Balloon angioplasty

Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart.  These blood vessels are called the coronary arteries.  Angioplasty is not considered to be a type of surgery.  It is called a percutaneous coronary intervention (PCI).

Alternative names: Balloon angioplasty; Coronary angioplasty; PTCA; Percutaneous transluminal coronary angioplasty.

Balloon angioplasty with stents

During a coronary angioplasty, doctors insert a long, slender tube called a catheter through an incision in the groin and guide it into the heart. With a balloon angioplasty, a small balloon at the tip of the catheter is inflated to stretch the artery open.

What is a stent and how is one used?
A stent is a wire metal mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain). Within a few weeks of the time the stent was placed, the inside lining of the artery (the endothelium) grows over the metal surface of the stent.

When are stents used?
Stents are used depending on certain features of the artery blockage. This includes the size of the artery and where the blockage is. Stenting is a fairly common procedure; in fact, over 70 percent of coronary angioplasty procedures also include stenting.

What are the advantages of using a stent?
In certain patients, stents reduce the re-narrowing that occurs after balloon angioplasty or other procedures that use catheters. Stents also help restore normal blood flow and keep an artery open if it's been torn or injured by the balloon catheter.

Drug-eluting stents

In April 2003, the U.S. Food and Drug Administration (FDA) approved the first drug-eluting stent to open clogged coronary arteries

Cardiac pacing

Cardiac pacing is the use of a small electrical current to artificially produce a heartbeat. A pacing box at the bedside creates a current and a specialised wire on the inside or outside surface of the heart delivers the electrical stimulation to the heart. Temporary pacing systems are used for a short period of time (days or weeks) and the pacing wire is put in at the bedside (no surgery is required). Treatment of certain long-term heart rhythm problems requires insertion of a small pacing box inside the body. This is attached to a pacing wire that sits in the heart (surgery is needed).

Diagnostic cardiac catheterization

This is a procedure to examine blood flow to the heart and test how well the heart is pumping. A doctor inserts a thin plastic tube (catheter) (KATH'eh-ter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries.

Electrophysiology studies for arrhythmias

Under sterile conditions, thin tubes called electrode catheters are inserted into veins in the groin or neck area and threaded into the heart. The heart's electrical conduction system is measured. Electrical impulses are applied to the heart to provoke and analyze a fast heart rate. This study can diagnose symptomatic and potentially life-threatening slow and fast heart rates.

Internal Cardiac Defibrillator (ICD) implantation

An implantable cardioverter defibrillator (ICD) is a small device that's placed in your chest or abdomen. This device uses electrical pulses or shocks to help control life-threatening, irregular heartbeats, especially those that could lead the heart to suddenly stop beating (sudden cardiac arrest).

Permanent pacemaker implantation

The pacemaker system is made up of two parts - the generator and the leads. The pacemaker generator constantly monitors your heart for the electrical signals that keep your heart beating. If no signals are detected within the programmed amount of time (chosen by your doctor and based on your condition), the pacemaker will send an electrical impulse to make your heart beat. The generator also contains the pacemaker's battery, which generally needs to be replaced every 3-6 years.

The leads (or wires) connect the generator to the heart muscle, convey the heart's electrical signals to the generator, and (when necessary) deliver electrical shocks to the heart. The leads are typically placed into the right side of the heart through veins in the chest area, under the collarbone.

Pulmonary arterial hypertension

Pulmonary Hypertension (PH) - Pulmonary Hypertension (PH) is high blood pressure in the arteries of the lungs that can lead to heart failure.

Symptoms of PH - PH patients experience symptoms such as shortness of breath, dizziness and fatigue, and the severity of symptoms usually correlates with the progression of the disease.

Risk Factors for PH - People of all ages, races and ethnic backgrounds are diagnosed with pulmonary hypertension (PH). Even though anyone can be diagnosed with PH, certain risk factors make some people more likely to get the disease.

Risk factors include:

Family History – If two or more members of your family have PH or if a family member in your lineage is known to have a PH-causing gene mutation, the risk of getting PH is more likely. Genetic counseling is available to discuss these issues.

Obesity and obstructive sleep apnea – In isolation, obesity is not a risk factor. However, if obesity is combined with obstructive sleep apnea (meaning that oxygen levels fall while a person is sleeping), mild PH may occur.

Gender – Idiopathic and familial PH (IPAH and FPAH) are at least two-and-a-half times more common in women than in men. Females of childbearing age are also more susceptible.

Pregnancy – While pregnancy does not make someone more susceptible to pulmonary hypertension, women who already have PH and become pregnant have a much higher risk of mortality. Read more about Birth Control and Hormonal Therapy in PAH.

Altitude – Living at a high altitude for years can make you more predisposed to PH. When travelling to high altitudes, your PH symptoms can be aggravated by the altitude. High altitudes a can also cause other pulmonary problems, such as pulmonary edema, in some people.

Other diseases – Other diseases, including congenital heart disease, lung disease, liver disease and connective tissue disorders like scleroderma and lupus, can lead to the development of pulmonary hypertension.

Drugs and Toxins – Certain drugs, such as methamphetamines and the diet drug “fen phen” are known to cause pulmonary hypertension.

Pulmonary hypertension may be caused by other conditions. The cause of PH can also be idiopathic, which means that it is unknown.

Radiofrequency catheter ablation

Catheter ablation (ab-LA-shun) is a medical procedure used to treat some types of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat.

During catheter ablation, a long, thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. This tube is called an ablation catheter. It's guided into your heart through the blood vessel.

A special machine sends energy through the ablation catheter to your heart. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

Radiofrequency (RF) energy usually is used for catheter ablation. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy is safe and effective.

Tilt table testing

A tilt table test is used to evaluate the cause of unexplained fainting (syncope). During a tilt table test, you lie on a table that moves from a horizontal to a vertical position. Your heart rate and blood pressure are monitored throughout the tilt table test.