Medical Procedures are performed in the theater in the Buderim Hospital. All procedures require a day admission.
Angiography is an x-ray examination of the coronary arteries to see if they have been narrowed by fatty deposits called plaques.
Plaque can decrease blood flow through a coronary artery, causing recurrent chest pain known as “angina”.
An angiogram can also show how well the heart is functioning as it pumps.
This information is used to plan treatment by a specialist to relieve your symptoms. Treatment can include balloon angioplasty, stent placement, and coronary artery bypass graft surgery.
Angiography is performed in a cardiac cath lab by a cardiologist and a specialised team of nurses and technicians. A catheter is inserted into the femoral artery in the groin. Occasionally the catheter is inserted into your arm. Under x-ray imaging the catheter is guided to the heart. A dye is injected into the catheter and into the coronary arteries as x-ray images are taken. Coronary angiography usually takes about 20-30 minutes.
A local anaesthetic is injected into the groin where the catheter will be inserted into the femoral artery. You will be given sedation to help you relax. When the dye is injected some people occasionally experience nausea or chest discomfort of a short duration. Overall the procedure is painless.
Coronary Angioplasty and stents
Coronary angioplasty is a procedure used to improve blood flow to your heart. During the coronary angioplasty a small balloon is inflated inside of your coronary arteries to open up an area that has become very narrow.
After the angioplasty is performed to open a narrow artery, a special expandable metal tube, which is called a stent, is put into the artery, expanded and left in place to keep the artery open.
There are two types of stents: bare metal stent (BMS) and drug eluting stent (DES).
A stent is a very thin and hollow cylinder made of metal mesh. When the stent is expanded out towards by the force of an inflated balloon, it takes on a new rigid shape. Stents come in a wide variety of designs, and thickness and length to cater for different amounts of plaque and sizes of arteries. Coronary angioplasty is not a cure for coronary heart disease. It only treats the particular area of the coronary artery that has become very narrowed due to coronary heart disease.
The best way to reduce the risk of further health problems is to take medicines as prescribed by your doctor and reduce or remove risk factors. These are the factors that increase your chance of developing coronary heart disease.
Recovery after stent placement
After the procedure you will be moved to the coronary care unit. For several hours a nurse will check your blood pressure, heart rate, groin puncture site and your overall well-being. You will have a drink and a small bit to eat when you feel well. An overnight stay is common.
The heart has its only natural pacemaker called sinoatrial (SA) node that maintains a normal heart rhythm and pulse rate. The SA node sends a signal from the top chamber to the bottom chamber. This signal is coordinated by other group of specialise muscle fibres called (AV) node and the bundle of HIS. The normal heart rate typically varies from 60-80 beats per minute.
As people age, the SA node, the AV node and bundle of HIS may start to wear out. The electric signals can also be interrupted or disorganized by heart attacks or other heart disease. These events cause the heart to beat too slowly all of the time, beat too slowly some of the time, beat too quickly or too slowly at unpredictable times. The pacemaker generates a precisely timed and strong electric impulses for each heart beat, taking over the role of the SA node, AV node and bundle of HIS.
Pacemakers have become an increasingly common treatment option. Some pacemakers are rate modulated, that is they can increase or decrease the heart rate depending on need. Modern pacemakers are reliable, small and long lasting.
Implantation of a permanent pacemaker
The procedure is performed under a local anesthetic in the cardiac cath lab by a cardiologist. A 3cm cut is made on the left hand or right hand side of the chest beneath the collarbone. The pacemaker is placed between the muscle and fat layer just under the skin. The incision is closed with dissolvable stitches that do not need to be removed, mostly. The procedure takes about an hour.
The pacemaker can be felt under the skin, and in thin patients a small lump is visible. Normally an overnight stay is needed in hospital and x-ray will be taken of your chest to look at the position of the pacemaker. The pacemaker needs interrogation every 6-12 months.
A TransesophagealEchocardiogram also known as a TOE involves the insertion of an ultrasound probe, which is the size of a middle finger, into the oesophagus down to the stomach.
The procedure usually only takes 15-20 minutes and carries little compilation. It is done under mild sedation and is well tolerated.
TOE provides a much better image of the heart as the ultrasound beams do not need to pass through the skin, fat and lung before scanning the heart. This method is particularly useful for the imaging of the valves of the heart, the aorta and the septal defects. It is particularly useful to look at valve infections and holes in the heart.
This is a procedure done under general anaesthetic and under the supervision of an anaesthetist; your cardiologist gives your heart an electric shock in order to regain the regular heart rhythm.
Most cardioversions are non urgent performed to treat atrial fibrillation.You are normally required to fast for at least 6 hours prior to the procedure. You will present to the hospital in the morning of the procedure as a day patient. Your cardiologist will guide you with the medication and you are normally on Warfarin for 3-4 weeks prior to the procedure. Usually a transoesophgeal echocardiogram is performed with this procedure to facilitate the procedure.
You will feel slightly drowsy after the procedure and normally given something after an hour and discharged home. Someone responsible will need to take you home and you should not be driving after the procedure.