Why is the test being done?
Cardiac catheterization is presently the most sensitive and specific test existing to diagnose disease of the coronary arteries including cholesterol plaques known as atherosclerosis or congenital malformations.
What makes up the plaque?
The plaque consists of cholesterol, fibrous material, certain blood cells and blood cell products.
Why does the plaque form?
The blockage, or plaque, is created in response to an injury of the lining of the artery. This injury is affected by factors such as genetics, smoking, diabetes, hypertension, obesity and high cholesterol.
Why is an angioplasty or stent being done?
Cardiac testing has shown that you have a cholesterol plaque (atherosclerosis) causing blockage of the blood flow of an artery. This will cause either chest pain (angina) or a heart attack, if the artery is totally blocked.
Is the procedure dangerous?
All precautions are taken in order to avoid a complication. Cardiac catheterization is presently performed in the hospital with the cardiologist, catheterization nurses, and medical technologists present. Each patient is screened for allergies to contrast and medications including sedatives or anesthesia. An evaluation of the patient’s wrist or groin is taken prior to the test.
Is the procedure painful?
The patient will be sedated and appropriate local anesthesia is administered to alleviate pain at the site of access in the wrist or groin. When the angioplasty or stent balloon is inflated, causing momentary stoppage of coronary blood flow, chest pain can be experienced. This will be resolved once the balloon is deflated.
What if I am allergic to the dye?
Patients allergic to contrast will be prepped with very specific medications prior to the procedure. Anyone with an allergy should always inform the doctor and catheterization staff prior to the test.
What if I have a cough or fever on the morning of the test?
Any significant cough or fever should be made know to the doctor prior to the test including on the morning of the exam.
Will the stent be removed at a later date?
No, when a stent is deployed, new blood vessel cells will cover the stent and become part of the artery wall eliminating any need to remove the stent.
Will I be able to be screened in an airport or have a CAT scan or MRI?
Metal stents will be stabilized in an artery within 3 months. It is recommended that a magnetic resonance test (MRI) be avoided for at least that time. Airport screenings, CAT scans and X-rays can be done at any time.
Will my catheterization and angioplasty or stent be done at the same time?
Usually these can be done at the same time but infrequently done at a separate time.
What are the symptoms I may experience with PAD?
Leg or arm pain or fatigue can exist especially when active. There may also be discoloration of the skin or a loss of hair on the limb. Disease of the kidney may result in high blood pressure or malfunction of the kidneys. Disease of the abdominal arteries may result in pain or malfunction of the gastrointestinal system.
Why is the test being done?
A duplex scan is performed by a licensed vascular sonographer and will identify the presence and severity of plaque in an artery. The laboratories at New York Cardiovascular Associates are recognized by the Intersocietal Accreditation of Vascular Laboratories which is a prestigious accreditation organization which guarantees the quality of a laboratory and its staff.
What is atherosclerotic plaque?
Plaque is made of cholesterol, calcium and fibrous tissue. As it develops, it can eventually obstruct blood flow through the arterial lumen and stiffen the arterial wall. This is called atherosclerosis.
Is atherosclerosis confined to one artery?
The disease is systemic and can affect all arteries of the body including the brain, heart, kidneys, liver and extremities. Therefore, patients with atherosclerosis may be at increased risk for stroke, heart attack, leg disease and death.
Is atherosclerosis always symptomatic?
No, atherosclerosis is generally symptom free until the artery has been significantly obstructed or if the plaque ruptures and causes an acute obstruction.
Is PAD a common condition?
PAD affects 8-12 million people in the U. S. This is in comparison to the 8.4 million Americans who have a history of cancer.
What are the risk factors for atherosclerosis?
The risk of atherosclerosis increases with advancing age, smoking, hypertension, diabetes, obesity and high cholesterol. Smoking is the number one cause of PAD. Studies show that smoking only 10 cigarettes per day may increase the risk of PAD by 30-50%.
How is it treated?
Atherosclerosis is treated by controlling hypertension, diabetes, and high cholesterol, cessation of smoking and loss of weight.
Are there other treatments?
If the obstruction is severe, peripheral interventions such as angioplasty and stenting or removal of the plaque may be done. In some cases, a patient may require surgical bypass of the lower extremity artery.
Is this a safe procedure?
All precautions are taken by the doctor and staff. The procedure is performed in the hospital and the patient is monitored at all times. Allergies are documented and the condition of the access sites is also evaluated. All precautions are taken to avoid any excess trauma or bleeding from the access site both during and after the procedure.
Will the procedure be painful?
The patient is given mild to moderate sedation and a local anesthetic at the access site to assure comfort and minimal to no pain. The actual mapping and ablation are not associated with pain.
Why can’t I be given medications for my condition?
There are certain medications that can be used to treat Atrial Fibrillation. These include: beta blockers, blood thinners and/or an anti-arrhythmic. Many patients may not be able to take a blood thinner due to age or medical reasons. They may also have many side effects to a standard anti-arrhythmic. Therefore, ablation can represent a safe and acceptable alternative.
Are there special tests that will be required?
In an effort to determine cardiac anatomy, most ablation therapies will require a cardiac CAT scan and a Transesophageal Echocardiogram (see Cardiac Procedures for an explanation) performed 1 or more days prior to the procedure.
Could ablation be required more than once?
In experienced hands, ablation therapy is highly successful but in rare instances a repeat procedure may be required.
Will my palpitations be cured?
Even in the most successful ablation procedures, a patient will still feel skipped beats or palpitations. However, long periods of palpitations or tachycardia (rapid heartbeats) are unlikely.
Why do strokes occur in atrial fibrillation?
One out of every 5 strokes is caused by atrial fibrillation. The chaotic beating of the upper chamber of the heart (atrium) results in a weak, inefficient contraction. This will result in minimal movement of the blood which can form small blood clots in an area of the atrium called the appendage. These could be dislodged becoming an embolus (a clot traveling in the bloodstream) and lodge in any part of the body including the brain creating a stroke.
What is my stroke risk?
Your doctor can determine the overall risk of stroke that you have based on age greater than 75, presence of hypertension, heart failure, diabetes, prior stroke or mini-stroke (TIA). Some studies also feel that women may also be at a higher risk.
What are the symptoms?
Patients with atrial fibrillation may experience chest pounding or pain, throat fullness, shortness of breath, dizziness or fainting. Many patients may not have any symptoms at all.
What causes atrial fibrillation?
Atrial fibrillation can be caused by: heart valve disease, heart enlargement or failure, thyroid disease, high blood pressure, coronary artery disease, advanced age, pericarditis (inflammation of the tissue surrounding the heart), myocarditis (inflammation of the heart muscle) or disease of the electrical system of the heartbeat.
Does the onset atrial fibrillation mean I am having a heart attack?
The onset of atrial fibrillation does not usually cause a myocardial infarction (heart attack). However, a small percentage of patients having a heart attack may experience atrial fibrillation.
Should all patients be treated?
Many patients who do not experience tachycardia (rapid heart rate), have low stroke risk and have no other medical problems may be observed but not require therapy.
Who cares for atrial fibrillation?
A cardiologist or an eletrophysiologist (heart rhythm specialist) is trained to diagnose and manage arrhythmias.
What treatments exist for atrial fibrillation?
There can be several different therapies including: medications, ablation therapy and surgery (Maze procedure).
Will medications are available for atrial fibrillation?
Medical therapy may include blood thinners such as Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), aspirin plus Plavix (clopidogrel); beta blockers that that inhibit the effect of adrenaline (metotprolol, atenolol, propranolol); and antiarrhthmics that help suppress the arrhythmia itself (amiodarone, propafenone and flecainide).
What other treatments are available?
Initially, a surgical procedure, known as the Maze procedure, was the only non-medication therapy that existed and it required a traditional surgical approach. Most recently, ablation therapy has been improved with excellent results and performed under mild to moderate sedation and similar to a catheterization.
What rhythm problems are treated with medications?
Many heart rhythm disturbances are treated with oral medications. These include tachycardia (rapid heart rates), supraventricular tachycardia (organized rapid rhythm of the upper heart chamber), atrial fibrillation (chaotic rhythm of the upper heart chamber) and ventricular tachycardia (rapid responses of the lower chamber of the heart).
What is digoxin?
Digoxin is a derivative of a drug that has been used for hundreds of years. It has derived from the foxglove plant and has been given for several reasons including arrhythmia. It has well known profile of side effects in and can also be followed with specific blood levels.
What are some of the common beta blockers?
Commonly used beta blockers include metoprolol (Lopressor, Toprol), atenolol (Tenormin), propranolol (Inderal), and nadolol (Corgard). They effectively block adrenaline and will cause a slowing of the heart beat (bradycardia) and help suppress arrhythmia. Beta blockers have been clinically used for over 50 years and the side effects are well known.
What are some of the common calcium channel blockers?
Commonly used calcium channel blockers include verapamil (Calan), and diltiazem (Cardizem, Tiazac). They have been in use for 30 years and also have a well-recognized list of side effects. They block the flow of calcium through cell walls and can also slow the heart rate. They were amongst the first drugs to effectively stop a persistent tachycardia such as supraventricular tachycardia.
What are some of the common anti-arrhythmics?
Earlier drugs such as quinidine or procainamide were associated with many serious side effects. As a result, newer more successful drugs were developed. Amiodarone (Cordarone), propafenone (Rythmol) and sotalolol (Betapace) are some of the later drugs. They are relatively simple to take but can be associated with disadvantages such as a proarhythmia, which is an appearance of a new arrhythmia.
Are the medications used alone or in combination?
Arrhythmia medications are used alone or in combination. If combined, side effects are more likely to occur therefore regular follow up is required.
How do I check for toxic effects of these drugs?
Most people will be on these drugs for indefinite time and therefore must be constantly followed for signs of toxic effects. In addition, several drugs can have blood testing to determine if levels are within a safe range.
How is the need for a pacemaker or defibrillator made?
A simple electrocardiogram can show the problem. At other times, the patient may wear a monitor for 24 hours (Holter monitor) or several days (Event monitor) to reveal the problem. Rarely, a patient will require a small implanted monitor which can be used for several months.
Who does the procedure?
A heart rhythm specialist known as an electrophysiologist will implant the devices in a hospital operating room to maintain sterile technique and provide proper observation. The patient will usually stay in the hospital for one night.
Is the procedure painful?
The patient will receive mild to moderate sedation and local anesthetic to assure comfort and minimal pain. There will be mild discomfort over the chest site for 2-3 days after the procedure.
Will the chest site appear obvious afterward?
Depending on the amount of body fat, a small rise in the skin may or may not appear at the site. Minimal scarring of a small thin incision may remain depending on the skin type of the individual.
Is there a way to identify my device in the future?
Your cardiologist should always have the type, manufacturer and serial number of the device. In addition, the pacemaker/defibrillator company will always provide the patient with an identification card that that can be carried at all times.
Will I feel the electric impulse of the devices?
No sensation will be felt due to the activity of the pacemaker. The charge delivered by the defibrillator will be appreciated as if someone had slapped you on the back. Any discharge of the defibrillator should be immediately reported to your doctor.
Can I walk through an airport detector?
Most airport detectors are fluoroscopy units and do not represent any problems with the devices. It is important that you carry your pacemaker/defibrillator card and if there are questions ask the security officers what type of scanning is used.
Can I get an X-ray in the future if I have a pacemaker/defibrillator?
Standard x-rays and CAT scans do not represent a problem for the devices. However, an MRI could create a problem and should be avoided unless cleared by a physician.