Cardiology
Cardiology

Interventional Cardiology

Many heart conditions can be treated with minimally-invasive procedures that relieve symptoms and minimize the risk for serious events such as a heart attack or stroke. These procedures are usually done with a device called a catheter, which is a thin, flexible tube. Instead of making an open incision, your doctor will make a small cut to insert the catheter and advance it to the area to be treated. Catheter procedures are also used with imaging processes, such as X-ray and ultrasound, to diagnose cardiovascular problems.

At the Montana Heart Center, Dr. David Jinich and his staff use the latest equipment and technologies to help patients with conditions such as coronary artery disease, peripheral artery disease, aneurysms, and more. In many cases, interventional cardiology procedures help patients avoid the need for surgery. You can expect the highest level of expert care during these procedures:

  • Angioplasty – The use of catheters and other devices to restore circulation to blood vessels in the heart and elsewhere in the body.
  • Atherectomy – Cutting away plaque (fatty buildup) inside arteries with blades or other devices.
  • Cardiac catheterization – Using a catheter to access blood vessels in the heart in order to diagnose or treat heart disease.
  • Cardioversion – Delivering low-energy electric shocks from outside the chest to the heart to restore a normal rhythm.
  • Stenting – Placing mesh cylinders called stents in arteries to keep them open
  • Trans-radial cardiac catheterization – A method of cardiac catheterization that uses the radial artery near the wrist instead of the femoral artery in the leg.

 

Angioplasty

People who have atherosclerosis – buildup of a fatty substance called plaque inside their arteries – often have this procedure to relieve blockages and improve their circulation. To perform your angioplasty, your doctor will make a very small cut in your skin to access an artery in your wrist or leg. He or she will then insert a thin, flexible tube called a catheter into the artery and maneuver it to the site of the blockage. A contrast material, or dye, will be injected there to illuminate the site of the blockage on an X-ray. This is called an angiogram.

With this information, your doctor will exchange the first catheter for a specialized one with a balloon at its tip, and guide it to the blockage. The balloon is inflated to compress the plaque, then deflated and removed. In some cases, doctors place a mesh cylinder called a stent at the site to support the artery walls and keep the area open.

Angioplasty can improve circulation in vessels throughout the body. At the Montana Heart Center, this procedure helps people with:

  • Coronary artery disease – the narrowing of arteries from atherosclerosis in the heart.
  • Peripheral artery disease – circulation problems from atherosclerosis in the legs, arm or other areas.
  • Impaired kidney function – narrowed kidney arteries can reduce kidney function and also raise blood pressure.
  • Narrowing of major arteries – plaque can also impair circulation in the aorta and its branches.

Angioplasty can greatly improve circulation, relieving symptoms and reducing the risk for serious cardiovascular events such as heart attack or stroke. In many cases its benefits are similar to those from invasive cardiac surgeries, but with much lower risks and quicker recovery.

To learn more about angioplasty, visit the National Library of Medicine at www.nlm.nih.gov/medlineplus.

 

Atherectomy

Atherosclerosis – buildup of a fatty substance called plaque inside their arteries – can occur in vessels throughout the body. People with this condition may have a procedure called atherectomy to relieve blockages and improve their circulation.

To perform your atherectomy, your doctor will make a very small cut in your skin to access the narrowed artery. He or she will then thread a thin, flexible tube called a catheter into the artery and maneuver it to the site of the blockage. A small cutting device is then inserted through the catheter to the narrowed area, and used to cut, sand or shave off the plaque. The pieces of plaque are removed through the catheter.

At the Montana Heart Center, Dr. Jinich was the first doctor in Montana to use an innovative technique called orbital atherectomy. This treatment can be used to treat peripheral artery disease in the leg, a condition that can cause severe pain, especially during walking. Orbital atherectomy has advantages over traditional methods, in that it requires only one pass through the vessel to remove the plaque, instead of several. Also, its specialized movement sands rather than cuts, and minimizes the risk to healthy artery walls.

To learn more about atherectomy, visit the National Library of Medicine at www.nlm.nih.gov/medlineplus.

 

Cardiac Catheterization

This procedure is used to diagnose and treat narrowed or blocked arteries in your heart. It provides access to these vessels so your doctor can perform tests such as angiography (taking X-ray images of heart vessels using a special contrast dye), and treatments such as angioplasty (opening narrowed or blocked areas with a balloon-tipped catheter).

To perform a cardiac catheterization, your doctor will make a very small cut in your skin to access an artery in your wrist or leg. He or she will then insert a thin, flexible tube called a catheter into the artery and maneuver it to your heart. For angiography, a contrast material, or dye, will be injected into your coronary arteries to illuminate the site of the blockage on an X-ray.

With that information, your doctor can use a different catheter, with a balloon at its tip, to treat the blockage. The balloon is inflated to compress the plaque, then deflated and removed. In some cases, doctors place a mesh cylinder called a stent at the site to support the artery walls and keep the area open.

Cardiac catheterization is also used to measure blood flow in the heart, evaluate how well heart valves are working and take samples of heart muscle to biopsy. It can also reveal heart defects and the overall size and shape of your heart.

To learn more about stress cardiac catheterization, visit the National Library of Medicine at www.nlm.nih.gov/medlineplus.

 

Cardioversion

If you have a fast or irregular heartbeat, your doctor may recommend cardioversion to restore your heart’s normal rhythm. This procedure is usually scheduled in advance, but if your symptoms are severe you may have it right away.

Unlike most other interventional cardiology procedures, cardioversion does not use a catheter. Instead, it uses soft pads with electrodes to deliver one or more low-energy electrical shocks to the outside of your chest. The electric current travels to your heart to bring it back into normal rhythm.

In most cases you will be asleep during the procedure and will not feel pain.

To learn more about stress cardioversion, visit the National Library of Medicine at www.nlm.nih.gov/medlineplus.

 

Stenting

People with coronary artery disease have deposits called plaque that narrow the arteries in their heart. If you have this condition, your doctor may use a mesh cylinder called a stent to keep your artery open after it is treated with angioplasty.

During an angioplasty, your doctor threads a balloon-tipped catheter through a blood vessel to the narrowed or blocked artery. The balloon is inflated to compress the plaque and open the artery. The stent, which is around the balloon, expands with the balloon and stays in place when it is deflated and removed.

To learn more about stents, visit the American Heart Association at www.heart.org.
 

Transradial cardiac catheterization

This technique provides an approach to cardiac catheterization that is safer and more comfortable for many patients.

In a cardiac catheterization, or “heart cath,” a cardiologist threads a long, thin tube called a catheter through a vessel to the heart. After injecting a special dye into the catheter, the physician uses a computer monitor to see blood flowing through the heart’s vessels.

Catheterization is also used to open narrowed arteries with balloon angioplasty and to place stents to keep them open.

The traditional approach is to start the catheter in the femoral artery, in the upper thigh. While most heart caths are still done this way, a newer technique called transradial cardiac catheterization is gaining popularity. In this approach, the catheter is inserted instead into the radial artery in the wrist.

Both methods are very safe. According to the American Heart Association, however, using the wrist artery has these advantages:

  • The risk of internal bleeding is greatly reduced. That’s because the radial artery is closer to the skin surface, and any bleeding is easily identified and treated. The femoral artery is both larger and deeper, and internal bleeding can become severe before it’s found. This is uncommon, but it can require blood transfusion or surgery to repair the artery.
  • Recovery time is much shorter and more comfortable. After a heart cath with the femoral artery approach, patients must lie very still on their backs for several hours. That’s especially difficult for people with back problems or who have trouble breathing. With the wrist approach, patients can sit up. They often go home the same day, while patients who have had the femoral approach usually stay overnight.
  • Less pain medication is required after the procedure.
  • Since patients can get up and use the restroom, they don’t need to be catheterized to urinate.

Problems are rare with transradial cardiac catheterization, and it’s made even safer by precautions that protect the patient. For example, at the Montana Heart Center at Community Medical Center, cardiologists first make sure there is adequate circulation to the patient’s hand through the ulnar artery. That ensures that the hand will get enough blood if the radial artery becomes obstructed during surgery. Patients also receive medications to relax the artery, which helps avoid a spasm that could make inserting instruments difficult. And the team is always prepared to switch smoothly to the femoral artery if necessary.

Transradial cardiac catheterization is especially useful when the patient is taking anticoagulant medicines that raise the risk for bleeding. It’s also helpful in patients who are obese, since extra weight makes the femoral artery harder to access and to monitor afterward. At the Montana Heart Center, the majority of cardiac catheterizations are now done with the transradial approach.

People who have had a previous heart catheterization via their femoral artery are often surprised at how comfortable the procedure is with the wrist artery approach.