and their causes.

Coronary artery disease (CAD) is associated with atherosclerosis (“hardening of the arteries”).Atherosclerosis is caused by the build-up of plaque, which is made of cholesterol and other substances, along the walls of the arteries. Angina (chest pain) occurs when the heart is receiving less oxygen than it needs to work normally. This is caused by narrowing of arteries lined with plaque and cholesterol, reducing the amount of blood reaching a particular area of the heart. If plaque in an artery ruptures, the body forms a blood clot to repair the damage. The clot can block an artery to the heart and cause a heart attack.

Arrhythmia may occur because the special nerve cells that produce the electrical signals of the heart (telling the heart when to pump) don’t work properly or the signals are in some way being blocked, slowed down, sped up, or forced to move in a different path. Arrhythmias can also occur when another part of the heart starts to produce electrical signals, adding to the signals from the special nerve cells and disrupting the normal heartbeat.

Heart failure is caused by conditions that weaken the heart or affect its ability to pump blood.Coronary artery disease, heart attack, high blood pressure, diabetes, heart valve disease, heart enlargement, abnormal heart structures caused by inherited disease, and severe lung disease are all possible causes of heart failure.

Heart valve disease can either be present at birth or be acquired after birth. When heart valve disease is present at birth, it is referred to as congenital heart valve disease and usually involves the aortic or pulmonic valve. Heart valve disease that occurs later in life can be caused by infections such as rheumatic fever or endocarditis (infection of the heart valves), heart attack high blood pressure, and heart muscle disease.

Heart muscle disease or cardiomyopathy can be caused by viral infections of the heart muscle (myocarditis), genetics, radiation, or connective tissue disorders (e.g., amyloidosis. In some cases, there is no known caused of the heart muscle disease.

Congenital heart disease is a type of birth defect that causes problems with the heart at birth.For most people, the cause of congenital heart disease is unknown.

SYMPTOMS OF HEART DISEASE (DIAGNOSING HEART DISEASE)

Heart disease symptoms may result from the body or brain not receiving enough oxygen and nutrients (e.g., excess fatigue, pain, dizziness, shortness of breath) or from a portion of the heart not receiving enough oxygen (e.g., chest pain).

Symptoms of heart disease vary depending on the specific heart condition, but many symptoms are similar between types. Symptoms can vary in severity depending on extent of heart disease.

Coronary artery disease (CAD)

In its early stages, coronary artery disease (CAD) may not produce any symptoms, but as the disease progresses and arteries start to become blocked, the most common symptoms are:

Chest pain, pressure, or squeezing that may move to the arms, jaw, neck, back, or throat
Choking sensation
Dizziness
Tiredness
Vague chest discomfort

If you experience any of these symptoms, contact your doctor or get immediate medical attention.

Arrhythmias (abnormal heart rhythms)

The symptoms of an arrhythmia depend on the type and severity of the arrhythmia and on the health of your heart.

Some symptoms of arrhythmias include:

Dizziness
Fainting
Shortness of breath
Tiredness
Fast, slow, pounding, or irregular heartbeat

If you experience any of these symptoms, contact your doctor immediately or get immediate medical attention.

Heart failure

The symptoms of heart failure include:

Shortness of breath, especially when you lie down
Tiredness
Swollen ankles, feet or legs
Coughing
Sudden weight gain
Decrease in appetite

If you experience any symptoms of heart failure, contact your doctor. If your symptoms are severe, get immediate medical attention.

Heart valve disease

Heart valve disease symptoms result from the heart muscle not getting enough blood or the heart not pumping enough blood to the body. The most common symptoms of heart valve disease include:

Chest pain
Extreme tiredness
Shortness of breath
Swelling of the feet, ankles, or hands

If you have any of these symptoms, contact your doctor immediately.

Heart muscle disease (Cardiomyopathy)

Many of the symptoms of heart muscle disease are similar to other heart problems. If you experience any of the following symptoms, you may have heart muscle disease and should contact your doctor or get immediate medical attention:

Shortness of breath
Pounding or fast heartbeat
Dizziness or fainting
Swelling of the feet, ankles, or hands
Congenital heart disease

Congenital heart disease is heart disease that’s already present at birth. Symptoms of congenital heart disease include:

Shortness of breath or fast breathing
Heart murmur
Poor feeding or weight gain in babies
Bluish lips or fingernails
Tiredness, especially during activity

If your baby or child shows any of these symptoms, contact your doctor immediately.

Keep in mind that not everyone experiences the same symptoms of heart disease and that the severity of the symptoms is different for each person. Some people with heart disease have no symptoms at all and may not be diagnosed until symptoms appear.

Heart attack: Know the symptoms

It is extremely important to know the signs of a heart attack so that you can take quick action

.The Heart and Stroke Foundation lists the following warning signs to look out for:

Chest discomfort (pain, pressure, tightness, squeezing, burning or heaviness)
Discomfort in the neck, jaw, shoulder, arms, or back
Shortness of breath
Nausea
Sweating
Lightheadedness

Other symptoms you might experience include vomiting, fear, anxiety and cool, clammy skin.

If you or anyone you know is experiencing any of these signals, you should:

Stop all activity. Sit or lie down in a comfortable position.

If you take nitroglycerin, take the recommended dosage.

Chew and swallow one 325 mg ASA tablet (acetylsalicylic acid) or two 81 mg tablets. It is important to chew or crush the tablet so that the medication works quickly. Taking ASA at the first signs can reduce the risk of dying from the heart attack.

Heart Tests: Physical Exam

tear doctor will probably begin by giving you a physical exam. This exam may include:Taking your blood pressure.

Observing how you look and act. For example, if your skin has a bluish tone, it might mean there is a problem with your heart. If you are pale, it might indicate that you are anemic (low iron levels in your blood). Swelling in your feet and legs may indicate signs of heart disease.Listening to your heart to see if there are any sounds that might indicate a problem such as a heart rhythm disorder. Your doctor may also take your pulse in several different parts of the body to see if there are any areas with blood flow problems.

Taking your pulse to check your heart’s rate, rhythm and regularity.

Assessing your breathing. Listening to your lungs for abnormal breath sounds, or crackling sounds that may indicate signs of heart disease.

Listening to your abdomen with a stethoscope to hear the sounds of blood flow. Certain sounds may indicate a narrowed blood vessel in the abdomen.

Looking in your eyes for signs of hemorrhage (e.g. blood spots), high blood pressure or reduced blood flow (ischemia). Changes in the blood vessels in the eye can also give clues to the presence of diabetes.

Asking you a series of questions, including:

What symptoms or warning signals you had before your heart attack or stroke.
What medications you are taking.
Your family history of stroke or heart disease, if any.
Your past health and medical history.
Your risk factors for heart disease.

Based on this examination, your doctor may order other tests to get more information about your condition.

Blood Tests & Urine Test

A blood test is a lab analysis of the elements in your blood. Depending on why your doctor recommended a blood test, he or she might be looking for only one factor in your blood, or several. Your doctor might order a blood test to find out if you are sick, if your body is responding to an allergy, or if you are at risk for certain health conditions. Regular blood tests might be ordered to keep track of how well you and your doctor are managing a condition such as diabetes or high cholesterol.

It is your right to know why a certain test has been ordered, so ask your doctor if you are not sure why he or she wants you to have the test.

Types of blood tests
These are common blood tests:
Complete blood count also called a CBC
Blood chemistry tests
Blood enzyme tests

Blood tests for heart disease risk

Blood tests can provide a lot of information about whether certain elements in your blood fall within a normal range, but in many instances they are only part of the information your doctor needs to make a diagnosis of a medical condition. You might need to have some other types of tests as well.

URINE TEST

Although it isn’t always possible at the time of your initial examination, a simple urine test can help your doctor diagnose conditions related to stroke including blood clots, kidney disease, other metabolic diseases or diabetes.

Test to diagnose heart disease

Chest X-Ray A chest X-ray is a picture of the heart, lungs and bones of the chest. It can help your doctor determine if your heart is an unusual shape or if it is larger than it should be. It can also help confirm the presence of a valve disorder and provide important detailed information about your condition and its seriousness. Chest X-rays are useful for diagnosing an enlargement of the heart (cardiomyopathy or heart failure. Chest X-rays may provide important information regarding the size, shape, contour, and anatomic location of the heart, lungs, bronchi, great vessels (aorta, aortic arch, pulmonary arteries), mediastinum (an area in the middle of the chest separating the lungs), and the bones (cervical and thoracic spine, clavicles, shoulder girdle, and ribs). Changes in the normal structure of the heart, lungs, and/or lung vessels may indicate disease or other conditions.

CT Scan Computed tomography (CT scan or CAT scan) is a noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

In computed tomography, the X-ray beam moves in a circle around the body. This allows many different views of the same organ or structure. The X-ray information is sent to a computer that interprets the X-ray data and displays it in a two-dimensional (2D) form on a monitor.CT angiography

CT angiography is a type of medical exam that combines a CT scan with an injection of a special dye to produce pictures of blood vessels and tissues in a part of your body.

Doppler Ultrasound Similar to an echocardiogram, a Doppler ultrasound (or Doppler echocardiography) is a test in which very high frequency sound waves are bounced off your heart and blood vessels. The returning sound waves (echoes) are picked up and turned into pictures showing blood flow through the arteries or the heart itself. Doppler ultrasound testing allows doctors to clearly see how blood flows through the heart and blood vessels. It also lets them see and measure obstructions in arteries and measure the degree of narrowing or leakage of heart valves. It may be recommended for patients with atherosclerosis or coronary artery disease. It is used to assess blood flow through the coronary arteries (the blood vessels supplying the heart), the carotid artery (the main artery in the neck), the major arteries in the arms and legs, or in the heart itself (echocardiography).

2D Echocardiogram (ECHO) An echocardiogram (ECHO) uses sound waves (ultrasound) to create a picture of your heart. The recorded waves show the shape, texture and movement of your heart valves, as well as the size of your heart chambers and how well they are working. An ECHO may be done to assess a variety of heart conditions, such as heart murmurs, damage to heart muscle in those who have had a heart attack, and infections in the heart. It may also be recommended if you are experiencing abnormal heart sounds, shortness of breath, palpitations, angina (chest pain) or have a history of stroke. It is very useful in diagnosing heart valve problems.

Electrocardiogram ECG/EKG An electrocardiogram (ECG or EKG) is a test that checks how your heart is functioning by measuring the electrical activity of the heart. With each heart beat, an electrical impulse (or wave) travels through your heart. This wave causes the muscle to squeeze and pump blood from the heart. An ECG measures and records the electrical activity that passes through the heart. A doctor can determine if this electrical activity is normal or irregular. An ECG may be recommended if you are experiencing arrhythmia, chest pain, or palpitations and an abnormal ECG result can be a signal of a number of different heart conditions.

An ECG is used to:

Detect abnormal heart rhythms that may have caused blood clots to form.Detect heart problems, including a recent or ongoing heart attack, abnormal heart rhythms (arrhythmias), coronary artery blockage, areas of damaged heart muscle (from a prior heart attack), enlargement of the heart, and inflammation of the sac surrounding the heart (pericarditis).

Detect non-heart conditions such as electrolyte imbalances and lung diseases.Monitor recovery from a heart attack, progression of heart disease, or the effectiveness of certain heart medications or a pacemaker.

Rule out hidden heart disease in patients about to undergo surgery.

Electrophysiology Study (EPS) An electrophysiology study (EPS) is a test that helps determine what kind of arrhythmia (irregular heartbeat) you have and what can be done to control it. Not everyone with an abnormal heartbeat needs an EPS and many people may just be given an electrocardiogram (ECG/EKG).

Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (MRI) is a diagnostic exam that uses a combination of a large magnet, radio waves, and a computer to produce detailed images of organs and structures within the body.

Atherosclerosis. A gradual clogging of the arteries over many years by fatty materials and other substances in the blood streamCardiomyopathy.

An enlargement of the heart due to thickening or weakening of the heart muscle Congenital heart disease. Defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart)Congestive heart failure. A condition in which the heart muscle has become weakened to an extent that blood cannot be pumped efficiently, causing buildup (congestion) in the blood vessels, lungs, feet, ankles, and other parts of the bodyAneurysm

A dilation of a part of the heart muscle or the aorta (the large artery that carries oxygenated blood out of the heart to the rest of the body), which may cause weakness of the tissue at the site of the aneurysm Valvular heart disease.

Malfunction of one or more of the heart valves that may cause an obstruction of the blood flow within the heart Cardiac tumor. A tumor of the heart that may occur on the outside surface of the heart, within one or more chambers of the heart (intracavitary), or within the muscle tissue of the heart

Exercise Electrocardiogram/Stress Test/TMT) An exercise electrocardiogram (ECG) records your heart’s response to the stress of exercise. An exercise ECG measures your heart’s electrical activity, blood pressure and heart rate while you exercise, usually by walking on a treadmill.

It is usually done to pinpoint the cause of unexplained chest pain, especially if coronary artery disease (heart disease) is suspected. If you have been diagnosed with coronary artery disease, you may be given an exercise ECG to determine how far the disease has progressed and how much exercise you can do safely. If you have had a heart attack or heart surgery, it can help determine how much work or exercise you can do safely. It may also be recommended if you are experiencing irregular heartbeats (arrhythmia), very fast or slow heartbeats (tachycardia or bradycardia), palpitations (unusual throbbing or fluttering sensations in the heart), dizziness or excessive fatigue.

Holter monitoring Holter monitoring is usually used to diagnose heart rhythm disturbances, specifically to find the cause of palpitations or dizziness. You wear a small recording device, called a Holter monitor, which is connected to small metal disks (called electrodes that are placed on your chest to get a reading of your heart rate and rhythm over a 24-hour period or longer. Your heart’s rhythm is transmitted and recorded on a tape, then played back into a computer so it can be analyzed to find out what is causing your arrhythmia. Some monitors let you push a record button to capture a rhythm as soon as you feel any symptoms.

HEART PROCEDURES

Coronary Angiography A procedure performed to view blood vessels after injecting them with a radioopaque dye that outlines them on x-ray. This technique can be usefully used to look at arteries in many areas of the body, including the brain, neck (carotids), heart, aorta, chest, pulmonary circuit, kidneys, gastrointestinal tract, and limbs.

An angiogram is a test that takes X-ray pictures of the coronary arteries and the vessels that supply blood to the heart. During an angiogram, a special dye is released into the coronary arteries from a catheter (special tube) inserted in a blood vessel. This dye makes the blood vessels visible when an X-ray is taken. Angiography allows doctors to clearly see how blood flows into the heart. This allows them to pinpoint problems with the coronary arteries.

Angiography may be recommended for patients with angina (chest pain) or those with suspected coronary artery disease (CAD). The test gives doctors valuable information on the condition of the coronary arteries, such as atherosclerosis, regurgitation (blood flowing backwards through the heart valves) or pooling of blood in a chamber because of a valve malfunction.

What to expect

Angiography is performed in a hospital or clinic. You will be asked to lie on a table, and the site where the catheter is to be inserted (the groin or arm) will be cleaned. You will be given a local anesthetic to numb the skin so you feel no pain. Then, a catheter is carefully guided through a vein or artery to a position near the heart. When the catheter is in place, it releases a special dye into the bloodstream. While the dye is being released, you might feel a brief sensation of heat, which usually passes quickly. An angiogram can take about one to two hours. However, it is best to check with the centre where you are having the procedure to find out how long it will take.

Angiography is a very common procedure and is generally considered safe. In some patients, the contrast dye may cause nausea, the need to urinate or even allergic reactions, although these side effects are rare

FRACTIONAL FLOW RESERVE (FFR)

What is FFR?

Fractional Flow Reserve, or FF, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FF is done through a standard diagnostic catheter at the time of a coronary angiogram (a.k.a. cardiac catheterization). The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages.

The point of opening up narrowing or blockages in the coronary arteries is to increase blood flow to the heart. But a number of studies have shown that if a “functional measurement”, such as Fractional Flow Reserve, shows that the flow is not significantly obstructed, the blockage or lesion does not need to be revascularized (angioplasty) and the patient can be treated safely with medical therapy.

How can FFR Affect Treatment of the patient?

For example, a lesion measures 50% on the coronary angiogram. The patient hasn’t experienced symptoms, like angina or chest pain. Nonetheless the lesion can be seen clearly on the TV monitor in the cath lab. The cardiologist (and patient) may be tempted to stent the lesion (a.k.a the stenosis) for any number of reasons. After all, there’s a blockage there – why not take care of it? This reaction has been referred to in the medical literature as the “oculo-stenotic reflex” – you see a stenosis, so you open it up and stent it. However, a few minutes of measurement with a special guide wire may reveal that an intervention won’t have a significant impact on this particular blockage. Being able to better select cases not only saves health care costs, but contributes to more appropriate patient care. However, it is best to check with the centre where you are having the procedure to find out how long it will take.

INTRAVASCULAR ULTRASOUND (IVUS)

What is IVUS?

IVUS has played a role in important research studies looking at internal changes to the artery – such as evaluating the role of vulnerable plaque and the impact of cholesterol lowering medications on regression.

Intravascular Ultrasound (or IVUS) allows us to see a coronary artery from the inside-out. This unique point-of-view picture, generated in real time, yields information that goes beyond what is possible with routine imaging methods, such as coronary angiography, performed in the cath lab, or even non-invasive Multislice CT scans.

This cross-section view can aid in stent sizing, and in confirmation that the stent has been placed optimally, is fully expanded and hugging the vessel wall. A growing number of cardiologists feel that the new information yielded by IVUS can make a significant difference in how a patient is treated, and can provide for more accurate stent placement, reducing complications and the incidence of stent thrombosis.

How Does IVUS Work?

IVUS uses echocardiography: the same technology as the ultrasound imaging used in treadmill tests and many other medical exams. Very high frequency sound waves, called ultrasound, are emitted by a transducer. These ultrasound waves, which are beyond the range of human hearing, bounce off the various types of tissue structures in the body and the echo of these waves is then converted into a picture.

How is IVUS Different from Standard Angiography?

The current “gold standard” of invasive angiography shows only the lumen, as an X-ray shadow image created by the injection of contrast dye (as seen on the left).

Although angiography shows “narrowings”, as well as a dynamic picture of the blood flow, it does not differentiate the other layers (or even the plaque itself, as shown in the artist’s rendition on the right).

In several situations, the increased information provided by Intravascular Ultrasound literally can change the picture of the disease, and affect treatment decisions. For example, in a normal artery the intimal layer is thin – when measured, there is little difference between the diameter of the lumen (open channel) and the diameter of the media (the arterial wall). In a “blocked” or diseased artery, the intima is thickened by plaques or other tissue growth, and the lumen diameter is reduced.

But often the plaque or tissue growth is not evenly distributed, resulting in an eccentric shaped lumen. This eccentric shape is clearly shown by intravascular ultrasound. But the X-ray angiogram only shows a “side-view” and the eccentric shape is not seen. Depending on the angle of view, this may make the artery look more blocked than it really is – – or conversely, may give a false impression that the artery is only slightly blocked and does not need to be treated.

With IVUS, just a few clicks on the console measures the area of the blockage, the size of the artery and yields an accurate percentage of narrowing.

Another example is that sometimes the plaque pushes deeper into the vessel wall, giving the appearance that the lumen is not significantly blocked. Yet a significant amount of diseased plaque may exist within the arterial wall, ready to rupture and cause a cascade of events, resulting in a heart attack. This is called vulnerable plaque, and cannot be visualized using standard angiography.

When is IVUS Done?

Intravascular ultrasound is done in the catheterization laboratory in conjunction with angiography. Some cardiologists use it occasionally, in difficult cases, or to assist in the selection and sizing of stents and balloons. Others use it routinely, to confirm accurate stent placement and optimal stent deployment.

How Can IVUS Make Stenting More Accurate?

One of the causes of stent thrombosis or restenosis is poor “stent apposition” – the stent has not been expanded to the full width of the artery, and this under-expansion creates a “pocket” which can collect platelets and other debris, causing a reblockage. Research conducted using IVUS has confirmed that one of the causes of restenosis is inadequate dilatation; that is, physicians, concerned with injuring or dissecting the artery with a balloon inflation, have tended to “play it safe” and end up under-sizing or under-inflating the balloon and stent.

With the accurate measurements of both the true diameter of the artery and the diameter of the open lumen channel provided by IVUS, the guesswork is taken out of choosing the correct size balloon and stent. Using only angiography, a cardiologist may underestimate the size of a diseased artery.

IVUS can also measure the length of the diseased area, so the precise length of the stent needed can be determined ahead of time, reducing the need for overlapping stents which are known to increase the risk of thrombosis.

Once the stent has been implanted, IVUS can clearly show the stent struts in relation to the arterial wall and plaque. If the stent has been undersized or if there is any area that needs

“touching up”, a larger balloon can be directed to it and expanded to fit the stent optimally.

Although IVUS was first used over 20 years ago, the current concerns over stent thrombosis and patient outcomes have spurred a new interest. The recent S.T.L.L.R. study, sponsored by Johnson & Johnson, showed that current DES deployment techniques led to some form of geographic miss in 66.5% of patients. That means two-thirds of stents are not optimally placed, which translates into negatively impacted patient outcomes, with significantly higher restenosis, thrombosis and myocardial infarction rates in patients where the stent was not placed properly. The study concluded that “a re-examination of stent placement technique including the use of IVUS is certainly warranted.”

Modern IVUS systems are completely integrated into the catheterization lab and with proper training, the cardiologist can add this new imaging technology to a standard diagnostic angiogram with a minimum of impact on the patient.

Percutaneous Transluminal Coronary Angioplasty (PTCA)/ Coronary Angioplasty:

Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open blocked coronary arteries (caused by coronary artery disease and restore blood flow to the heart muscle without open-heart surgery.

For angioplasty, a special catheter (a long, thin, hollow tube) is inserted into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the coronary artery. This presses the fatty tissue against the sides of the artery making more room for blood flow.

The use of fluoroscopy (a special type of X-ray that’s like an X-ray “movie” helps the doctor find the blockages in the coronary arteries as a contrast dye moves through the arteries.

The doctor may determine that another type of procedure is necessary. This may include the use of atherectomy (removal of plaque) at the site of the narrowing of the artery. In atherectomy, there may be tiny blades on a balloon or a rotating tip at the end of the catheter. When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery.

STENTS

Part of an artery showing plaque buildup. A catheter and stent are in place. Click image to enlarge Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil that is put into the newly-opened area of the artery to help keep the artery from narrowing or closing again.

Once the stent has been placed, tissue will begin to form over it within a few days after the procedure. The stent will be completely covered by scar tissue within a month or so. Medication must be taken to decrease the “stickiness” of platelets (special blood cells that clump together to stop bleeding), to keep blood clots from forming inside the stent. Your doctor will give specific instructions on which medications need to be taken and for how long.

Some stents are coated with medication to prevent the formation of too much scar tissue inside the stent. These stents, called drug-eluting stents, or DES, release medication within the blood vessel that inhibits the overgrowth of tissue within the stent, and helps deter re- narrowing of the blood vessel.

Because stents can become blocked, it is important for you to talk with your doctor about what you need to do if you have chest pain after a stent placement.

If scar tissue does form inside the stent, a repeat procedure may be needed, either with balloon angioplasty or with a second stent. In some cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue and open up the vessel.

Angioplasty is done to restore coronary artery blood flow when the narrowed artery is in a location that can be reached in this manner. Not all coronary artery disease (CAD) can be treated with angioplasty. Your doctor will decide the best way to treat your CAD based on your circumstances.

(Please refer by Dr Rasesh A Pothiwala) Cardiac Catheterization Cardiac catheterization is a technique that is used in several different tests and procedures. It is usually used in conjunction with other tests such as angiography and electrophysiology studies.

Cardiac catheterization is normally used to evaluate heart valves, heart function and blood supply, as well as heart abnormalities in newborns. It may also be performed to determine whether or not you need heart surgery. As well, cardiac catheterization may be used therapeutically to repair a heart defect, perform heart grafts, or open a stenotic heart valve or blocked arteries.

What is involved

A thin flexible tube called a catheter is passed through an artery or vein at the top of the leg (groin) or in the arm to reach the heart. Then X-rays are used to see the blood vessels and heart. The catheter also measures the pressure inside your heart and blood vessels and can determine if blood is mixing between the two sides of the heart.

Sometimes, a dye is injected though the catheter to see the heart and its arteries (coronary angiography). This lets your doctor see the flow of blood through your heart and blood vessels.

Controlled electrical impulses may also be sent through the catheter to see how your heart reacts, or to trigger irregular heartbeats (electrophysiology studies).

Pacemaker What is a pacemaker insertion?

A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart. A pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate.

The heart is basically a pump made up of muscle tissue that is stimulated by electrical currents, which normally follow a specific circuit within the heart.

This normal electrical circuit begins in the sinus or sinoatrial (SA) node, which is a small mass of specialized tissue located in the right atrium (upper chamber) of the heart. The SA node generates an electrical stimulus at 60 to 100 times per minute (for adults) under normal conditions; this electrical impulse from the SA node starts the heartbeat.

The electrical impulse travels from the SA node via the atria to the atrioventricular (AV) node in the bottom of the right atrium. From there the impulse continues down an electrical conduction pathway called the Bundle of His and then on through the “His-Purkinje” system into the ventricles (lower chambers) of the heart. When the electrical stimulus occurs it causes the muscle to contract and pump blood to the rest of the body. This process of electrical stimulation followed by muscle contraction is what makes the heart beat.

A pacemaker may be needed when problems occur with the electrical conduction system of the heart. When the timing of the electrical stimulation of the heart to the heart muscle and the subsequent response of the heart’s pumping chambers is altered, a pacemaker may help.

What is a pacemaker?

A pacemaker is composed of three parts: a pulse generator, one or more leads, and an electrode on each lead. A pacemaker signals the heart to beat when the heartbeat is too slow or irregular.

A pulse generator is a small metal case that contains electronic circuitry with a small computer and a battery that regulate the impulses sent to the heart.

CABG: What is coronary artery bypass surgery?Normal heart and arteries, as well as plaque buildup in the arterial wall Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease in certain circumstances. Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries. This buildup causes the inside of the arteries to become narrowed, limiting the supply of oxygen-rich blood to the heart muscle.A dobutamine stress echocardiogram is a diagnostic procedure in which an intravenous medication called dobutamine is used when an exercise stress test is not recommended.Dobutamine mimics the effects of exercise on the heart.

HEART DISEASE RISK FACTORS

There are several risk factors that increase the risk of developing heart disease or the risk that heart disease will worsen. Some risk factors are things you can change: they are called modifiable risk factors. The ones you can’t change are called non-modifiable risk factors.Things you can change include:

Smoking: Smoking, including exposure to second-hand smoke, plays a role in the buildup of plaque in the arteries, reduces the oxygen in the blood, increases blood pressure, and increases the risk of heart disease.
Physical inactivity: Low levels of physical activity are associated with a higher risk of heart disease. Try to aim for at least 150 minutes of moderate-to-vigorous physical activity each week. If you have heart disease or are starting an exercise program, speak to your doctor first.
Poor nutrition: A high intake of saturated fats coupled with a low intake of fruits and vegetables increases the risk of heart disease.
Being overweight or obese: One study estimated that about 1 in 10 premature deaths among Canadian adults 20 to 64 years of age is directly attributable to being overweight or obese. Achieving and maintaining a healthy weight can reduce the risk of heart disease.
High blood pressure: High blood pressure – over 140/90 mm Hg for most people or over 130/80 mm Hg for those with diabetes – is associated with an increased risk for heart disease.
High cholesterol: If you do not have cholesterol levels at target (especially “bad cholesterol” or LDL), you are at an increased risk for heart disease.
Diabetes: Diabetes, especially if blood sugar is not controlled, increases the risk of heart disease and other blood vessel problems (e.g., high blood pressure, stroke).
Drinking too much alcohol: As with most things in life, moderation is key. Too much alcohol can increase your risk of heart disease. If you drink alcohol, stick to no more than 9 drinks per week if you are female and 14 if you are male.
Stress: Too much stress can also contribute to heart disease.

Things you can’t change include:

Age: As we grow older, our risk for heart disease increases.
Gender: Men over 55 years of age and women who are past menopause have a greater risk of heart disease. Until they reach menopause, women have a lower risk of heart disease than men.
Family history: If you have parents, siblings, or children who had heart disease at an early age (e.g., before the age of 55 for men or before menopause for women), you are at increased risk for heart disease.

MEDICAL TERMINOLOGY OF HEART WORDS

Ace Inhibitor: Medication used to treat high blood pressure.

Angina (Angina Pectoris): Pain or discomfort which occurs when the heart does not receive adequate blood flow – and thus oxygen — to the heart muscle. Angina may be experienced in the chest, neck, jaw, arms, shoulder or back. No permanent damage is done to the heart.

Angioplasty: A procedure performed by cardiac surgeons to open an obstruction or narrowing of a blood vessel, using a balloon that is inserted with a catheter. Also known as a Percutaneous Transluminal Coronary Angioplasty (PTCA).

Anticoagulant: A drug that slows or prevents the blood from clotting.

Aneurysm: An aneurysm is an abnormal widening of a blood vessel. Aneurysms can sometimes burst, causing a serious medical emergency. If not caught in time, they can be life-threatening.

Aorta: The main artery leaving the heart.

Arteries: Vessels that transport oxygen-rich blood from the heart to the rest of the body.

Atrial Fibrillation:A rapid and irregular rhythm that begins in the upper chambers of the heart (the atria). As a result, the lower chambers also beat irregularly. This condition requires diagnosis and treatment.

Arterial Line: A small plastic tube that is placed in an artery in your wrist in order to monitor arterial blood pressure. Blood samples can also be taken through this tube

Arrhythmia: An abnormal rhythm of the heart, including rate, regularity, or site of impulse origin.

Types of arrhythmias include tachycardias (fast heart rhythms) and bradycardias (slow heart rhuthms).

Atherosclerosis: A disease process in which fatty substances (plaque), such as cholesterol, are deposited on the inner lining of blood vessels.

Arteriosclerosis: Arteriosclerosis is a general term for a condition that is characterized by the thickening, hardening and loss of elasticity of the walls of the arteries

Beta Blocker: Medication used to treat high blood pressure, angina, myocardial infarction and other heart conditions, by controlling the heart rate.

Bradycardia: An abnormally slow heart rhythm.

Bypass Graft (Vein, Mammary Artery, Aorta-Coronary Bypass Graft): A surgical procedure where a piece of vein, taken from the leg, or a piece or artery, taken from the inside of the chest wall, replaces a diseased coronary artery. The graft helps get more blood to the heart muscle.

Calcium Channel Blocker: A drug used to treat high blood pressure and angina. It decreases the workload of the heart by blocking the influx of calcium ions into the smooth muscle cells, which reduces the oxygen demand on the heart.

Cardiac: Relating to the heart.

Cardiac Angiogram or Catheterization: An X-ray procedure which involves the injection of dye into the heart chambers and into the coronary arteries for diagnostic purposes. An X-ray reveals the exact site where the artery is narrowed or blocked and measures how well the heart

Catheter: A hollow, flexible tube used to withdraw or inject fluid into the body.

Chest Tube: A tube or tubes in the chest which drain fluids from the area of the operation. The chest tubes remain in place for approximately two days.

Cholesterol: A waxy substance that circulates in the blood and plays a role in the formation of blockages. Cholesterol originates in foods that are rich in animal fats.

Congestive Heart Failure: The condition which results when the heart is unable to pump adequately. Congestive heart failure (CH) can result from coronary heart disease.

Coronary Arteries: Special arteries which supply the heart muscle with blood.

Coronary Artery Disease: A condition in which the arteries supplying the heart muscle become blocked. The cause of this is unknown, but some known risk factors include: hypertension, family history, smoking, diabetes, obesity, diet and stress.

Diabetes: A disease that negatively affects the metabolism of glucose (sugar) and cause changes in blood vessels that, untreated, may lead to circulation issues, development of coronary artery disease, blindness and other health issues.

Dilation: The gradual opening of the narrowed coronary artery by cracking and compressing the narrowing or obstructing plaque.

Echocardiogram: An ultrasound of the heart.

Electrocardiogram (EKG/ ECG): A recording of the electrical activity of the heart. The EKG recording can be used to detect many abnormalities in the heart.

Endotrachael Tube (ETT): Breathing tube placed in the trachea during surgery or respiratory emergencies to assist with breathing. Removed when the patient is able to breathe on his/her own.

Fibrillation: A rapid and irregular heart rhythm caused by abnormal electrical impulses. This is a potentially serious condition.

Fibrillation, Atrial: See Atrial Fibrillation.

Heart Lung Machine (Bypass): This machine performs the function of the heart and lungs in surgery, when grafts are being attached to the heart.

Hypertension: High blood pressure, usually above 135/85.

Hypotension: Low blood pressure. The tolerance for low blood pressure varies greatly, but generally a systolic blood pressure less than 90 indicates hypotension…

Hypercholesterolemia: Hypercholesterolemia refers to levels of cholesterol in the blood that are higher than normal.

Incentive Spirometer: This machine lets you know if you are breathing deeply enough.

Respiratory therapists teach patients how to use the spirometer.

Ischemia: Lack of or insufficient oxygen to the heart muscle. Ischemia is a reversible condition if normal blood flow is restored.

IV (Intravenous): Small tubes which are placed into the veins for the purpose of giving fluids and drugs, taking blood samples, and measuring pressures. These “lines” as they are called, will remain in place for several days after surgery.

Left Ventricle: The largest chamber of the heart. It is responsible for pumping blood throughout the body.

Local (Anesthetic): Numbing medicine which is used to decrease discomfort when intravenous lines are put into place.

Lungs: Sponge-like organs of the body which allow oxygen to enter the blood when you breathe.

Mammary Artery: An artery that runs down the inside of the chest wall and is sometimes used in coronary artery bypass graft surgery.

Murmur: A heart murmur is defined as the sound caused by turbulent blood flow through the heart, as heard by a physician through a stethoscope. Most heart murmurs are benign, but sometimes a murmur can indicate problems such as a malfunctioning heart valve.

Myocardial Infarction (M.I.): A “heart-attack”, with loss of part of the heart muscle due to a severe decrease in blood supply. Permanent damage to the heart occurs.

Myocarditis: An inflammatory disease of the heart muscle (myocardium) that can result from a variety of causes. While most cases are produced by a viral infection, an inflammation of the heart muscle may also be instigated by toxins, drugs, and hypersensitive immune reactions.

Myocarditis is a rare but serious condition that affects both males and females of any age.

NG Tube (Nasogastric): A small tube placed through the nose and into the stomach to draw out secretions and lessen stomach upset immediately after surgery.

Pacemaker: Electronic device used to control the heart rate. Used after open heart surgery to maintain a steady heart rate for recovery, and, in emergencies, to stimulate the heart to bea

Pericarditis: Two thin membranes enclose the heart in a sac-like structure. If these membranes become irritated or inflamed, the condition is known as pericarditis. Pericarditis is fairly common, affecting about 1 in 1,000 people at some point in their lives. It can be caused by flu, polio, injury, or German measles. Other causes are rheumatoid arthritis or lupus. This condition sometimes follows a heart attack.

Pericardial Tamponade: Pericardial Tamponade is a dangerous form of pericarditis. The membranes enclosing the heart do not easily stretch, so if fluid accumulates between the membranes and the heart, pressure from it may prevent the heart from working as a pump.

Pericardial tamponade usually is the result of trauma, such as an automobile accident, and must be treated immediately.

Percutaneous: Performed through a small opening in the skin.

Percutaneous Transluminal Coronary Angioplasty (PTCA).: See Angioplasty.

Plaque: The accumulated wax-like material that causes a blockage in a blood vessel. Also known as a lesion or stenosis.

Platelets: A substance in the blood that is involved in the formation of a clot.

Pressure monitors and pressure lines: Devices used to measure the internal pressures that the heart and lungs are emitting. Usually inserted through arteries in the neck, arm or leg.

Pulmonary Function Studies: A series of tests which are performed before surgery to evaluate the condition of your lungs.

Restenosis: A re-narrowing or blockage of an arterv at the same site where angioplasty was previously done.

Saphenous Vein: The large vein in the leg, often used as the “bypass graft” in coronary artery bypass graft surgery.

Stenosis: A narrowing of any canal. Used to describe narrowed coronary arteries or a narrowed heart valve.

Stent: An expandable, slotted metal tube that is inserted into a vessel. A stent acts as a scaffold to provide structural support for a vessel.

Sternum: The breastbone.

Suctioning: A procedure performed on patients connected to a ventilator. A small tube placed down the throat draws out mucous, in order the keep the lungs clear.

Sutures (also called Stitches): The material used to close a surgical incision.

Tachycardia: An abnormally fast heart rate.

Telemetry Monitory: A specialized wireless monitor that allows patients to move freely in their rooms and the hall, but still enables the staff to observe their EKG.

Thrombosis: A blockage caused by clumps of cells.

Triglycerides: Substances in the blood that are a component of the “bad” type of cholesterol.

Valves: The heart has 4 valves: the aortic, mitral, pulmonary and the tricuspid.

Aortic Valve: The valve that sits at the junction of the left ventricle and the aorta. When the valve is open it allows blood to flow from the left ventricle to the aorta, and when closed, prevents any backward flow.

Aortic Insufficiency: An incomplete closing of the aortic valve, causing blood to flow backward into the left ventricle.

Aortic Stenosis: A narrowing of the aortic valve, causing the left ventricle to work harder, but limiting the amount of blood that can be pumped forward into the aorta.

Mitral Valve: The valve that sits between the left atrium and the left ventricle.

Mitral Insufficiency: An incomplete closing of the mitral valve, causing blood to flow backward into the left atrium.

Mitral Stenosis: A narrowing of the mitral valve, causing blood to flow backward into the left atrium.

Pulmonary Valve: The valve that sits at the junction of the right ventricle and the pulmonary Artery.

Tricuspid Valve: The valve that sits between the right atrium and the right ventricle.

Veins: Vessels that transport blood back to the heart after the oxygen has been used by the body.

Vein Graft: A piece of a vein taken from either a leg or arm that is used to bypass the damaged coronary artery and restore blood flow to the heart muscle.

Ventilator: A machine that helos patients breathe after surgery.

Ventricle: One of the two lower chambers of the heart.

Ventricular Fibrillation: A very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal.