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Treatment of Common Heart Problems

• Angioplasty and Stents
• Open heart surgery
• Equipment To Help Your Heart Beat
• Procedures to Treat Abnormal Heart Beats

Angioplasty and Stents

When the doctor is concerned that plaque has built up and may be blocking the blood vessels to your heart, your doctor can look at the vessels by doing a coronary angiogram. The doctor will place a large IV in an artery in your leg, and put a catheter (a small tube) through it that goes into the blood vessels to your heart.  The doctor will then inject dye and use a special x-ray to look for blockages. If your doctor finds blockages, you may have an angioplasty or a stent placed.

Angioplasty

Angioplasty is when a balloon at the end of a catheter is placed inside the blocked area of your blood vessel. The balloon is then pumped up, pushing the plaque against the sides of the blood vessel (see figure 12). Blood can then easily move through the vessel. Your doctor may call angioplasty “percutaneous coronary intervention”, or PCI.

Stents

A stent is a tube made of wire that is placed in your blood vessel to help keep the plaque pushed against the side (see figure 13). Placing a stent is done the same way an angioplasty is done. The stent will stay in your artery after the balloon is taken out. If you have a stent placed, you will need to take a medicine called Plavix so that you don’t get a blood clot blocking your stent. Your doctor may have you take Plavix for a few months, a year, or for the rest of your life. Never stop taking or miss a dose of Plavix without your cardiologist’s approval.

Deciding on Treatment

Your doctor may do an angioplasty or put in a stent depending on:

• the size of the blockage
• the number of blockages
• whether you have bleeding problems.

Your doctor may also decide that you will need open heart bypass surgery to treat your blockages if:

• you have a lot of blockages
• it isn’t safe to fix your blockages with a stent or angioplasty
• your blockages are in an area a stent or balloon can’t reach.

Open heart surgery

Coronary Artery Bypass Grafting (CABG)

CABG surgery passes by blocked coronary arteries so blood can reach the heart muscle.  Instead of removing the part of your artery that is blocked, the surgeon uses a vein from your leg or an artery from your chest or arm to pass the blockage.  One end of the vein is sewn to the aorta and the other end is attached below the blockage. This allows blood to flow from the aorta to the heart muscle.

Valve Surgery

Valve Repair or Replacement

The surgeon repairs a valve by changing the shape of the damaged valve to help it work better. If the surgeon cannot repair the valve, it will need to be replaced.  An incision is made in the heart to remove part or all of the damaged valve. The replacement valve is then sewn into place and the incision in your heart is closed.

There are two kinds of replacement valves, mechanical and tissue valves.  Mechanical valves are made of metal or plastic.  Tissue valves come from pigs or cows.

• Mechanical valves last longer than tissue valves.  However, blood clots can form easily around the mechanical valve. You will have to be on a blood thinner, called Coumadin, for the rest of your life.
• Tissue valves are similar to your natural heart valves and a blood thinner is not needed.  However, they have to be replaced every 8-10 years through another open heart surgery.

Valvuloplasty

If you have stiff valves (stenosis), your doctor may recommend valvuloplasty.  This procedure is done in the cardiac catheterization laboratory.  A large IV is placed in your leg. Then a catheter (a long tube) is put through the IV and into your valve. A balloon is inflated and deflated to open the stiff valve.  The balloon and catheter are then removed.

How the Surgery Is Done

The surgeon will make a cut the length of your breastbone. Your breastbone is cut all the way through and spread apart to access your heart. Depending on your surgery, you may need to be put on the heart-lung bypass machine.  This machine takes over for the heart, making sure your body gets oxygen during surgery. Ice water and medicine are used to slow down your heart to make it easier for the surgeon to operate.

At the end of your surgery, your breastbone will be closed and held together with metal wires. These wires will stay in your body for the rest of your life. Most open heart surgeries take 3 - 5 hours.

Equipment To Help Your Heart Beat

Pacemaker

When your heart is not beating normally, you may need a pacemaker. A pacemaker is placed just under the skin on your chest with a wire that touches your heart muscle, stimulating it to beat regularly (figure 6). Pacemakers can have many different settings depending on what your heart needs. Some types of pacemakers are called CRT or CRT-P, but they are still pacemakers.

Automatic Internal Cardiac Defibrillator (AICD)

An AICD is a pacemaker that can also shock your heart out of v-fib or v-tach. This type of pacemaker may be placed if you have severe Congestive Heart Failure (CHF) or a history of rhythm problems.

Procedures to Treat Abnormal Heart Beats

Cardioversion

Cardioversion is a procedure that resets the electrical rhythm in the heart. During a cardioversion, you will be asleep for a few minutes while your chest is shocked. It may take several shocks to reset your heart rhythm, or it may not work. A cardioversion is generally done as an outpatient procedure. You may feel like you have a bad sunburn on your chest afterward.

Ablation

An ablation may be done to treat atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT), or ventricular tachycardia. During the procedure, the doctor will use a small catheter to burn  (ablate) the problem areas in your heart, helping your heart to beat normally. To ablate those areas in your heart, the doctor will put a large IV in each leg and one in your neck. The procedure takes 3-4 hours, and you may need to stay overnight in the hospital.

Maze

A maze is most often done to treat atrial fibrillation and atrial flutter. In order to have a maze procedure done, you have to have open heart surgery. Several lines are cut on the inside of the heart muscle to stop the extra signals. The scarry that occurs helps to make only one pathway the true signal can follow. (figure 7) A maze is most commonly done if you are having another open heart surgery, such as bypass or valve surgery.