Conditions and Treatments

Coronary Angiogram

 
 

Percutaneous coronary Intervention (PCI)- angioplasty and stenting

Arteries, blood vessels that carry oxygen-rich blood to all the parts of the body, are normally flexible and smooth on the inner side, but deposits of cholesterol, calcium, and fibrous tissue (plaque) can build up on the inner walls of the arteries, making them hard, stiff and narrow. This process of thickening and hardening of the arteries is called atherosclerosis. Atherosclerosis can effect any arteries including the coronary arteries which supply the heart muscle, this can reduce or completely stop the flow of blood through them, causing chest pain (angina) or potentially a heart attack.

Angioplasty is the surgical procedure that is performed to widen these blocked or narrowed arteries. During angioplasty, your surgeon inflates a small balloon within the narrowed artery to widen and improve the blood flow. Often, your surgeon may insert a stent, a tiny meshed tube to support the artery wall and keep the artery wide open. 

Procedure

 

Angioplasty is performed under local anaesthesia. A contrast dye is injected into the body to view the blood flow through the arteries, and X-ray images are taken. Using these X-ray images, your surgeon inserts a thin guide wire through a blood vessel in the wrist, the radial artery, and extends it up to the blocked artery. Occasionally, it is not possible to use the radial artery and the femoral artery in the groin may be required. A balloon catheter (thin tube) is then threaded through the guide wire to the narrowed artery. The balloon catheter has a deflated balloon at its tip, which is inflated at the site of blockage. The balloon widens the artery by compressing the plaque against the wall of the artery. Your surgeon may also insert a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again. The balloon and the catheters are removed, while the stent is left in place to keep the artery wide open and allow free flow of blood. 

 

Post-procedure care

 

Following the surgery, you will be able to go home the same day or may have to remain in the hospital for not more than 2 days. You can walk straight away if the procedure is carried out via the wrist, if via the groin then you will be able to start walking in 6 to 8 hours after the procedure.

 

Risks and complications

 

Risks and complications following this procedure are rare. However, some specific complications for angioplasty are 

  • bleeding from the catheter insertion site

  • irregular heartbeat

  • chest pain during the procedure

  • blood vessel damage from the catheter

  • kidney damage from the dye used with the angiogram

  • re-stenosis (re-accumulation of plaque or scar tissue causing narrowing or blockage of the coronary artery; occurs within 6 months)

  • blood clots

  • dislocation of stent

BHF patient information booklet on coronary angioplasty

Arrhythmia

 

Arrhythmia is a disorder characterized by abnormal heart beat such as beating too fast, too slow or irregularly. During arrhythmia, as the heart is not able to pump enough blood to the body, it can lead to organ dysfunction or damage. Most arrhythmias are harmless; however, some are more serious and life-threatening. 

 

Types of arrhythmias

 

There are different types of arrhythmias. Arrhythmias are classified by where they originate (atria or ventricles) and the speed of heart rate. 

  • Atrial fibrillation: irregular contraction of upper heart chambers

  • Bradycardia: slow heart beat

  • Conduction disorders: abnormal heart beat

  • Premature contraction: early heart beat

  • Tachycardia: fast heart beat

  • Ventricular fibrillation: irregular contraction of lower heart chambers

Causes

 

A heart attack or other conditions such as high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland, and congenital heart defects that damages the heart’s electrical system can cause arrhythmias. 

Smoking, excess consumption of caffeine or alcohol, high stress, and certain medications can also lead to arrhythmias.

Symptoms

 

Symptoms of arrhythmia can range from mild to severe. Some of these symptoms can go unnoticed, but those that show up include:

  • Chest pain

  • Paleness

  • Sweating

  • Light-headedness, dizziness or fainting

  • Fainting

  • Shortness of breath

Diagnosis 

 

To diagnose a heart arrhythmia, your doctor will collect detailed information about your family’s medical history, medications, health problems, and health habits. Your doctor may also carry out a physical examination, during which the doctor will listen to your heart and check your pulse to measure your heart rhythm and heart rate.

Your doctor may order other tests such as:

  • Electrocardiogram (ECG): a painless test that detects and records your heart’s electrical activity

  • Holter monitor: a portable machine that records your hearts activity over a 24-hour period

  • Coronary angiography: a procedure which uses a special dye and X-rays to view the pattern of flow of blood to the heart

  • Chest x-ray to check for heart enlargement

  • Blood tests to measure blood levels of potassium and thyroid hormone

  • Echocardiography to view the size, structure and movement of the heart

  • Stress test to determine irregular heart rhythms during exercise

  • Electrophysiology study (EPS), where wire electrodes are placed in the heart to measure the electrical activity

 

Treatment

 

Arrhythmia can be treated with medications, an implantable cardioverter defibrillator (ICD) or pacemaker, or sometimes surgery to restore a normal heart beat.

Catheter ablation: It is a procedure that uses radiofrequency energy to destroy abnormal heart tissue that is causing your heart rhythm problems.

Valvular Heart Disease

 

The heart is an organ that pumps oxygen-rich blood to every cell in the body. The human heart is divided into four chambers, two superior atria and two inferior ventricles that are connected by four valves (mitral, tricuspid, aortic, and pulmonary). The heart valves permit the unidirectional flow of blood between the chambers of the heart.

Valvular heart disease (VHD) occurs when your heart valves do not function properly. Any damage or defect of the valve causes an abnormal blood flow through the heart. Types of heart valve disease include:

  • Valvular stenosis is the narrowing of any of the heart valves causing obstruction of blood flow. 

  • Valvular regurgitation or incompetence, also known as leaky valve is a condition in which the valves do not close completely and allow the blood to leak backwards into the heart. 

 

The major causes of valvular heart disease include: 

  • Congenital heart disease (abnormal valves present at birth) 

  • Rheumatic fever

  • Heart muscle disease (cardiomyopathy)

  • Heart attack

  • Advanced age

  • Infection of the heart valves (endocarditis)

  • High blood pressure

  • Radiation therapy used to treat cancer

The symptoms of a valvular heart disease include: 

  • Shortness of breath

  • Weakness or dizziness

  • Chest pain and discomfort

  • Heart palpitations

  • Swelling of ankles, feet, or abdomen

  • Sudden weight gain

The diagnosis of VHD is based on your symptoms, medical history, and physical examination. 

The examination includes inspection, palpation, and auscultation of the heart. Your doctor listens to your heart sounds using a stethoscope. A murmur is an abnormal heart sound heard when the blood flows through a stenotic or leaky valve. Your doctor may order a few diagnostic tests such as: 

  • Echocardiography is an imaging test that uses sound waves to examine the heart anatomy and its functions.

  • Electrocardiogram (ECG or EKG) is a test that records the electrical activity of the heart.

  • Cardiac or treadmill stress test is used to determine the effects of exercise on the heart. It provides your doctor with information about your blood pressure, heart rate, and respiratory rate.

  • Cardiac catheterization or Angiography is a diagnostic test performed to assess the heart and blood vessel conditions. A thin flexible catheter is placed through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the heart blood vessel to be viewed, a contrast material is injected and X-ray images are taken.

The treatment of valvular heart disease depends on the cause and severity of the symptoms. 

  • Lifestyle modifications such as eating a healthy diet low in salt and fat, exercising regularly, maintaining a healthy weight, quitting smoking, and managing stress will help slow the progression of your heart disease. 

  • Your doctor may prescribe medications to improve your cardiac health. 

  • Surgery is indicated when conservative treatment measures fail to relieve cardiac symptoms. The surgical options depend on the patient’s age and health status and may include:

-Percutaneous balloon valvotomy is a procedure in which a balloon is placed across the stenosed valve and inflated. This results in widening of the valve and improved blood flow. 

-Minimally invasive heart valve surgeries to repair or replace the damaged heart valves are of two types:

Valve Repair: This is often performed for valves with mild to moderate damage. 

Valve Replacement: This is performed for seriously damaged valves. Here the diseased valve is removed and replaced with a new valve. The replacement valves can either be biological or mechanical valves.

The need for heart valve repair or replacement depends on many factors, such as the type, cause, and severity of the valve disease, the symptoms, and general overall health of the patient. Valvular surgery helps to reduce the symptoms and improve quality of life.

Dr Abdul Mozid

Consultant Cardiologist

BMedSci (Hons) MBBS FRCP MD

contact@leedscardiologist.co.uk