Cardiac catheterization is performed to further evaluate coronary artery disease, valvular heart disease, congestive heart failure, and/or certain congenital (present at birth) heart conditions, such as atrial septal defect or ventricular septal defect, when other less invasive types of diagnostic tests indicate the presence of one of these conditions.

The person will remain awake during the procedure, although a small amount of sedating medication will be given prior to the procedure to ensure the patient remains comfortable during the procedure. 


Doctors may recommend cardiac catheterization for various reasons. The most common reasons are:  

  • A cardiac catheterization may be performed to assist in the diagnosis of different heart conditions.
  • A cardiac catheterization may also be performed if you have recently had an episode(s) of one or more of the following cardiac symptoms:
  • Chest pain or angina
  • Shortness of breath
  • Dizziness
  • Fatigue
  • If a screening examination, such as an ECG or stress test suggests a possibility of a heart condition that needs to be explored further, a cardiac cath may be ordered by your doctor.
  • Other reasons for a cath procedure include evaluation of myocardial perfusion.  If chest pain or angina occurs after the following:
  • Heart attack
  • Heart bypass surgery
  • Coronary angioplasty (the opening of a coronary artery using a balloon or other method) or placement of a stent (a tiny expandable metal coil placed inside an artery to keep the artery open)

There may be other reasons for your doctor to recommend a cardiac catheterization.


  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
  • Notify your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
  • You will need to fast for a certain period of time prior to the procedure. Your doctor will notify you how long to fast, usually overnight.
  • If you are pregnant or suspect that you may be pregnant, you should notify your doctor.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
  • Your doctor may request a blood test prior to the procedure.
  • Notify your doctor if you have heart valve disease. 
  • Notify your doctor if you have a pacemaker.
  • You may receive a sedative prior to the procedure to help you relax. If a sedative is given, you will need someone to drive you home afterwards.
  • Based on your medical condition, your doctor may request other specific preparation.

A cardiac catheterization may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a cardiac catheterization follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aids if you use either of these.
  2. You will be asked to remove clothing and will be given a gown to wear.
  3. You will be asked to empty your bladder prior to the procedure.
  4. If there is excessive hair at the catheter insertion site (groin area), the hair may be clipped off.
  5. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  6. You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours.
  7. If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band may be secured near the insertion site.

In the hospital

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration.
In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bed rest.
You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may resume your usual diet after the procedure, unless your doctor decides otherwise.
When you have completed the recovery period, you may be discharged to your home unless your physician decides otherwise. Commonly, patients who undergo angioplasty or placement of a stent will spend the night in the hospital for careful observation. If this procedure was performed on an outpatient basis and a sedative was administered, you must have another person drive you home.

At home

Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities for a period of time after the procedure. Your doctor will instruct you about when you can return to work and resume normal activities.
Notify your doctor to report any of the following:

  • Fever and/or chills
  • Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
  • Coolness, numbness and/or tingling, or other changes in the affected extremity
  • Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
Risks of the Procedure
Possible risks associated with cardiac catheterization include, but are not limited to, the following:

  • Bleeding at the catheter insertion site (the groin, arm, or wrist)
  • Blood clot or damage to the blood vessel at the insertion site
  • Infection at the catheter insertion site
  • Problems with heart rhythm (usually temporary)
  • Ischemia (decreased blood flow to the heart tissue), chest pain, or heart attack
  • Kidney damage from the cath dye
  • Stroke (rare)

There is a risk for allergic reaction to the cath dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, or latex should notify their doctor. Also, patients with kidney failure or other kidney problems should notify their doctor.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.


Cardiovascular disease is a category of diseases that involve blood vessels (vascular) and heart (cardiac). Cardiovascular diseases are the number one cause of death globally. More people die annually from cardiovascular diseases. Most cardiovascular diseases are caused due to behavioral risk factors like using tobacco, unhealthy diet and obesity, lack of physical activity, harmful use of alcohol and diabetes mellitus. People with cardiovascular diseases need early detection and management.

1.Cardiovascular disease types
1.1 Coronary heart disease
1.2 Cerebrovascular disease or Stroke
1.3 Heart failure and cardiomyopathy
1.4 Acute rheumatic fever and rheumatic heart disease
1.5 Peripheral arterial disease
1.6 Congenital heart disease
2. Cardiovascular diseases causes
3. Cardiovascular diseases symptoms
4. Cardiovascular diseases tests
5. Cardiovascular diseases treatment
6. Conclusions
1. Coronary heart disease
It is the most common type of cardiovascular diseases. It is a disease of blood vessels supplying the heart muscle. It occurs when the flow of oxygen rich blood to your heart is blocked or reduced by forming a fatty material (arethoma) in coronary arteries. The coronary arteries are the two major blood vessels that supply heart with blood. As they narrow because of a build-up of arethoma, the blood supply to your heart will be restricted. This can cause angina (chest pain). If a coronary artery becomes completely blocked, it can cause a heart attack.

 

1.2 Cerebrovascular disease or Stroke
It is a serious medical condition. It is a disease of blood vessels supplying the brain. It occurs when the blood supply to part of the brain is stopped or suddenly blocked, like all organs brain need a constant supply of oxygen and nutrients to function properly this is provided with blood. Stroke is the most common form of cerebrovascular disease. This  disease leads to the sudden impairment in speaking, thinking, movement and communication,
1.3 Heart failure and cardiomyopathy
Heart failure is a condition where the heart is unable to maintain a strong enough blood flow. It is caused due to over load to heart, high blood pressure, damaged heart valve. It leads to certain disorders like chronic tiredness, shortness of breath, reduced capacity for physical exercises. It is a life threatening condition and cant be cured.               
Cardiomyopathy is a disease caused when heart muscle becomes enlarged, thickened reducing the effectiveness of heart and causing heart failure.
1.4 Acute rheumatic fever and rheumatic heart disease
It is a condition caused by a untreated infection of group A streptococcus bacteria, it effects the throat and skin.  acute rheumatic fever permanently damage the heart valve leading to rheumatic heart disease.
Rheumatic heart disease is a condition where permanent damage to the heart muscle is caused which is caused by acute rheumatic fever. Severe forms of this disease can cause death.
1.5 Peripheral arterial disease
It is also known as peripheral vascular disease. It is disease of blood vessels supplying the arms and legs. It mainly occurs when there is a blockage in arteries to your limbs. This is mainly caused due to having the habit of smoking and high blood pressure. The buildup of arethoma on the walls of arteries makes arteries narrow and restricts the blood flow to the legs this condition is called as atherosclerosis.
1.6 Congenital heart disease
It is a disease where the abnormal formation of heart structure occurs during the birth. It is a disorder of heart or central blood vessels that is present at birth. It includes breathlessness, failure to attain normal growth. This disease is the leading cause of the death. Most children with congenital heart disease are treated with surgery.
2. Cardiovascular diseases causes
Unhealthy diet.
Lack of physical activity.
Tobacco use.
Harmful use of alcohol.
Age.
Heredity (Family history).

3. Cardiovascular diseases symptoms
Shortness of breath.
Irregular heartbeats.
Faster heart beats.
Chest pain.
Nausea.
Weakness.
Sweating.
Numbness.

4. Cardiovascular diseases tests
Initially chest X-ray and blood test are performed. Later the test include
Electrocardiogram (ECG) : It regulates the electrical signals and can helps to see irregularities in heart rhythm and structure.
Cardiac computerized tomography (CT-SCAN) : This test is often used to check the heart problems. It helps to collect the X- ray of heart and chest.
Cardiac magnetic resonance imaging ( MRI) : This test is used to produce the actual functioning of the heart.
5. Cardiovascular diseases treatment
Life style changes like eating low fat and low sodium food, 30 minutes of moderate walk, quitting smoking, limiting alcohol intake.
Always take prescribed medicines. Never stop taking medicines.Medicine should be taken a over a long period of time to reduce the rick of heart attacks and death.
If medications are not enough medical procedures like surgery is recommended. The type of surgery depends upon the type of heart disease and the damage of your heart.
6. Conclusion
Cardiovascular diseases are the #1 causes of the death with 7.2 million people dying around world every year. Obesity is the main reason for any heart disease so healthy diet and 30 minutes of physical activity can prevent this disease.


Risk Factors

A risk factor is something that increases your likelihood of developing a disease or condition. It is certainly possible to develop cardiovascular disease (CVD) without risk factors, but having risk factors makes it more likely. Some risk factors for CVD are not modifiable

Non-modifiable Risk Factors

Non-modifiable risk factors are those that you cannot change. It is still a good idea to be aware of these factors to get a sense of your risk.

  • Age —For men, age 45 or older; for women, age 55 or older.
  • Family History — Children of parents with heart disease are more likely to develop it themselves. (males younger than 55, females younger than 65).
  • Gender —Men tend to suffer cardiovascular events sooner than women. After menopause, however, cardiovascular risk in women quickly catches up to that in men.

Modifiable Risk Factors

Modifiable risk factors can be reduced or eliminated through lifestyle changes, medical treatment, or a combination of both. Many of these risk factors are interrelated, and attending to one can often have beneficial effects on others.

  • Smoking —Smokers are twice as likely to have a heart attack as nonsmokers. Cigarette smoking is also the biggest risk factor for sudden cardiac death. Even nonsmokers can increase their risk of heart disease if they are constantly exposed to cigarette smoke.
  • High blood cholesterol—High total and low-denisty lipoprotein (LDL) cholesterol levels and low high-density lipoprotein (HDL) cholesterol levels increase the risk of atherosclerosis, coronary heart disease, and stroke. In general, a total cholesterol level less than 200 mg/dL (5.2 mmol/L) , an LDL cholesterol level less than 100 mg/dL (2.6 mmol/L), and an HDL cholesterol level greater than 60 mg/dL (1.6 mmol/L) are considered desirable.
  • High blood pressure—High blood pressure accelerates the progression of atherosclerosis and increases the risk of coronary artery disease (CAD), stroke, and heart failure. High blood pressure is defined as a blood pressure equal to or above 140/90 mmHg. However, individuals with blood pressure in the high-normal range (around 130/85 mmHg) are at increased risk of becoming hypertensive and should take steps to lower their blood pressure. Check with your doctor to see about your target range.
  • Physical inactivity —A sedentary lifestyle increases risk for CAD, while regular physical activity can prevent it. Exercise also helps control other CVD risk factors, including high LDL-cholesterol, low HDL-cholesterol, type 2 diabetes, obesity, and high blood pressure.
  • Obesity and overweight— Excess body fat, particularly in the abdominal region, is associated with an increased risk for heart disease and stroke. Surplus weight puts additional strain on your heart, and raises blood pressure, blood cholesterol and the risk of type 2 diabetes.
  • Type 2 Diabetes and prediabetes —Type 2 diabetes is a major risk factor for CVD. About two-thirds of people with diabetes die of some type of heart or blood vessel disease. Glucose intolerance prior to the onset of type 2 diabetes can also place you at increased risk.
  • Stress —Although it remains unclear exactly how much psychological stress contributes to the development of CVD, if you have already been diagnosed with a cardiovascular condition, you could benefit from stress management.
  • Emerging risk factors— The association of these risk factors with CVD is less well established, but many authorities believe they will become clinically important in the near future.
    • C-reactive protein —C-reactive protein is a marker of inflammation. High levels of the protein have been associated with increased risk of heart disease and stroke, even when total and LDL-cholesterol levels are low. It is not yet known how to reduce C-reactive proteins.
    • Homocysteine —Homocysteine is an amino acid (building block of protein) that appears to contribute to atherosclerosis and blood clotting. High levels of homocysteine have been linked to increased risk of heart disease. Folic acid in the diet is effective at reducing homocysteine levels.

Introduction

Heart disease is a term used for describing a number of conditions affecting the heart. This includes blood vessel diseases like coronary artery disease; arrhythmias (problems with the rhythm of the heart) and congenital heart defects among many others. Heart disease is also known as cardiovascular disease, but the latter is a term used for conditions involving narrowed or blocked blood vessels that can eventually cause chest pain, a heart attack and stroke. What people should be aware of is that most forms of heart disease can be prevented by making healthy lifestyle choices.

Types of Heart Disease

There are numerous types of heart disease but here are the more common ones:

  • Coronary Artery Disease: This is known as the number 1 killer in the United States affecting over 13 million Americans.
  • Enlarged Heart (Cardiomegaly): There are several possible causes for it is typically a result of hypertension (high blood pressure) or coronary artery disease.
  • Irregular Heart Rhythm: Also called an arrhythmia where the heart is not functioning properly due to several possible causes.
  • Atrial Fibrillation: This is a form of irregular heartbeat and it is the most common one.
  • Congenital Heart Disease: Also known as congenital heart anomaly, it is a defect in the structure of the heart and great vessels that are already present when a person is born.

Signs and Symptoms of Heart Disease

There are different signs and symptoms for particular types of heart disease but here are the heart symptoms that should not be ignored:

  • Chest Discomfort: This is a classic sign of heart disease but in some cases may also indicate digestive problems. If you have chest discomfort, it would be best to seek medical help immediately since it could be a sign that you are about to have a heart attack.
  • Anxiety: Having a heart attack typically causes intense anxiety. People who have survived a heart attack usually say they experienced a sense of “impending doom” during the attack.
  • Rapid Or Irregular Pulse: It is normal to have a skipped heartbeat now and then but an irregular or rapid pulse can be evidence of heart failure, a heart attack or arrhythmia. This is especially the case when it is accompanied by shortness of breath, dizziness and weakness.

Causes and Risk Factors

Cardiovascular diseases are usually caused by correctable problems like lack of physical activity, an unhealthy diet,  smoking and being  overweight. Take note that the causes differ from one heart disease to another.

Heart arrhythmias are usually caused by heart defects, high blood pressure, coronary artery disease, smoking and other lifestyle factors. Heart infections can be caused by parasites, bacteria or viruses.
Here are the top risk factors for developing heart disease:

  • Age: Getting the older increases risk of damaged and narrowed arteries or the weakening/thickening of the heart.
  • Sex: Generally, men have a higher risk of developing heart disease. The risk of heart disease increases after a woman goes through menopause.
  • Family History: Having a family history of heart disease increases a person’s risk of coronary artery disease especially if it involves a parent that developed it before the age of 55 (for men) or 65 (for women).
  • Smoking: Nicotine causes the blood vessels to constrict, and carbon monoxide can cause damage to their inner lining making a person more likely to develop atherosclerosis.
  • Poor Diet: A diet high in fat, salt, cholesterol and sugar can increase the risk of developing heart disease.

Tests and Diagnosis

The first step to getting diagnosed is a doctor’s examination that is usually followed by blood tests. Then he/she may order tests like an EKG, chest x-ray, stress test, tilt table test, echocardiogram, etc. depending on what is suspected.

Treatments and Medications

The treatments for heart disease depend on the particular condition. For example, heart infections are typically treated with antibiotics. Generally, the treatments for heart disease include the following:

  • Lifestyle changes: This includes following a low-fat and low-sodium diet, getting regular exercise, quitting smoking and limiting or eliminating alcohol intake.
  • Medications: Prescription medications can help control heart disease. The medication depends on the particular form of heart disease.
  • Surgery or Medical Procedures: If medications and lifestyle changes are not enough, specific procedures or surgery may be needed depending on the particular heart disease and extent of damage to the heart.

Precautions and Self Care

Living a healthy lifestyle is very important when it comes to preventing or controlling heart diseases. Of course, it is also imperative to be supervised closely by a physician. If you have a high risk of heart disease, you need to get a regular check-up. One of the best ways to prevent heart disease is by not smoking or quitting the nasty habit. This will also decrease your risk of developing many other health problems.


Heart disease is one of the leading causes of death each year, and the numbers are ever increasing. However, the situation does not have to be dire. Many of the risk factors of heart disease are controllable, making heart disease less likely to occur if you make changes to your habits and diet. Understanding the major risk factors can help you identify areas you can take control of.
Uncontrollable Risk Factors for Heart Disease

  • Family history and genetics do play a role in your risk for heart disease. If any of your relatives have had heart disease, it makes your risk higher.
  • Age is also an uncontrollable factor for heart disease. Approximately 40% of deaths due to heart disease or related complications is in those ages 60 and over.
  • Ethnicity can have an impact on your risk level as well. Genetic differences and environmental factors play a role in your risk for developing heart disease.
  • Gender does seem to also play a role in heart disease risk. In the oldest age group, men are more likely to suffer from heart disease than women.

Controllable Risk Factors for Heart Disease

  • People who have diabetes are three times more likely to develop heart disease than those who do not have diabetes. It’s important to know your risks for diabetes as well and ensure that you are maintaining a lifestyle that does not promote the disease.
  • High cholesterol is another controllable risk factor for heart disease that can be controlled through diet and exercise.
  • Smoking is one of the most controllable risk factors for heart disease. Smokers are twice as likely to develop heart disease than non-smokers.
  • Weight is also a highly controllable risk factor. People who are obese are six times more likely to develop heart disease.
  • Additional controllable risk factors for heart disease include stress, excessive alcohol intake, and high blood pressure.

If you have any of the controllable risk factors for heart disease, especially if you also have uncontrollable factors, it’s important to create a plan with your healthcare provider for improving your situation and lessening your risk for developing heart disease.


The key to preventing cardiovascular disease is managing your risk factors.
Major Risk Factors That Can’t Be Changed

  • Age:     About 80 percent of people who die of coronary heart disease are 50 or older.
  • Gender: Men have a greater risk of heart attack than women do.
  • Family History: Children of parents with heart disease are more likely to develop it themselves.

Major Risk Factors That Can Be Changed or Treated

  • Tobacco: Smokers’ risk of developing heart disease is 2-4 times that of nonsmokers.
  • High Blood Cholesterol: As LDL rises, so does risk of coronary heart disease.
  • High Blood Pressure: High blood pressure increases the heart’s workload, causing the arteries to thicken and become stiffer
  • Physical Inactivity: An inactive lifestyle is a risk factor for coronary heart disease. 
  • Obesity and Overweight: People who have excess body fat — especially at the waist — are more likely to develop heart disease and stroke.
  • Diabetes: Diabetes increases your risk of developing cardiovascular disease.
  • Diet and Nutrition: A healthy diet is one of the best weapons you have to fight cardiovascular disease.

The best way to find out is through Healthy heart screening. Regular screening is important because it helps you detect and treat the risk factors in their earliest stages, before it ultimately leads to the development of cardiovascular disease. Most regular cardiovascular screening tests should begin at age 20. Here are the key screening tests recommended for optimal cardiovascular health:

  • Blood Pressure. Adults should have their blood pressure checked at least every two years. You may need more-frequent checks if your numbers aren’t ideal or if you have other risk factors for heart disease. Optimal blood pressure is less than 120/80
  • Fasting Lipoprotein Profile (cholesterol and triglycerides): This is a blood test that measures total cholesterol, LDL (bad), HDL (good) cholesterol and triglycerides.
  • Diabetes Screening: Starting at age 45, you should have your blood glucose level checked. Untreated diabetes can lead to heart disease and stroke. If you’re overweight AND you have at least one additional cardiovascular risk factor, your doctor may recommend a blood glucose test even if you’re not yet 45.

Recommended Schedule for Screening Tests

Screenings

How Often

Starting when

Blood pressure

Each regular healthcare visit or at least once every 2 years if blood pressure is less than 120/80 mm Hg

Age 20

Cholesterol Every 4-6 years for normal-risk people; more often if any you Age 20 have elevated risk for heart disease and stroke

Blood glucose At least every 3 years (If you are overweight AND you have Age 45 at least one additional risk factor, your doctor may recommend a blood glucose test even if you are not yet 45 or more frequently.


The key to preventing cardiovascular disease is managing your risk factors. But how do you know which risk factors you have? The best way to find out is through screening tests. Regular cardiovascular screening helps you detect risk factors in their earliest stages when more treatment options are available.  You can treat the risk factor with lifestyle changes, before it ultimately leads to the development of cardiovascular disease.Shifa Heart Centre’s screening services are designed to identify those at risk for Heart diseases and prescribe treatment before their conditions become life threatening.

Who Should Be Screened?

If you are age 40 for men, 45 for women or older with the following risk factors:

  • High blood pressure
  • High cholesterol
  • Current or past history of smoking
  • Diabetes
  • Family history of heart attack
  • Previous interventions or operations for vascular disease

While the thought of discovering Cardio Vascular Disease may be frightening, it’s important to remember that finding it early is a victory in itself. Your doctor, armed with the results of your screening and diagnostic tests, can work with you to achieve the best possible outcome.


The heart is a muscle that pumps blood through your body. The blood carries oxygen and nutrients that your body needs to work correctly. For the heart to be able to do this work it must be fed with oxygen-filled blood. The blood vessels that feed that heart muscles are called coronary arteries

Human Heart


Coronary arteries are the special blood vessels of the heart, supplying it with oxygen and other useful chemicals. Any blockage, plaque or disease of these arteries is called coronary artery disease.

The disease may cause chest pain, heart attack or even death. Unfortunately this disease is a lifelong problem. Smoking, high cholesterol, high blood pressure, diabetes, and heart disease in family are the conditions, which increase the likelihood of this disease. These are the risk factors for coronary artery disease. There are three main coronary arteries; the right coronary artery, the left anterior descending and the left circumflex artery.

Artery

Diagnosis:

A history of your symptoms and your risk factors (including over-weight, smoking, high cholesterol and family history of coronary artery disease) are important to consider in making a diagnosis.
While there are many tests to indirectly test the blood flow in these coronary arteries, only angiography can reliably give us the real picture.

Treatment Options:

Once coronary angiography shows that there is coronary artery disease, treatment options are;

  • Medicines
  • PTCA Angioplasty
  • Bypass Surgery

To look for narrowed or blocked coronary arteries, your doctor may perform a special X-ray test called a coronary angiogram, sometimes called a “heart catheterization”. This test is performed in the cardiac catheterization laboratory (cath lab), a room designed especially for this procedure. This test takes between 20 to 40 minutes.

During the procedure the cath lab staff and you doctor will;

  • Insert a small intravenous (IV) tube into your arm. This IV allows fluids and medications to be given to you
  •  Place electrodes on your chest to monitor your heart rate and rhythm
  • Shave and wash the area where the catheter will be inserted (your arm or groin)
  • Cover your body with sterile sheets
  • Give you a mild sedative to help you relax
  • Use medication to numb the area that has been cleansed
  • Insert a hollow tube into the artery in your groin or arm. Through his hallow tube, the doctor can move or advance guide wires and catheters to the arteries in your heart
  • Inject a special X-ray called contrast through the tube to allow your doctor to see the chambers, valves and coronary arteries of your heart on an X-ray monitor similar to a television screen. You may be able to look at the monitor during the procedure
  • Ask you to take deep breath as the X-rays are taken. After the X-rays are taken, you may be asked to cough to clear the dye from the coronary arteries

After the angiogram, you will go to a recovery area for monitoring before returning to your hospital room or going room.

What should I do to prepare for Angiography:

  • Your doctor needs to know if you have had an allergic reaction to contract (X-ray dye) or iodine
  • If you are diabetic and on insulin: Since you will not be eating your usual diet, your doctor should inform you to adjust your insulin dose the morning / day of the exam. You should not have solid food 6 hours prior to your procedure and clear liquids only, 2 hours prior to the procedure
  • Your doctor needs to know if you are on any bllod thinning medicines (e,g. Coumadin, Warfarin, Plavix, Aspirin, etc.)
  • Better yet, bring all the prescription medicines with you
  • You must have a responsible adult available to drive/ escort you home from the hospital

Balloon angioplasty is a procedure that uses a catheter with a small balloon on it. The balloon is inflated to push apart the plaque in the clogged arteries. This improves the blood flow in the artery. This procedure is similar to a coronary angiogram.

It is normal to have some chest pain when the balloon is inflated. Tell your doctor or nurse if feel any pain during the procedure. Risk of restenosis (i.e., the artery again narrow down due to the growth of plaque) of the treated artery is 40 – 50% in a patient.

Balloon Angioplasty


Your doctor may recommend placing a coronary stent in the diseased area to help keep the artery open. The stent is placed on a uniquely designed balloon catheter and then delivered to the diseased area.

The balloon is inflated to expand the stent and to flatten the plaque against the artery wall. This increases blood flow by holding the artery wall open.

Once the stent is fully expanded, the balloon is deflated and removed. The stent stays in place permanently. It may be necessary to place more than one stent, depending on the length of your blockage.

Stent implantation is a alternative to coronary artery bypass, which requires open-heart surgery. It can also be used to open blocked arteries in your brain, neck, kidney, hip, abdomen, thigh, and knee. More than one blockage can be treated during a single session, depending on the location of the blockages and the patient’s condition. Risk of restenosis (i.e. the artery again narrow down due to the growth of plaque) of the treated artery with bare metal stunt is 20-30%. With due eluting stunt, it has been reduced to less than 10%.

Getting Ready for Angioplasty:

It is important to follow a few simple precautions before angioplasty. Talk to the doctor about how to prepare for the procedure.

  • Do not eat or drink anything after midnight the night before
  • Ask the doctor about taking regular medications the morning of the angioplasty

What Happens Afterwards?

Sedatives take a while to wear off and many patients sleep after the procedure

  • It is important to stay in bed for about 6 hours after angioplasty. Later, a nurse will assist the patient in getting out of bed and walking around
  • You will be required to stay in the hospital for at least 2 days

After Arriving Home:

After angioplasty, it’s a good idea to relax and take it easy for a few days.

  • Avoid driving a car with a standard transmission for a few days to rest the leg where the catheter was inserted
  • It is safe to return to a desk job almost immediately. However, your doctor may advise waiting for several days before returning to a job that involves using the legs a lot or bending or lifting
  • Many patients take some type of blood-thinning drug to prevent blood clots angioplasty. Talk to the doctor about exactly how to take the drug
  • You will require 2 weeks for clinical evaluation and routine blood tests
  • If chest pain or other cardiac symptoms return, contact the doctor immediately

Stenting Angioplasty


Your constantly pumping heart – you may not have thought about it much until your doctor told you that you have a problem with your heart rhythm, the speed and pattern of your heartbeat.
Electrical System of heart
In order for the heart to do its work (to pump oxygen rich blood throughout the body), it needs sort of “spark plug “or electrical impulse to generate a heartbeat. This electrical impulse begins its journey in the sinus node – the hearts natural pacemakers. The sinus node gives off electrical impulse that normally make your heart beat 60-100 times per minutes. There are conditions when the electrical impulse becomes blocked which causes an abnormal slowing of your rhythm. In other conditions an abnormal or irritable pacemaker may cause and an unusually faster heart rhythm to occur. Either too slow or too fast a heart beat may cause the following symptoms:
Symptoms:
Symptoms of a heart rhythm problem include the following:

  • Dizziness or light  headiness
  • Fatigue 
  • Weakness
  • Fainting spells
  • Shortness of breath
  • Palpitations (A fluttering, strong , or fast heartbeat)
  • Chest pain or discomfort

A Serious heart rhythm problem can stop the heart form pumping blood. This life-threatening condition is known as Cardiac Arrest. (Note: Cardiac Arrest is not the same as a heart attack, which is when a blockage prevents blood flow through a part of the heart.)

Slow Heart Rhythms
Sometimes the heart’s electrical signals are not sent, are blocked or take a detour, leading to a slow heart rhythm (bradycardia).  When the heart rhythm is slow, your heart beats too slowly, As a result blood doesn’t move through the heart and to the body the way it should. This may happen all the times or only once in a while.
Fast Heart Rhythms
Sometimes problem with the heart’s electrical signals lead to a fast heart rhythm. Too many signals may make the heart beat very fast (tachycardia). Or signals may be sent so rapidly and irregularly that the heart muscle sometimes quivers and doest beat at all (fibrillation). Because the ventricles do most of the work to pump blood fast rhythm in the ventricles are often more serious than those in the atria.
 EP Studies can help
An EP is study is an accurate method for assessing the hearts electrical function. It allows doctor to locate abnormal sites inside the heart that may be causing serious arrhythmias (abnormal heart rhythms). EP study can help determine exactly what your rhythm problem is and what can be done to control it. A specially trained doctor (Electrophysiologist) performs the EP study.
During an EP study, doctor insert special electrode catheters(long, flexible wires) into vein and guide them into your heart. Once inside, the catheters can sense electrical impulses in various area of the heart.
Before The EP Study
To prepare for your EP study

  • Tell your doctor which medication you take and ask if you should stop taking them before your procedure.
  • Don’t eat or drink anything after midnight the night before procedure.
  • Have any routine tests that your doctor recommended. These tests may be done a few days before the procedure, or they may be done the day of the procedure.
  • The day of your procedure the skin on your groin, neck, chest or arm is washed and shaved. Right before the EP study you may be given medication by an intravenous (IV) line or in pill form to help you relax or sleep .

Risks
The risks are low and are outweighed by the benefits of learning more about your arrhythmia. The risks include;

  • Bleeding
  • Blood clots
  • Perforation of the heart muscles or a blood vessel
  • Stroke or heart attack (very rare)
  • Death (extremely rare )

The Electrophysiology Study
The EP Study take from 1 to 4 hours. You may be given medication to relax you or you may be asleep during the procedure. After the study you usually remain in the hospital for several hours  or overnight.

Inserting the Wire
The area (groin neck chest or arm) where the electrode catheter will be inserted is number with local anesthetic so you won’t feel the pain. A small puncture is then made in the vein. One or more catheters are inserted into veins and moved towards heart. Their movement is monitored on a video screen. The Catheter or catheters are then positioned in the heart. You won’t feel the catheters moving through blood vessels or heart.
Studying your Heart Rhythm
Electrode catheters can record electrical activity in the heart. The catheters find where and when signals begin and how often they are sent. Procedures that may be done during the study include the following:

  • Electrical signals can be sent through the catheters to stimulate the heart. If these signals bring on an arrhythmia it is monitored. If you are awake you may feel your heartbeat changing or your heart racing from time to time.
  • If an arrhythmia is induced, medications may be given to you through the IV line to test how they can stop the arrhythmia or keep it from happening.
  • Arrhythmias may be stopped by using the electrode catheters to regulate (pace) the heartbeat. Sometimes the heart is given an electric shock (defibrillation) to stop an arrhythmia.
  • In some cases, a catheter ablation maybe performed during the EP Study to help treat an arrhythmia.      

Recovering from EP Study
After the EP S is finished the catheters are removed and pressure is applied to the insertion site for 10 to 20 minutes. You will need to remain lying down for 4 to 6 hours to allow the blood vessel to seal. If the catheter was inserted into your groin you will be asked not to move your leg to prevent bleeding. You may go home from the hospital the same day or you may Stay one or more days.
When to call your Doctor 
Call your doctor if you notice any of these symptoms:

  • The insertion site bleeds or discomfort at the insertion site increase.
  • You feel shortness of breath or chest pain.
  • The arm or leg in which catheter was inserted feels cold or numb.
  • Bruising or swelling increase.
  • You develop a fever over 100 F.

Treating your abnormal Heart Rhythm
The detailed information provided by your EP study can help your doctor plan the next step is treating your arrhythmia. Depending on your particulars rhythm problem, Treatment options may include medications, catheter ablation, or placement of a device to help control your heart rhythm.
Medication
If medications can help control your arrhythmia, your doctor will choose the type that’s best for you. In many cases the effectiveness of certain medication may have been tested during the EP Study. Take your medication exactly as prescribed and don’t stop taking your medication without taking to your doctor.
Catheter Ablation
Catheter Ablation destroys (ablates) an abnormal electrical pathway or group of electrical cells that may be causing an arrhythmia. The procedure is often done during or after an EP study. During the procedure an ablating electrode catheter is placed in the heart. Radio frequency waves are then sent through the catheter to destroy the abnormal pathway or cells.

  • One procedure is usually successful in treating an arrhythmia.
  • For certain types of arrhythmias, ablating the entire AV node is necessary. In these cases a permanent pacemaker must then be implanted to keep the heart beating at the right pace.
  • Rarely arrhythmia medications are still necessary after ablation.

Pacemaker for slow heart
A pacemaker helps treat a slow heart rhythm. It is a small lightweight, electronic device that’s placed permanently inside your body. A pacemaker keeps track of your heartbeat and, when necessary generates electrical signals similar to the heart’s natural signals. These signals keep your heart beating at the right speed. Lifelong, regular checkups help make sure that your pacemaker continues to run smoothly.
ICD For a Fast Heart Rhythm
If you have ventricular tachycardia or ventricular fibrillation that’s sometimes dangerously fast, an implantable cardioverter defibrillator (ICD) may help. An ICD is a small electronic device placed permanently inside your body. Like a pace maker the ICD continuously monitors your heart rhythm. If it senses your heart beating too fast the ICD can pace the heart to slow down the heart rhythm. If necessary the ICD can also send out one or more electronic shocks to return the heart to its normal rhythm. Lifelong monitoring is necessary to be sure that your ICD continues working correctly and to check for any further changes in your heart rhythm.


The heart’s electrical system

The heart is a pump made up of muscle tissue. The heart’s pumping action is regulated by an electrical system that coordinates the contraction of the various chambers of the heart.

How does the heart beat?

An electrical stimulus is generated by the sinus node (SA node), which is a small mass of specialized tissue located in the right upper chamber of the heart. This electrical stimulus travels down through the conduction pathways (the way electricity flows through power lines from the power plant to your house) and causes the heart’s lower chambers to contract and pump out blood. The right and left upper chambers of the heart are stimulated first and contract a short period of time before the right and left lower chambers of the heart.

The electrical impulse travels from the sinus node through the atria to the atrioventricular node  AV node, where impulses are slowed down for a very short period, then continue down the conduction pathway via the bundle of His into the ventricles. The bundle of His divides into right and left pathways to provide electrical stimulation to the right and left ventricles.

Normally at rest, as the electrical impulse moves through the heart, the heart contracts about 60 to 100 times a minute, depending on a person’s age. Each contraction of the ventricles represents one heartbeat. The atria contract a fraction of a second before the ventricles so their blood empties into the ventricles before the ventricles contract. Under some abnormal conditions, certain heart tissue is capable of starting a heartbeat, or becoming the pacemaker.

An arrhythmia (abnormal heartbeat) occurs when:>

  • The heart’s natural pacemaker develops an abnormal rate or rhythm
  • The normal conduction pathway is interrupted
  • Another part of the heart takes over as pacemaker

In any of these situations, the body may not receive enough blood because the heart cannot pump out an adequate amount with each beat as a result of the arrhythmia’s effects on the heart rate. The effects on the body are often the same, however, whether the heartbeat is too fast, too slow, or too irregular. Some symptoms of arrhythmias include, but are not limited to:

  • Weakness
  • Fatigue
  • Palpitations
  • Low blood pressure
  • Dizziness
  • Fainting

The symptoms of arrhythmias may resemble other medical conditions. Consult your doctor for a diagnosis.

Permanent Pacemaker

A permanent pacemaker, a device that is implanted under the skin sends electrical signals to start or regulate a slow heartbeat. A permanent pacemaker may be used to make the heart beat when:

  • the heart’s natural pacemaker (the SA node) is not functioning properly
  • abnormally slow heart rate or rhythm
  • Electrical pathways are blocked.

A newer type of pacemaker, called a biventricular pacemaker, is currently used in the treatment of ventricular dyssynchrony (irregular conduction pattern in the lower heart chambers) or heart failure. Sometimes in heart failure, the two ventricles do not pump together in a normal manner. When this happens, less blood is pumped by the heart. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy.

Implantable Converter Defibrillator (ICD)

An implantable converter defibrillator (ICD) looks very similar to a pacemaker, except that it is slightly larger. It has a generator, one or more leads, and an electrode for each lead. These components work very much like a pacemaker. However, the ICD is designed to deliver two levels of electrical energy:

  • A low energy shock that can convert  a beating heart that is in an abnormal rhythm back to a normal heartbeat
  • A high energy shock that is delivered only if the arrhythmia is so severe that the heart is only quivering instead of beating. 

An ICD senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm. After the shock is delivered, a "back-up" pacing mode is available if needed for a short while.

The ICD has another type of treatment for certain fast rhythms called anti-tachycardia pacing, a fast-pacing impulse sent to correct the rhythm.

Components of a permanent pacemaker/ICD

A permanent pacemaker or ICD has three main components:

  • A pulse generator which has a sealed lithium battery and an electronic circuitry package.
  • One or more wires also called leads. Leads are flexible wires that conduct electrical signals to the heart from the pulse generator.
  • Electrodes, which are found on each lead.

Pacemaker leads may be positioned in the right atrium, right ventricle, or positioned to pace both ventricles. An atrial arrhythmia caused by a dysfunction of the sinus node or the development of another atrial pacemaker within the heart tissue may be treated with an atrial permanent pacemaker whose lead wire is located in the atrium.

When the ventricles are not stimulated normally by the sinus node or another natural atrial pacemaker site, a ventricular pacemaker whose lead wire is located in the ventricle is placed/used. It is possible to have both atrial and ventricular arrhythmias, and there are pacemakers who have lead wires positioned in both the atrium and the ventricle.

An ICD has a lead wire that is positioned in the ventricle, as it is used for treating fast ventricular arrhythmias. Commonly, ICDs will have an atrial lead and ventricular lead.

Pacemakers that pace either the right atrium or the right ventricle are called "single-chamber" pacemakers. Pacemakers that pace both the right atrium and right ventricle of the heart and require two pacing leads are called "dual-chamber" pacemakers. Pacemakers that pace the right atrium and right and left ventricles are called "biventricular" pacemakers.

How is a pacemaker/ICD implanted?

Pacemaker/ICD insertion is done in the cardiac catheterization laboratory, or the electrophysiology laboratory. The patient is awake during the procedure, although local anesthesia is given over the incision site, and generally sedation is given to help the patient relax during the procedure. A night or two of hospitalization may be recommended so that the functioning of the implanted device may be observed.

A small incision will be made just under the collarbone. The pacemaker/ICD lead(s) will be inserted into the heart through a blood vessel which runs under the collarbone. Once the lead is in place, it is tested to make sure it is in the right place and is functional. The lead is then attached to the generator, which is placed just under the skin through the incision made earlier. Once the procedure has been completed, the patient goes through a recovery period of several hours.