INTERVENTIONAL CARDIOLOGY SERVICES OFFERED
Our practice specializes in the prevention, diagnosis, and interventional treatment of diseases of the heart and blood vessels. Our physicians have all taken advanced training in the field of cardiology and have met the requirements for certification in the specialty of cardiology.
WHAT IS CORONARY ANGIOPLASTY?
Coronary angioplasty (AN-jee-oh-plas-tee) is a procedure used to open blocked or narrowed coronary (heart) arteries. The procedure improves blood flow to the heart muscle.
Over time, a fatty substance called plaque (plak) can build up in your arteries, causing them to harden and narrow. This condition is called atherosclerosis (ath-er-o-skler-O-sis).
Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.
Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD.
Angioplasty is a common medical procedure. It may be used to:
- Improve symptoms of CHD, such as angina (an-JI-nuh or AN-juh-nuh) and shortness of breath. (Angina is chest pain or discomfort.)
- Reduce damage to the heart muscle caused by a heart attack. A heart attack occurs if blood flow through a coronary artery is completely blocked. The blockage usually is due to a blood clot that forms on the surface of plaque. During angioplasty, a small balloon is expanded inside the coronary artery to relieve the blockage.
- Reduce the risk of death in some patients.
Angioplasty is done on more than 1 million people a year in the United States. Serious complications don’t occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.
Research on angioplasty is ongoing to make it safer and more effective, to prevent treated arteries from narrowing again, and to make the procedure an option for more people.
HOW IS CORONARY ANGIOPLASTY DONE?
Before coronary angioplasty is done, your doctor will need to know the location and extent of the blockages in your coronary (heart) arteries. To find this information, your doctor will use coronary angiography (an-jee-OG-ra-fee). This test uses dye and special x rays to show the insides of your arteries.
During angiography, a small tube (or tubes) called a catheter is inserted in an artery, usually in the groin (upper thigh). The catheter is threaded to the coronary arteries.
Special dye, which can be seen on an x ray, is injected through the catheter. X-ray pictures are taken as the dye flows through your coronary arteries. This outlines blockages, if any are present, and tells your doctor the location and extent of the blockages.
For the angioplasty procedure, another catheter with a balloon on its tip (a balloon catheter) is inserted in the coronary artery and positioned in the blockage. The balloon is then expanded. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow.
The illustration shows a cross-section of a coronary artery with plaque buildup. The coronary artery is located on the surface of the heart. Figure A shows the deflated balloon catheter inserted into the narrowed coronary artery. In figure B, the balloon is inflated, compressing the plaque and restoring the size of the artery. Figure C shows the widened artery.
WHAT IS A STENT?
A stent is a small mesh tube that’s used to treat narrowed or weakened arteries in the body. Arteries are blood vessels that carry blood away from your heart to other parts of your body.
You may have a stent placed in an artery as part of a procedure called angioplasty (AN-jee-oh-plas-tee). Angioplasty restores blood flow through narrowed or blocked arteries. Stents help prevent the arteries from becoming narrowed or blocked again in the months or years after angioplasty.
You also may have a stent placed in a weakened artery to improve blood flow and to help prevent the artery from bursting.
Some stents are coated with medicines that are slowly and continuously released into the artery. These stents are called drug-eluting stents. The medicines help prevent the artery from becoming blocked again.
The illustration shows the placement of a stent in a coronary artery with plaque buildup. Figure A shows the deflated balloon catheter and closed stent inserted into the narrowed coronary artery. The inset image on figure A shows a cross-section of the artery with the inserted balloon catheter and closed stent. In figure B, the balloon is inflated, expanding the stent and compressing the plaque to restore the size of the artery. Figure C shows the stent-widened artery. The inset image on figure C shows a cross-section of the compressed plaque and stent-widened artery.
PERIPHERAL ARTERIAL DISEASE DIAGNOSES AND TESTING
Peripheral arterial disease (P.A.D.) is diagnosed based on your medical and family histories, a physical exam, and results from tests.
P.A.D. often is diagnosed after symptoms are reported. An accurate diagnosis is important, because people who have P.A.D. are at increased risk for coronary artery disease (CAD), heart attack, stroke, and transient ischemic attack (“mini-stroke”). If you have P.A.D., your doctor also may want to look for signs of these conditions.
Primary care doctors, such as internists and family practitioners, may treat people who have mild P.A.D. For more advanced P.A.D., a vascular specialist may be involved. This is a doctor who specializes in treating blood vessel problems.
A cardiologist also may be involved in treating people who have P.A.D. Cardiologists treat heart problems, such as CAD and heart attack, which often affect people who have P.A.D.
MEDICAL AND FAMILY HISTORIES
To learn about your medical and family histories, your doctor may ask:
- Whether you have any risk factors for P.A.D.
- About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing
- About your diet
- About any medicines you take, including prescription and over-the-counter medicines
- Whether anyone in your family has a history of cardiovascular disease
During the physical exam, your doctor will look for signs and symptoms of P.A.D. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses.
Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit (broo-E). He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked section of artery.
During the physical exam, your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb.
He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of P.A.D.
A simple test called an ankle-brachial index (ABI) is often used to diagnose P.A.D. The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs. ABI can show whether P.A.D. is affecting your limbs, but it won’t show which blood vessels are narrowed or blocked.
A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles. This test may be done yearly to see whether P.A.D. is getting worse.
The illustration shows the ABI test. The ABI compares blood pressure in the ankle to blood pressure in the arm. As the cuff deflates, the blood pressure in the arteries is recorded.
A Doppler ultrasound is a test that uses sound waves to show whether a blood vessel is blocked. This test uses a blood pressure cuff and special device to measure blood flow in the veins and arteries of the limbs. A Doppler ultrasound can help find out how severe P.A.D. is.
A treadmill test can show how severe your symptoms are and what level of exercise brings them on. For this test, you walk on a treadmill. This shows whether you have any problems during normal walking.
You may have an ABI test done before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.
Magnetic Resonance Angiogram
A magnetic resonance angiogram (MRA) uses magnetic and radio wave energy to take pictures of blood vessels inside your body. An MRA is a type of magnetic resonance imaging (MRI).
An MRA can find the location of a blocked blood vessel and show how severe the blockage is.
If you have a pacemaker, man-made joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be able to have an MRA. Ask your doctor whether an MRA is an option for you.
An arteriogram provides a “road map” of the arteries. It’s used to find the exact location of a blocked artery.
For this test, dye is injected through a needle or catheter (tube) into an artery. This may make you feel mildly flushed. After the dye is injected, an x ray is taken. The pictures from the x ray can show the location, type, and extent of the blockage in the artery.
Some hospitals use a newer method of arteriogram that uses tiny ultrasound cameras that take pictures of the insides of the blood vessels. This method is called intravascular ultrasound.
Your doctor may recommend blood tests to check for P.A.D. risk factors. For example, you may get a blood test to check for diabetes. You may also get a blood test to check your cholesterol levels.