Cardiac Catheterization

Cardiac catheterization is a test which is performed to obtain certain diagnostic information about the heart. Patients may require this medical therapy rather than undergo angioplasty or bypass surgery when they suffer from rare or easily controlled episodes of angina. Alternatively, cardiac catheterization is not performed in patients who have infrequent episodes of angina and in whom angina can be easily controlled. When a patient has heart failure due to suspected coronary artery disease or there is suspected coronary artery disease, cardiac catheterization is conducted. Cardiac catheterization can help:

• Measure blood pressure within heart.
  
• Know the amount of oxygen in the blood.
  
• Check the pumping ability of the heart muscle.
  
• Check blood flow through the heart after surgery.
  
• Collect blood samples from the heart.
  
• Inject dye into the coronary arteries.
  
• To provide treatment in certain types of heart conditions like congenital heart defects and how severe it is.
  
• To find out a coronary artery disease and if found to pinpoint the size and location of fat and calcium deposits that have built up in coronary artery from atherosclerosis.
  
• To determine whether the patient needs bypass surgery or angioplasty.
  
• Examine the arteries of the heart with an x-ray technique called fluoroscopy.

The patient is asked not to drink or eat anything, except a small amount of water, for atleast 6 to 12 hours before the test. The patient is tested for allergy to iodine or other medications. Patients suffering from kidney disease or diabetes or bleeding disorders must keep the cardiologist informed. The cardiac catheterization test is performed in a cath lab by a cardiologist. The actual catheterization procedure takes about 15 - 30 minutes. The patient's electrocardiogram that continuously records the electrical activity of the heart is taken.

A pulse oximeter device that measures the oxygen levels of the patients' blood is monitored. An intravenous needle is inserted into the patients' vein to give fluids or medicine during the catheterization procedure. A sedative is also given through this IV line which helps the patient to relax.

Cardiac catheterization procedure involves passing a catheter, a thin flexible tube, into the right or left side of the heart. The doctor inserts this thin plastic tube into the groin - femoral artery. Other places where in the catheter may be inserted are the elbow- brachial artery or the wrist - radial artery. From there it is slowly advanced into the chambers of the heart or into the coronary arteries. The doctor watches the progress of the catheter into the heart's vessels and chambers on the imaging screen. Pressures within the heart chambers are measured and the blood and tissue samples are also removed through the catheter. A small amount of dye is also injected through the catheter into the heart chamber or into one of the coronary arteries.

Therapeutic catheterization: Certain types of heart defects can be repaired using catheterization. For instance, if the coronary arteries are blocked, the cardiologist can use a catheter, guide wire and balloon to open and improve blood flow to the heart. This is termed as percutaneous coronary intervention (PCI).

Normal result indicate that there is no significant narrowing or blockage in the coronary arteries. Abnormal results may suggest that the heart does not pump blood normally or the valves in the heart may be weak. There may be leakage between heart chambers. There is a possibility of aortic aneurysm. Some complications with cardiac catheterization include heart attack or stroke, hematoma, puncture of the heart or arrhthmias.

Atherosclerotic Vascular Disease

Atherosclerotic Vascular Disease affects nearly 10% of the population over the age of 65 years. It is noticed more commonly among men. Atherosclerotic vascular disease is probably one of the most common causes for death and disability. Atherosclerotic peripheral vascular disease is a condition where there is a build-up of plaque in the arteries outside the heart. The thickened arteries constrict the flow of blood. This leads to inadequate supply of oxygen to all parts of the body. The mortality rate for this vascular disease is high and there is possibility of loss of limb too. Typically the limbs, kidneys and neck are affected. The symptoms of atherosclerotic peripheral vascular disease include numbness and tingling feeling in the limbs, sores that do not heal and dull, cramping pain in the hips or thighs. Claudication or pain in the lower extremity muscles is a common symptom. Smoking increases chances of peripheral atherosclerotic vascular disease. Other risk factors for atherosclerotic vascular disease are obesity, coronary heart disease and lack of exercise.

ABI (Ankle/Branchial Index) is a popular test that helps in detecting atherosclerotic vascular disease. Angiography is a special x-ray that helps in tracking artery blockages and narrowing. Ultrasonograpy and MRI aid the physician in non-invasive diagnosis of atherosclerotic vascular Disease. Simple tips to keep atherosclerotic vascular disease at bay:

• Maitain healthy weight
  
• Keep high blood pressure and high cholesterol under control
  
• Control diabetes

Angioplasty is used to enlarge blocked arteries without surgery. But it is not a permanent solution. Medications such as Pentoxifylline (Trental) and Cilostazol (Pletal) are used to treat atherosclerotic vascular disease. they help in reducing blood viscocity. Surgery is resorted to when the arteries are blocked considerably. Bypass surgeryis a surgical procedure whereby the affected artery is bypassed so that blood flow is restored.

Angina

Angina or chest pain is a typical symptom associated with coronary artery disease. Angina is a sign that the heart is not getting sufficient blood flow. This is usually due to narrowing of the arteries (atherosclerosis. It can also be the result of extreme hypertension, hypertrophic cardiomyopathy or valvular heart disease. Stable angina ia a pain that occurs when there is extra load on the heart and occurs in a regular pattern. This type of angina pain can be tackled with medication and rest. On the other hand, unstable angina can be dangerous as it may the precursor to a heart attack. The pain in such a case is more prolonged and severe. Prinzmetal's angina or variant angina pectoris occurs due to transient spasm of the coronary artery. This does not get trigerred due to physical exertion.

The pain associated with angina is uncomfortable pressure and squeezing on the chest. There is pain or discomfort in the neck, shoulder and arms. But not all chest pains are signs of angina. ECG (electrocardiograph) helps in tracing heart activity. Exercise-ECG assesses your heart condition when you are on a treadmill. Beta-blocker drugs help prevent angina pain. Potassium channel blockers and calcium channel blockers aid in improving blood flow to the coronary arteries. Glyceryl Trinitrate or GTN tablets work instantaneously by relaxing blood vessels and easening the blood flow to the heart muscles. Aspirin is prescribed to reduce the probability of blood clots and reducing blood viscocity. Statin medicines are prescribed to reduce cholesterol levels. Angioplasty involves passing a tiny balloon into a large artery and then blowing it up inside to widen the artery. Bypass surgery is done to bypass the narrowed section of arteries and provide the heart with blood vessels that are not obstructed. Angina can be controlled with medication and lifestyle changes in diet and exercise.

• Quit smoking
  
• Control cholesterol levels
  
• Control blood pressure levels
  
• Regular exercise regimen
  
• Nutritious diet - low in fat, high in fibers, rich in fruits, vegetables and oily fish
  
• Maintain healthy body weight