Information about the heart, coronary artery disease, cardiac catherization, treatment for cardiac catherization, balloon angioplasty, and coronary stent implantation.

The Heart

The heart is a muscle located in your chest under the lower part of your sternum (breast bone).  In healthy adults, the heart is usually about the size of a man's closed fist.

The job of the heart is to pump blood to all parts of the body by way of blood vessels (elastic tubes) which are called arteries and veins.   Arteries carry blood filled with oxygen and other nutrients to the body; veins carry "used" blood from the body back to the heart.  The heart also sends the blood to the lungs where the oxygen we breathe is added to the blood.

The heart is divided into right and left sides, and upper and lower chambers.  The upper chambers, called atria, receive blood and pass it on to the lower chambers, called the ventricles.  The ventricles pump blood out of the heart, the right ventricle to the lungs, and the left ventricle to the body.  Blood flow into and out of the chambers of the heart is controlled by valves.  These valves open and close like doors to keep the blood moving in one direction.

Blood flow through the heart, lungs, and the body is called circulation.  As the heart pumps, it produces a pulse.  Counting the pulse tells us how many times the heart beats in one minute.

In order for the heart to be able to do its work, it must be fed with oxygen-filled blood.  The blood vessels which feed the heart muscles are called coronary arteries.

The heart pumps the blood through the circulatory system and throughout the body.   There are four valves within the heart.  Any may have problems requiring medical attention.
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Coronary Artery Disease

Having Coronary Artery Disease (CAD) means that the inside of one or more of your coronary arteries has become narrowed, or blocked with fatty deposits, calcium, or other materials.  This is the most common problem found in the heart.

Because of this narrowing, part of your heart does not always get enough oxygen-filled blood to do its work.  This usually causes chest discomfort, shortness of breath, pressure, or pain.  If you have experienced any of these sensations, your doctor has probably referred to this discomfort as angina.

Risk factors for Coronary Artery Disease include:  smoking, high blood pressure, high levels of fatty substances in blood, excessive weight, lack of exercise, and stress.   Other risk factors are diabetes mellitus and a family history of heart disease.

It is very important for patients with CAD to know the risk factors so they can do something to decrease the risk of their disease getting worse.  This includes eliminating or modifying the risk factors that you have control over.  Your doctor may suggest ways to lose weight, reduce stress, or increase exercise.

Other heart problems, different from CAD, can occur in the valves or in the heart muscle itself.  One way doctors diagnose CAD or other heart problems is through cardiac catheterization.
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Cardiac Catheterization

A cardiac catheterization is a special x-ray study of the heart.  A flexible narrow plastic tube called a catheter is inserted into a vein or an artery in your arm or upper leg.  The catheter is then passed through the blood vessel into a heart chamber or to a coronary artery.  Special x-ray dye, called contrast, is injected and allows your doctor to see the chambers, valves, or coronary arteries in your heart on an x-ray television screen.  Certain pressures within the heart may be measured and blood samples may be drawn.

Your heart has three main coronary arteries.  On the left, the Left Main coronary splits into the Left Anterior Descending that is on the front of the heart and the Left Circumflex artery that travels around the left side and to the back.  The third is the Right Coronary Artery that wraps around the right and bottom of the heart.  Each artery is responsible for blood flow to a certain section of heart muscle.

Once your doctor feels a cardiac cath should be performed, he/she will talk to you about it and try to decide on the best time to have it done.
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Treatment for Coronary Artery Disease

Following your cardiac catherization, your doctor will review the x-ray films taken during the procedure and determine if there is narrowing or blockage requiring further treatment.  Your doctor will discuss the results of your angiogram with you and advise treatment options based on your medical history, individual anatomy, and personal needs.  The treatment options available may include medication, balloon angioplasty or coronary artery bypass graft surgery.  If angioplasty is the best treatment for your coronary artery disease, it may also include the placement of a coronary stent.
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Balloon Angioplasty

The setup and preparation for the balloon angioplasty procedure is very similar to a cardiac catherization procedure.  The difference in balloon angioplasty, also known as Percutaneous Transluminal Coronary Angioplasty or PTCA, is that a small balloon attached to a catheter is passed into the artery to the site of the blockage or lesion.  The balloon is then inflated to compress the fatty plaque deposits and expand the artery in order to increase blood flow through the artery.

Pre-Angioplasty Narrowing

You will have an intravenous (IV) infusion of the medication heparin which is an anticoagulant that works as a blood thinner to aid in the prevention of blood clot formation or thrombus.  If you feel discomfort at any time during the PTCA procedure you are encouraged to tell the doctor or nursing staff about it immediately.

Post-Angioplasty Enlarged Lumen

Although approximately 400,000 balloon angioplasty procedures are performed each year in the United States, studies have shown that 30-50% of those patients develop a re-narrowing or restenosis of the lesion within 3-12 months after the procedure.  If your doctor feels it is necessary, he or she may recommend placement of a coronary stent, which is a device designed to keep the treated area of the artery open after PCTA.
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Coronary Stent Implantation

A coronary stent is a device made of medical grade stainless steel or some other type of metal.  It is shaped like a small tube that acts as a scaffold against the artery wall.  The stent is mounted on a balloon catheter.

Balloon Withdrawn-Stent Implanted

The stent and balloon are advanced to the angioplasty site, the balloon is inflated, and the stent expands against the inner wall of the artery.  It may be necessary to re-inflate the balloon multiple times to fully expand the stent.  Your doctor may also decide to implant more than one stent to adequately cover the diseased area and minimize the chance of restenosis or abrupt closure of the artery.

After the stent is fully expanded, the balloon is removed and the stent remains permanently implanted to hold the artery open, improving blood flow and relieving symptoms of angina or chest pain.

Within several weeks after the stent implantation, the body will grow tissue over the stent ensuring that the device will remain in its intended position in the artery.
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Vijay M. Haryani, M.D., FACC
455 West Court Street, Suite 302, Kankakee, Illinois 60901
(Phone): 815-936-3240 * (FAX): 815-936-3243