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Treating Heart Disease

Emergency Room Cardiac Care Team

Because delays in treating a heart attack (acute myocardial infarction or AMI) increase the likelihood and amount of cardiac muscle damage due to localized hypoxia (inadequate oxygen reaching the body’s tissue), United Regional has adopted the guidelines put forth by the American College of Cardiology and the American Heart Association to achieve a “door-to-balloon” time of 90 minutes or less.

In 2013, United Regional average “door-to-balloon” time was 62 minutes, much better than the national standard of 90 minutes set by the American Heart Association.

Door-to-balloon is a time measurement from when a patient enters the emergency room with symptoms of a heart attack to when the patient is in the cardiac catheterization lab and the “balloon” has been inflated in the blocked artery to open it and restore blood flow.

If a Patient Drives to our Emergency Room

As soon as the patient arrives at the emergency room with heart attack symptoms, the patient is taken to a room and an EKG is immediately performed. The EKG is shown to the emergency room physician who determines if the patient is experiencing a heart attack. When confirmed, the “AMI” team – made up of staff from the catheterization lab, a cardiologist, respiratory technologist, security, and the nursing house supervisor – is alerted. The patient is quickly taken to the catheterization lab and prepared for the “balloon” procedure.

It is Better to Call 911 and Arrive by Ambulance – Here’s Why

When a heart attack occurs, every minute of delay in opening up the coronary artery increases the likelihood and the amount of heart muscle damage due to oxygen deprivation. So, if you have any symptoms, don’t wait more than five minutes before calling for help.

Go by Ambulance

Call 9-1-1 and go by ambulance. EMS now has the ability to perform an EKG in the field to confirm a heart attack and alert United Regional’s emergency room so that the Cardiac Catherization team is in place to perform life-saving treatment upon your arrival.

Minimally Invasive Procedures

Atherectomy/laser

Similar to balloon angioplasty, except the catheter carries a rotating drill that shaves or burns off bits of plaque that have hardened to such a degree that they can no longer be compressed. The bits of plaque are contained in the catheter and removed when the catheter is removed.

Angioplasty and Coronary Artery Stenting

Balloon Angioplasty

In the angioplasty procedure, imaging techniques are used to guide a balloon-tipped catheter into an artery or vein and advance it to where the vessel is narrow or blocked. The balloon is then inflated to open the vessel, compressing the fatty deposits, and helping the flow of blood to the heart muscle and other areas of the body. The balloon is then deflated and removed.

Coronary Artery Stents

A stent is a small device that is permanently placed in the artery to help keep it open. This procedure may be performed when angioplasty cannot widen the artery enough to reduce the chances that blockage will reoccur.

Coronary artery stenting can be performed during cardiac catheterization or at a later date. Coronary artery stents are devices (small metallic mesh tubes) that are placed over a balloon catheter and delivered to the narrowed portion of the coronary artery. The balloon is used to expand the stent. The stent presses against the narrowed vessel wall holding the vessel open. This makes a wider channel to improve blood to the heart muscle. Once the balloon is deflated and withdrawn, the stent stays in place permanently. The inner lining of the artery grows over the stent, making the stent a permanent part of the patient’s artery.

Some of the currently available stents are: Uncoated stents – An expandable, slotted metal tube that acts as a mechanical scaffold in a vessel. Coated stents – A stent with a thin surface covering. Drug-eluting stents – A drug-eluting stent allows for the release of a drug at the stent site. The action of the drug is intended to limit the over-growth of normal tissue as the healing process occurs following coronary stent placement.

What are the limitations of Angioplasty and Vascular Stenting?

Angioplasty and vascular stenting are just two ways to treat narrowed or blocked arteries. Medications and exercise are often the first step in treating atherosclerosis.

Regardless of which artery is blocked, angioplasty and stenting do not reverse or cure the underlying disease of atherosclerosis. It is very important for patients to make lifestyle changes, including eating a healthy diet that is low in saturated fat, being physically active or regular exercise, losing weight if overweight, and not smoking.

Individuals with diabetes, high blood pressure and/or high cholesterol should follow the treatment plan prescribed by their physicians.

Angioplasty and stenting may have to be repeated if the same artery becomes blocked again, a condition called restenosis. If a stent is placed at the time of the angioplasty, the chance of restenosis may be reduced but it can still occur.

Catheter Ablation

This procedure is sometimes done during an EP (electrophysiology study). Radio-frequency energy is applied to a small area of tissue through a special catheter. The energy destroys only the problem cells that are causing the arrhythmia (abnormal beating of the heart).

Cardioversion

This procedure is used to treat an arrhythmia when a patient has not responded well to medication. The patient is sedated and the electrical shock is delivered from a defibrillator to the heart using paddles on the patient’s chest. The electrical shock usually makes the heart convert back to a normal rhythm.

Bi-V for CHF Management

The Bi-V looks similar to a pacemaker and is inserted in the same manner. However, Bi-Vs are used to treat patients with heart failure. It coordinates the function of the main pumping chamber of the heart. Some Bi-Vs are equipped with ICD functions.

Implantable Cardioverter Defibrillator (ICD)

An ICD also looks a lot like a pacemaker. It constantly monitors the heart and through electronic circuitry, senses the heart’s rhythm and delivers treatment to stop an abnormally fast rate. Although its main function is to correct rapid, abnormal heart rhythms, many ICDs can treat slow rhythms as well.

Open Heart Surgery

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended for:

  • Disease of the left main coronary artery
  • Disease of three or more vessels (triple vessel disease)
  • Cases in which nonsurgical management (medication or angioplasty) haven’t worked

Surgery -Coronary Artery Bypass Grafting (CABG) is a common surgical procedure that removes a section of artery or vein from another part of the patient’s body. This vessel is then connected (grafted) to the coronary artery at the blockage site. This creates a new path for blood to flow around (bypass) the blocked artery and to your heart. Often, several blocked arteries are bypassed during the same operation.

Pacemakers

A pacemaker is surgically implanted in the upper chest or abdomen. It is made up of computer chips and a battery in a sealed case. It recognizes a problem with the heart’s rhythm and sends out its own electrical pulse to make the heart beat regularly and on time when needed.