The term “heart disease” in developed countries typically refers to coronary artery disease, namely cholesterol plaque buildup and obstruction of the arteries that feed the heart itself. Obstruction of one or more of the coronary arteries by plaque may result in poor blood supply to the heart muscle and cause chest discomfort (“angina”) or a heart attack. Low blood flow can also cause serious heart rhythm disturbances and even sudden cardiac death. Plaque can develop in the native coronary arteries as well as in bypass grafts in patients who have had previous coronary artery bypass surgery. Exercise Echocardiography and Myocardial Perfusion Imaging can identify patients with obstructed coronary arteries or bypass grafts.
Patients with severe angina, unstable coronary artery disease (known as “Acute Coronary Syndromes”, or “ACS”), as well as those with abnormal stress tests, are potential candidates for cardiac catheterization and coronary angiography. Coronary angiography is an invasive procedure during which the coronary arteries are directly imaged in a specialized radiology suite in the hospital. Using local anesthetic and sterile technique, slender hollow plastic tubes called catheters are passed painlessly through the vessels back to the heart and are used to inject a liquid imaging agent into each artery to identify important obstructions to blood flow. The typical duration of a coronary angiographic study is about 15 minutes. Additional important information that may be gained at the time of a catheterization procedure includes an assessment of ventricular pump function, valve function, and pressure data. This information may be critical in determining the need for coronary artery bypass surgery or heart valve surgery.
Treatment recommendations are directly based on the extent and severity of artery obstructions. Many patients may only require the addition or adjustment of medications. Coronary artery intervention, also known as “angioplasty,” is considered for patients with severe symptoms and the appropriate coronary anatomy. Most coronary interventions involve the implantation of coronary artery stents. Stents are small metal tubes that are expanded in diseased artery segments to relieve obstructions and reduce symptoms. Stent implantation for unstable symptoms and heart attacks can be life-saving. Various types of stents are available with important differences between them, and your cardiologist will discuss these options with you in advance of your procedure. If very severe and extensive artery disease is identified, patients may be referred for coronary artery bypass graft surgery, or “open heart surgery.”
Only cardiologists with supplemental technical training and additional board certification may perform coronary artery interventional procedures. Those cardiologists in our group with this expertise are on call around-the-clock to serve the needs of our patients and our community at a moment’s notice.
For elective procedures, patients typically arrive at the hospital on the same day as their scheduled procedure. If only coronary angiography is performed, patients are usually discharged home the same day. Stable patients who undergo coronary artery intervention with stents may be eligible to be discharged home the same day, if feasible, or admitted to the hospital overnight for observation. Those who will require coronary artery bypass grafting may also be discharged the same day, but the discovery of critical disease may result in admission to the hospital and prompt consultation by our cardiac surgeons.