You are here: Home / Archives for Treatment / Procedures

Treatment Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices

October 19, 2010 By Leave a Comment

The American College of Cardiology/American Heart Association Task Force on Practice Guidelines has a published set of guidelines on when and how to use pacemakers and other antiarrythmia devices. The guidelines classify various treatments based on whether the benefit outways the risk of treatment.

A class I treatment the benefits greatly outweigh the risks. In a Class II treatment the benefits outweigh the risks by a smaller margin. In a class III treatment the benefits and risks are close, and in a class IV treatment, the risks outweigh the benefits. Here is how the task force viewed various treatments for arrhythmias.

[Read more...]

Filed Under: Guidelines, Procedures Tagged With: , ,

Guidelines for use of Endomyocardial Biopsy

October 3, 2010 By Leave a Comment


If you are wondering what the procedure and guidelines for the role of endomyocardial biopsy in the management of cardiovascular disease, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

To define the current role of EMB in the management of cardiovascular disease, a multidisciplinary group of experts in cardiomyopathies and cardiovascular pathology was convened by the American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC). The present Writing Group was charged with reviewing the published literature on the role of EMB in cardiovascular diseases, summarizing this information, and making useful recommendations for clinical practice with classifications of recommendations and levels of evidence.

The Writing Group identified 14 clinical scenarios in which the incremental diagnostic, prognostic, and therapeutic value of EMB could be estimated and compared with the procedural risks.

Classification of Recommendations

Class I: Conditions for which there is evidence or there is general agreement that a given procedure is beneficial, useful, and effective

Endomyocardial biopsy (EMB) should be performed in the setting of unexplained, new-onset heart failure of <2 weeks' duration associated with a normal-sized or dilated left ventricle in addition to hemodynamic compromise. Class of Recommendation I, Level of Evidence B.

EMB should be performed in the setting of unexplained new-onset heart failure of 2 weeks' to 3 months' duration associated with a dilated left ventricle and new ventricular arrhythmias, Mobitz type II second- or third-degree atrioventricular (AV) heart block, or failure to respond to usual care within 1 to 2 weeks. Class of Recommendation I, Level of Evidence B.

EMB is reasonable in the clinical setting of unexplained heart failure of >3 months’ duration associated with a dilated left ventricle and new ventricular arrhythmias, Mobitz type II second- or third-degree AV heart block, or failure to respond to usual care within 1 to 2 weeks. Class of Recommendation IIa, Level of Evidence C.

EMB is reasonable in the setting of unexplained heart failure associated with a dilated cardiomyopathy (DCM) of any duration that is associated with suspected allergic reaction in addition to eosinophilia. Class of Recommendation IIa, Level of Evidence C.

EMB is reasonable in the setting of unexplained heart failure associated with suspected anthracycline cardiomyopathy. Class of Recommendation IIa, Level of Evidence C.

EMB is reasonable in the setting of heart failure associated with unexplained restrictive cardiomyopathy. Class of Recommendation IIa, Level of Evidence C.

EMB is reasonable in the setting of suspected cardiac tumors, with the exception of typical myxomas. Class of Recommendation IIa, Level of Evidence C.

EMB is reasonable in the setting of unexplained cardiomyopathy in children. Class of Recommendation IIa, Level of Evidence C.

EMB may be considered in the setting of unexplained, new-onset heart failure of 2 weeks’ to 3 months’ duration associated with a dilated left ventricle, without new ventricular arrhythmias or Mobitz type II second- or third-degree AV heart block, that responds to usual care within 1 to 2 weeks. Class of Recommendation IIb, Level of Evidence B.

EMB may be considered in the setting of unexplained heart failure of >3 months’ duration associated with a dilated left ventricle, without new ventricular arrhythmias or Mobitz type II second- or third-degree AV heart block, that responds to usual care within 1 to 2 weeks. Class of Recommendation IIb, Level of Evidence C.

EMB may be considered in the setting of heart failure associated with unexplained hypertrophic cardiomyopathy (HCM). Class of Recommendation IIb, Level of Evidence C.

EMB may be considered in the setting of suspected arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Class of Recommendation IIb, Level of Evidence C.

EMB may be considered in the setting of unexplained ventricular arrhythmias. Class of Recommendation IIb, Level of Evidence C.

EMB should not be performed in the setting of unexplained atrial fibrillation. Class of Recommendation III, Level of Evidence C.

For the complete guideline, please visit the website here.

Filed Under: Guidelines, Procedures Tagged With:

Cardiac Ablation

September 1, 2010 By Leave a Comment

Cardiac ablation is also known as cardiac catheter ablation, radiofrequency ablation, or simply ablation. It is a non-surgical procedure that gets rid of “short circuits”– a disruption in normal heart rhythms. It does so by inserting a catheter into a blood vessel, often through the groin or neck, and winding it up into the heart. The wire is navigated by  images created on a fluoroscope (an x-ray-like machine that provides continuous, live images of the catheter).

Once the catheter is inside the heart, it is used to send electrodes to gather data and measurements. This allows the catheter to pinpoint the faulty spot in the heart. Once the damaged area is confirmed by the cardiology specialist, energy from the catheter destroys the small amount of tissue that is creating the short circuits. This energy can be in the form of heat (radiofrequency ablation), cold (cryoablation) or light (laser ablation) which destroys the misfiring tissue leaving behind dormant scar tissue.

Cardiac Ablation

High frequency (>500,000 Hz) RF energy flows easily up the ablation catheter because it has a very low resistance. When this energy flow encounters human tissue, the higher impedance produces resistive heat which pushes the cellular temperature above 50 degrees celsius and kills the cells. The dead tissue no longer propagates electrical signals, and the irregular rhythm patterns are disrupted. RF ablation is an effective treatment for supraventricular tachycardia (SVT) and atrioventricular nodal reentry tachycardia (AVNRT).

During the procedure, patients rarely report pain, but just minimal discomfort. Cardiac Ablation is generally performed under general anesthetic. After the procedure, the patient has to lie still for 4-6 hours to make sure the entry point of the catheter heals properly. Afterwards, the patient may still feel stiff and achy from lying still.

Ablation is recommended for people who have abnormal heart beats that cannot be treated with lifestyle changes or medications. Most ablations are used to treat rapid heartbeats, often known as supraventricular tachycardias, or SVTs. Some of these include:

  • Atrial fibrillation
  • Atrial flutter
  • Atrial tachycardia
  • Reentrant tachycardia

Ablation can also be used for other heart conditions, for example, for patients at risk for sudden cardiac death. Ablation often is used along with an implantable cardioverter device (ICD). The ablation decreases the frequency of abnormal heart rhythms in the ventricles and therefore reduces the number of ICD shocks a patient may experience.

Generally speaking, ablation has a success rate of 90-98 percent in their cases, which is very helpful since it eliminates the need for open-heart surgeries or long-term medications.

Here are the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation which suggest ablation for rate control and the maintenance of a steady sinus rhythm in cases where a drug regimin is not sufficient.

Filed Under: Procedures Tagged With:

MRI: Magnetic Resonance Imaging

August 27, 2010 By Leave a Comment

Magnetic resonance imaging, also known as MRI, is a test that takes pictures of internal organs using magnetic fields and pulses of radio wave energy. An MRI gives a lot of different information including things that can be seen with an X-ray, ultrasound, or a CT (computed tomography). It also shows problems that cannot be detected with other imaging methods.

For an MRI, the specific area of the body being examined is placed inside a special machine that contains a strong magnet. The pictures then are scanned and saved to a computer for future studying. You will need to take off your clothing and any metal jewelry. During the test, you will lie on your back on the MRI scanner table. The table will slide into the space that contains the magnet. Inside the scanner, you will hear a fan and feel air moving around. You will also hear scanning noises.

This test is done mainly to find tumors, bleeding, injury, blood vessel diseases and infection. It is generally done for the head, the chest, the abdomen, the spine, various bones, joints, and blood vessels. An MRI usually takes 30 to 60 minutes, but can take up to 2 hours if necessary.

Because Cardiac MRIs provide your cardiologist with a reasonably clear view “inside” at living, functioning tissue,
it has become especially helpful as a tool to allow a cardiologist to diagnose, or evaluate such “soft tissue” issues as:

  • Coronary heart disease, also called coronary artery disease
  • Damage caused by a heart attack
  • Heart failure
  • Heart valve problems
  • Congenital heart defects
  • Pericarditis (a condition in which the membrane, or sac, around your heart is inflamed)
  • Cardiac tumors

Cardiac MRI can help explain results from other procedures, such as x rays and CT scans. Cardiac MRI can often eliminate the use invasive procedures or tests that use radiation (such as x rays) or iodine based dyes.

Sometimes during cardiac MRI, a contrast agent is injected into a vein to highlight portions of the heart or blood vessels.

Filed Under: Heart Health, Procedures, Treatment

Coronary Bypass Surgery

August 26, 2010 By Leave a Comment

Bypass surgery is a procedure that allows blood restoration to the heart. This procedure uses a healthy blood vessel taken from either the leg, arm, chest or abdomen and connects it to other arteries. This is how the blood is bypassed around the diseased area. After coronary bypass surgery, normal blood flow resumes.

Bypass surgery is used to help reduce the risk of having heart diseases, such as heart attack. Symptoms such as chest pain and shortness of breath are significantly reduced after having the surgery.

Keep in mind though, that this procedure does not cure underlying heart diseases that caused the blockages in the first place. Even with having done with surgery, it is still important that the individual makes permanent life style changes to lower his/her cholesterol and reducing the chances of developing a blood clot.

The entire procedure takes between3 to 6 hours in the operating room and requires general anesthesia. The number of bypasses depends on the location and severity of each individual. A large incision is made in the chest while blood flow is diverted through a heart-lung machine. The surgeon then takes a healthy blood vessel and attaches the ends to the blocked artery so that the blood is diverted.

After the procedure, it will take a couple of days to recover in the intensive care unit. You will be discharged from the hospital in a week if there are no complications. It will take a while to resume normal activity; you must take extreme caution as to not get an infection from the chest wound.

Generally, individuals who receive the surgery will remain symptom-free for about 10 to 15 years. Below is a brief image of coronary bypass surgery.

Filed Under: Heart Health, Procedures Tagged With:

Angioplasty

August 26, 2010 By Leave a Comment

Angioplasty is a non-surgical procedure used to open blocked heart arteries. What happens during angioplasty is that a cardiac catheterization will take place. The patient will receive local anesthesia as well as medication to relax his/her body. The next step is to insert a sheath into an artery. Then, a catheter (a long, narrow, hollow tube) is passed through the sheath and is then guided up the blood vessel to the arteries near the heart.

Angioplasty Balloon

The doctor will insert a small amount of contrast material through the catheter that will travel through the heart’s chambers, valves, and major vessels. From the contrast material, the doctors can tell whether arteries are narrowed and whether heart valves are functioning correctly. Lastly, the doctor will perform a intervention procedure. There are 5 different procedures for intervention:

Balloon angioplasty: this is where a catheter with a small balloon tip is inflated to compress the fatty parts into the walls of the artery and stretch the artery open to increase blood flow.

  • Stent: this is where a small metal mesh tube acts as a scaffold to provide support inside your artery.
  • Rotoblation: this is where an acorn-shaped, diamond-coated tip catheter spins around at high speed and grinds away plaque on your artery walls.
  • Atherectomy: This is a hollow cylindrical catheter with a ballon that also pushes against the fatty materials. A blade within the cylinder rotates and shaves off any fat that protrudes.
  • Cutting balloon:  this is a cutting balloon catheter with a small blade. The blades turn on when the balloon is inflated.

Following The Procedure

After an angioplasty, you will have to lay flat and not bend your legs for about 6 hours because a groin sheath is in place. You should not eat or drink anything except clear liquids until the sheath is removed. When you resume eating, you should have a low-cholesterol and low-salt diet. Notify your doctor immediately if you have a fever or experience chest pain.

Filed Under: Life Style, Procedures Tagged With: , ,

EKG: Electrocardiogram

August 25, 2010 By 1 Comment

An electrocardiogram, or EKG for short, is a simple and painless test that records the heart’s activity. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom, causing the heart to contract and pump blood. This process repeats with every heartbeat.

An EKG shows:

  • The rate of the heart beats
  • The rhythm of the heart beats
  • Irregularity in the heart beats
  • Strength and timing of electrical signals as they pass through the heart

The test is used to detect heart conditions, such as heart attacks or arrhythmia. EKGs can also show results of other disorders that affect heart functions. Doctors use EKGs to find the cause of unexplained chest pain and other heart related symptoms.

During an EKG, you will lie on a bed and a special paste will be placed between the electrodes and your skin to improve conduction of the electrical impulses. Several electrodes are attached to the skin on arms and legs and the chest. These electrodes are then hooked on to a machine that traces your heart’s electrical activity from different locations on your chest. You will have to lie very still and breath normally during the test. You should avoid talking at all during the test.

Below is an image of a typical EKG procedure and reading:

Filed Under: Heart Health, Procedures Tagged With: ,

Heart Transplants

August 24, 2010 By Leave a Comment

You’ve probably seen this done on an episode of Grey’s Anatomy or House. A heart transplant is one of the most critical types of surgeries in cardiothoracic medicine. It is the replacement of a person’s malfunctioning heart with a healthy donor’s heart. The donor is an individual who has agreed to donate their viable organs after they have passed away.

Heart transplants have been around for nearly 40 years and nowadays, 2300 heart transplants are performed annually in the United States.While it is a major operation with certain risks, medical technology has improved dramatically over the years, proving that an individual’s chance of surviving is higher with the transplant rather than without one.

Heart Transplants Require Heart Donations

The process of a heart transplant requires a lot of research and self-awareness, including informing yourself of the preparations, the surgery itself, and follow-up care. First off, you must be placed on a transplant list. In order to be placed, you must be screened carefully by heart physicians, social workers, bioethicists and psychologists to review your medical history. These experts want to see if you are able to survive the procedure and also able to comply with the continuous care after the surgery. Once you are approved, you must wait for a donor heart that matches yours to become available. This is the where the waiting game starts. The amount of time it will take to find a match is unknown, and your doctor and health care team will work alongside you and your family to maintain your health until that day comes.

What Happens During A Transplant?

The surgeon will acquire the donor’s heart and prepare for the operation. During the transplant, the patient is placed on a heart-lung machine that gives the body oxygen and nutrients from the blood while the heart is being operated. The surgeons remove the patient’s heart and sew the new heart into place. They connect the respective blood vessels, allowing blood to flow through the heart and lungs. The heart will slowly warm up and begin to beat. Lastly, the surgeon will check last-minute blood vessels to make sure everything is connected. The entire operation takes about 4 to 10 hours. Most patients will show healing several days after the surgery. If there are no signs of the body rejecting the organ, the patient is allowed to go home within 1 to 2 weeks.

Most people who get heart transplants can return to work and regular activity within 3 to 6 months. The overall survival rate is 90 percent post-transplant. However, the transplants aren’t always successful and sometimes the new heart may fail because the body rejects it. If this is the case, your doctor could recommend different types of medications or if all fails, another heart transplant.

For more information on heart transplants, please visit the American Heart Association website here.

Filed Under: Heart Health, Procedures