Interventional cardiology

Definition

The investigation of choice that allows the diagnosis of coronary artery disease (presence of the arteries that supply the heart bottlenecks), establishes treatment options (medical, interventional or surgical) and determine prognosis.

Best for:

– Stable angina pectoris;

– Atypical chest pain in patients with non-invasive tests that indicate an increased risk of coronary heart disease;

– Acute coronary syndrome without ST segment elevation (unstable angina);

– Acute myocardial infarction;

– Post-ischemia revascularization (angioplasty or recurrence of chest pain after coronary artery bypass grafting);

– Perioperative evaluation for non-cardiac surgery (valvular, congenital heart disease)

Procedure

After local anesthesia in the groin (or forearm) is inserted into the femoral artery sheath / radial / brachial; by advancing the catheter sheath is to root diagnostic coronary arteries and inject the contrast. Filming images obtained and stored digitally. At the end of the procedure retire catheters and sheath and manual compression is performed at the puncture site; subsequently bandaged and apply a sterile bandage.

Definition

Non-surgical procedure for the treatment of stenoses and occlusions of coronary arteries (arteries that supply the heart muscle).

Arterial stenoses are usually the result of atherosclerosis (cholesterol and calcium deposits in the arterial wall). The location and severity of coronary stenosis defined by angiography (injection of contrast coronary arteries).

Depending on the anatomy of coronary interventional cardiologist determines the indication of treatment: medical, interventional (PCI) or surgery (coronary artery bypass grafting).

Coronary angioplasty is a procedure common in cardiac catheterization laboratories.

Best for:

– Angina of effort;

– Acute myocardial infarction (primary angioplasty);

– Acute coronary syndrome without ST segment elevation

Coronary angioplasty performed for acute myocardial infarction in the early hours of installation is called primary angioplasty and is the most effective method of treatment that saves myocardium, reduce complications and death rate.

Procedure

After local anesthesia in the groin (or forearm), the doctor inserts a sheath into the femoral artery / radial / brachial; through a catheter sheath guide that is positioned in the diseased artery origin; This catheter is advanced through a balloon up to the stenosis / occlusion. The balloon is inflated so that the plaque (cholesterol) is squeezed against the wall, to give the dilatation of the artery.

Usually, angioplasty combined with stent placement (metal prosthesis) covering plaque and keep the artery open.

There are two types of stents:

– Metal (BMS) that are at risk for restenosis (restrangulare) up to 20-30%;

– The drug-coated metal (DES) where the risk of restrangulare is 0-6%.

After stent placement, balloon withdraw and inject contrast agent to view the dilated artery; Finally withdraw the catheter and sheath guide and manual compression is performed at the puncture site. It bandaged and apply a sterile bandage.

Definition:

Imaging procedure that allows visualization of blood vessels using x-rays

Best for:

– Diagnosis of aortic aneurysm and dissection / its main branches;

– Diagnosis of stenosis / occlusion of the carotid arteries, renal arteries, arteries of the arms and legs, coronary artery;

– Diagnosis aneurysms and cerebral arteriovenous malformations;

– Diagnosis of post-traumatic arterial lesions;

– Assessment of tumor vasculature before embolization;

– Diagnosis of pulmonary embolism

Procedure

After local anesthesia in the groin (or forearm) is inserted into the femoral artery sheath / radial / brachial or femoral vein for pulmonary angiography; the sheath is advanced diagnostic catheter to its origin arteries and inject dye. Filming images obtained and stored digitally.

At the end of the procedure retire catheters and sheath and manual compression is performed at the puncture site; subsequently bandaged and apply a sterile bandage.

Definition:

Non-surgical procedure for the treatment of stenoses and occlusions of the arteries legs / renal arteries.

Arterial stenoses are usually the result of atherosclerosis (cholesterol and calcium deposits in the arterial wall).

The location and severity of stenosis are defined by angiography (injection of contrast arteries legs / kidney).

Depending on the anatomy interventional cardiologist determines the indication of treatment: medical, interventional (PCI) or surgery (CABG).

Procedure

After anesthesia, the doctor inserts a sheath into the femoral artery / radial / brachial; by advancing a catheter sheath guide that is positioned in the diseased artery origin; This catheter is advanced through a balloon up to the stenosis / occlusion. The balloon is inflated so that the plaque (cholesterol) is squeezed against the wall, to give the dilatation of the artery. Usually angioplasty combined with stent placement (metal prosthesis) covering plaque and keep the artery open.

Finally, the guide catheter and sheath is withdrawn and manual compression is performed at the puncture site. It bandaged and apply a sterile bandage.

Definition:

Non-surgical procedure of carotid artery stenosis mechanical expansion.

Carotid artery stenoses are atherosclerotic concerned and are located mainly at the origin of the internal carotid artery.

These are either asymptomatic stenosis (identified as some murmurs physical examination) or is manifested in the form of transient ischemic stroke / up.

Angioplasty is an alternative to carotid endarterectomy surgery has numerous advantages:

– local anesthesia

– Rare complications

– The short duration of intervention

– Quick recovery (the day after the procedure, the patient can be discharged)

– Minimal discomfort

Best for:

– Asymptomatic carotid stenosis – stenosis recent studies have shown that severely & gt; 50% require intervention;

– Symptomatic carotid stenosis – stenosis any & gt; 50% require intervention; the risk of stroke in these patients is 26%;

– Carotid stenosis & lt; 50% receive medical treatment.

Procedure

After local anesthesia with 1% lidocaine groin, the doctor inserts a sheath into the femoral artery; sheath is advanced through the catheter and guide places a lesion distal filter that protects the brain from cholesterol microemboliile resulting from mechanical expansion.

Subsequently, a balloon is advanced to the stenosis so that it swells plaque wall is crushed to obtain the expansion of the artery.

Usually angioplasty with stent placement combined self extracting (metal prosthesis) covering plaque and keep the artery open.

After the balloon and stent placement withdraw protection filter; the contrast is injected to view the dilated artery; Finally withdraw the catheter and sheath guide and manual compression is performed at the puncture site.

It bandaged and apply a sterile bandage.

Permanent pacemaker (permanent pacemaker) is a medical device that emits electrical impulses transmitted by electrodes which are in contact with the heart muscle.

The electronic excitations miniaturized issue with regular rhythm to a heart unable to provide normal heart rhythm.

The two main components of a pacemaker are:

– Electric battery that generates pulses and has a lifespan of between 5 and 15;

– Stimulating electrodes are inserted into the cavities venous route straight up (right atrium and / or ventricle).

A pacemaker is designed to interrupt the activity in the presence of a spontaneous heart rate, thus avoiding competition between spontaneous cardiac activity and activity initiated by the pulse generator.

Best for

– Sick sinus syndrome;

– Total atrioventricular block / level II;

– QT syndrome;

– Cardiomyopathy (dilated / hypertrophic);

– Carotid sinus syndrome;

– Recurrent syncope syncope

Procedure

Permanent pacemaker implantation is a surgical procedure that is performed in the cardiac catheterization lab / electrophysiology.

After local anesthesia in the region over- / subclavian right / left to perform a small incision through which advances electrodes to stimulate the venous route to cavities straight (right atrium and / or ventricle).

Attach electrodes to the pulse generator which is placed in a pocket located between the skin and pectoral muscle.

Test electrodes and then the pacemaker is programmed using an external system.

Sterile bandaged.

Definition:

Procedure for conversion of arrhythmias by restoring the heart’s normal sinus rhythm by applying an electric shock to the chest.

The aim of the procedure is to reduce the risks posed by a heart rhythm abnormality, such as the inability of the heart to contract efficiently and thrombus formation (blood clots) in the heart cavities.

Best for:

– Cardioversion „emergency” unstable patients (chest pain, pulmonary edema, hypotension) with narrow QRS complex tachycardia / ventricular frequency range and & gt; 150 / min;

– Cardioversion stable ventricular tachycardia that does not respond to medication i.v;

– Cardioversion „elective” stable patients with atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia.