About the Heart Strong muscle about the size of a fist It lies in the center and tilted to the left Pumps blood, oxygen, and nutrients to al parts of the body The septum divides the heart into the left and right sides The right side pumps blood only to the lungs The left side pumps blood to the whole body The left side is thicker
Blood Flow Through the Heart Superior/Inferior vena cava Right atrium Tricuspid Valve Right ventricle Pulmonary vein Lungs Pulmonary artery Left atrium Mitral Valve Left ventricle Aorta (body)
What is Coronary Artery Disease? The walls inside your arteries are normally smooth and flexible, which allows blood to flow through easily. Over years, fatty deposits may build up on the inside of the artery’s wall. Therefore, vessels carrying blood and oxygen to your heart may be narrowed or blocked
Coronary Artery Disease (CAD) Risk Factors Risk Factors You CANNOT change Risk Factors you CAN change Your age - risk goes up as you get older Gender - men are at greater risk than women and have attacks earlier in life. But women are more likely to die from a heart attack Heredity - Children of parents with heart disease are more likely to develop it themselves Race - African American have higher risks, possibly due to high blood pressure, obesity, and diabetes Your family - most people with strong family history of heart disease have one or more other risk factors Exposure to tobacco smoke - secondhand smoke increases the risk for heart disease High blood pressure – makes the heart work harder, which causes the heart muscles to thick and weak. It also increases your risk for stroke, heart attack and kidney/heart failure High blood cholesterol – can be lowered with changes in diet, activity, and medicine Physical inactivity –regular activity helps prevent heart and blood vessel disease Diabetes – seriously increases your risk of developing CAD Excess body fat – increases the heart’s workload and raises blood pressure
Diagnostic Tests Electrocardiogram (ECG)
records the electrical activity of your heart at rest. It can show new heart attack, damaged heart muscle, enlarged heart chambers, abnormal rhythms, and other heart conditions
Exercise ECG Test (stress test)
is done while walking on a treadmill or stationary bicycle. It allows doctors to see how well your heart pumps when it is made to work harder. The exercise ECG can detect problems that may not show up on a resting ECG.
uses a radioactive substance to produce images of the heart muscle.
uses a radioactive substance to produce images of the heart muscle. The heart scan helps identify areas of the heart muscle that is not receiving enough blood.
Preparing for the Procedure NOTHING to eat or drink 6-8 hours before procedure Check with your doctor several days before because you may be asked to take some medications for a few days before Bring a list of the names and dosages of ALL the medications you are taking Tell the nurse/doctor if you are allergic to any medications, x-ray dye (contrast), iodine/seafood, or if you have a history of bleeding problems For you comfort empty your bladder as much as possible before the procedure begins You may also be asked to remove any underclothing and jewelry before the procedure
What Happens During Catherization? Site is cleansed thoroughly (usually the groin) A small incision is made in the skin A guidewire is threaded into the artery A sheath is slipped over the guidewire and into the artery (guidewire is then removed) The catheter is inserted into the artery and guided toward the heart, while staff watches its progress on a screen The catheter maybe removed and replaced several times. It’s done to reach each of the heart chambers or coronary arteries Once the catheter is inside the heart, the doctor can measure the pressures in the left ventricle and take pictures of the coronary arteries and left ventricle
What Do Catherization Show? Measuring the Pressures Coronary Angiography Left Ventriculography
How Angioplasty Is Done? The sheath that was inserted in your artery during catherization can be used for inserting additional catheters Guided catheter is inserted through the sheath The catheter is directed toward the opening of the diseased artery while the staff watches its progress Contrast is then injected into the artery to show exactly where the narrowed/blocked area is Next, a thinner balloon catheter is inserted through the guiding catheter. It has a small balloon at the tip that is used to open or widen the narrowed artery The balloon catheter is threaded into the artery and placed across the narrowed area Once the balloon is in place the balloon is inflated, this stretches the artery and flattens the plaque The balloon is then deflated and then removed The larger opening in the artery allows more blood to flow through
How Is a Stent Implanted If a stent is needed, it is usually implanted right after angioplasty, before the sheath is removed The stent is usually mounted on a balloon catheter It’s threaded into the coronary artery and placed at the site where the artery was widened When the balloon inflated, the stent expands and presses against the inside wall of the artery The balloon is then deflated and removed The stent remains in place, helping to keep the artery open One or more stents may be used in the artery to span the length of the area where the narrowing was It’s a permanent implant that remains in the artery Within a few weeks, a thin layer of tissue will slowly grow over the stent and cover it
After the Procedure You will be taken do a recovery area or special care unit The sheath is left in place for several hours, which allows doctors to check the treated coronary artery If no problems occur, the sheath is removed and a firm pressure is applied over the groin for about 20-30 minutes to keep site from bleeding After the sheath is removed, you will have to lie flat on your back for up to 8 hours, so that the site can begin to heal properly (DO NOT bend or lift leg) The nurse will check your pulse and blood pressure frequently, and will also check insertion site for bleeding If you feel sudden pain at the site or if you notice bleeding let you nurse know IMMEDIATELY!!! Most patients go home within 24 hours after the procedure Before leaving you will be given instructions about medications, physical activity, and follow up care. You should have someone to drive you home
Treatment Options Medicationscan reduce symptoms of angina by increasing the amount of oxygen that reaches the heart muscle and by reducing the amount of oxygen the heart needs. Ballooning angioplasty is used to widen narrowed arteries without surgery. It helps relieve symptoms of angina by improving the flow of blood to the heart muscle. Stent is a small device that is placed in an artery to help keep it open. It may be implanted to help reduce the chances that the artery will narrow again. The stent is a permanent implant that remains in the artery. Atherectomy is like a balloon angioplasty in many ways, except there is a catheter carries a tiny drill or a cutter at the tip. This is most useful when the plaque is large or hardened.
Ways to Prevent CAD Maintain a healthy weight Exercise or do physical activity Eat a heart healthy diet low in fat and salt and high in fiber Control your blood pressure to keep in below 120/80 Keep your cholesterol at a level that lowers your risk Manage diabetes (if you have it) STOP smoking Learn how to manage stress
Life Style Changes Eat heart healthy Lose weight and keep it off STOP smoking Exercise regularly Watch blood pressure Control diabetes