Diagnosing heart issues through interventional cardiology

Thanks to advances in medical technology over the years and an ongoing commitment to incorporating into their practices minimally invasive methods that reduce the need for open surgery, interventional cardiologists at St. Charles Heart and Lung Center offer patients throughout Central Oregon wide-ranging treatments for a variety of cardiovascular conditions.

Interventional cardiology’s main goal is to reduce or manage coronary artery blockage, prevent heart attacks, repair heart valves and treat vascular problems in areas such as the legs and other locations away from the heart.

Angiograms, angioplasty and more at St. Charles Heart and Lung Center

St. Charles interventional cardiologists perform most of their procedures in a cardiac catheterization lab, where they numb an incision site in the groin or arm with local anesthetic, then thread a catheter to the problem area — most often the heart, its coronary arteries and carotid arteries. Due to the minimally invasive nature of these procedures, doctors keep patients comfortable using mild sedatives rather than general anesthesia. Some of the more common procedures performed at St. Charles are:

• Angiography — doctors inject dye into an artery to obtain blood vessel images that can help them determine if there may be narrowing, blockage or disease
• Angioplasty and stenting — inflating a small balloon, then inserting a small flexible stent (usually made of plastic or wire mesh) to hold open blocked or narrowed arteries and restore proper blood flow
• Atherectomy — a tiny blade attached to the catheter is used to shave plaque from inside the artery
• Balloon valvuloplasty — as in angioplasty, doctors use a balloon to enlarge a stiff or narrowed heart valve
• Biopsy — doctors insert a small needle into an abnormal area to collect a heart tissue sample so a pathologist can evaluate it
• Intravascular ultrasound — uses sound waves to generate images of blood vessels and blood flow
• Radiofrequency ablation — uses radio waves, which are painless, to destroy clusters of cells that are causing arrhythmias (abnormal heart rhythm)
• Transcatheter aortic valve replacement (TAVR) — a minimally invasive procedure that wedges a replacement valve into the aortic valve’s space without removing the faulty valve

Heart and vascular disease treatment excellence

St. Charles Heart and Lung Center’s interventional cardiologists are proud to be at the forefront in offering minimally invasive cardiovascular treatment options to patients in this region. The benefits of this approach include reduced recovery time and less pain than traditional open surgery procedures.

For more information, or to schedule an appointment, contact us at 541-388-4333 today.

From angiograms to TAVR procedures, the St. Charles Heart and Lung Center offers Central Oregon a wide range of interventional cardiology services.

What are pacemakers?

A pacemaker is a tiny battery-powered device that keeps your heart beating in a regular rhythm. It works by sensing when your heart has lost a regular or healthy rhythm by measuring the electrical impulses your heart is producing. The heart’s natural pacemaker is called the sinus node. It’s a grouping of cells in the upper chamber of the heart that produces electrical impulses that cause your heart to beat. When those cells aren’t functioning properly, your heartbeat could become too fast, too slow or irregular. Problems can also occur because of a disconnect in your heart’s natural electrical pathways. When an irregularity is sensed, the artificial pacemaker comes into play by shocking the heart back into its regular rhythm.

How does a pacemaker work?

Most of us know that when a person’s heart stops suddenly in cardiac arrest, it can be restarted with the use of a defibrillator or more frequently known as an AED. They have become very common in exercise facilities and sports venues all across the country. They save lives by creating a strong electrical shock that restarts the heart. A pacemaker works the same way, except it is often implanted in your chest.

Who can be helped by a pacemaker? For people who have suffered heart damage from heart attack or recurrent arrhythmias caused by coronary disease, a pacemaker may be the only solution to ensure their heart keeps beating. A pacemaker, also known as an ICD or implantable cardioverter defibrillator, works by continuously monitoring your heart and its electrical system. If an arrhythmia starts to occur, the pacemaker shocks the heart and resets it to a normal heartbeat.

If you think or have been told by a doctor that you may need a pacemaker, don’t wait. Please consult your primary care doctor right away.

In Central Oregon, the specialists at the St. Charles Heart and Lung Center strive to help people with artificial pacemakers lead normal, healthy and happy lives.

What are the most common heart attack signs and symptoms?

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It may feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, ear or stomach. Cold sweat, nausea/upset stomach, dizziness, weakness or lightheadedness.
• Feelings of impending death.
• Shortness of breath, weakness, nausea/vomiting and back or jaw pain. (Women are somewhat more likely than men to experience these symptoms.)
• Diabetics will often present without the classic signs outlined above and are often likely to experience the other common symptoms.

What do I do if I experience these symptoms?

If you think you may be having a heart attack, don’t wait — call 911. Uncertainty is normal, but taking a "wait and see" approach can cost you valuable time to save your heart and your life. Even if you're not sure it's a heart attack, have your symptoms checked out. Minutes matter and fast action can save a life. Patient delay is the biggest cause of not getting rapid care for heart attacks. If you are experiencing heart attack symptoms:

• DIAL 911 and follow the emergency operator's instructions.
• CHEW one adult aspirin.
• SIT OR LIE DOWN until medical help arrives.

What is a heart attack?

Blood is supplied to the heart through its coronary arteries. Over a lifetime, plaques or fatty substances gradually build up inside the walls of the arteries, leading to coronary heart disease (CHD). As CHD narrows the arteries, the flow of blood through the arteries is reduced. If a clot breaks loose and suddenly cuts off most or all of the blood supply to the heart, you're having a heart attack.

Cells in the heart muscle that do not receive enough oxygenated blood begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

Why call 911?

• To be most effective, common heart attack treatments must be given within one hour of the onset of symptoms. Calling 9-1-1 is almost always the fastest way to receive lifesaving treatment.
• Emergency medical services (EMS) staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. They have training and equipment that can be effective in reversing cardiac arrest.
• EMS providers can alert the hospital that a heart patient is coming in for treatment, which means a team is assembled and ready to help you by the time you arrive. They are also trained to take you to the hospital that has the services that your symptoms require.
• EMS staff members are trained to revive someone whose heart has stopped.
• Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital and can avoid the intake process.
• If you are experiencing heart attack symptoms, it's extremely unsafe to drive or be a passenger in a car in case you lose consciousness.

What can happen if I do not receive rapid treatment?

• Each year, 1.1 million Americans suffer heart attacks. About 460,000 of those heart attacks are fatal, frequently because a patient did not seek medical treatment immediately.
• Waiting 30 minutes to seek help after the onset of symptoms of a STEMI heart attack (ST segment elevation myocardial infarction) leads to a 10 percent loss of heart muscle. Waiting 60 minutes is 30 percent and six hours means you'll lose 90 percent of your heart muscle to oxygen deprivation.
• It is best to call EMS for rapid transport to the emergency room.

Results of your stress test

All of the information gathered from your stress test including images, ECG tracings, blood pressure readings, symptoms, etc., will be reviewed and reported by a St. Charles Heart and Lung Center cardiologist within 24 hours of your test. The results from your test will be sent to your ordering physician and other health care providers you request.

To find out the results of your stress test, please contact your ordering or primary care physician after three business days from your test. Many physician’s offices will contact you once they have your results, or they may have an appointment already scheduled to review your results and care plan.

What to avoid

Unless otherwise instructed by your doctor, stop taking any beta blocker or calcium channel blocker medications the day before and the day of your test. Below is a comprehensive list of medications to avoid.

Beta blockers

Calcium channel blockers

Preparing for your test

• Tell your doctor about any medicines (including over-the-counter medications, herbs and vitamins) you take. He or she may ask you not to take them before the test. Don’t stop taking them unless instructed to.
  • Unless otherwise instructed by your doctor, stop taking any beta blocker or calcium channel blocker medications the day before and the day of your test.
    • View a comprehensive list of beta blocker and calcium channel blocker medications.
  • If you use an inhaler for your breathing, bring it with you to the test.
• Wear comfortable, loose-fitting clothing and walking shoes with rubber soles. Shorts or sweatpants and jogging or tennis shoes are good choices.
• If you are scheduled for a Nuclear Stress Test, follow the above directions and the additional directions below:
  • It is absolutely necessary to avoid all caffeinated items for the entire day prior to your test and the day of your test. These include coffee and tea (including decaf), caffeinated sodas, chocolate, cocoa and certain pain medications that contain caffeine, such as Excedrine, Anacin, Midol, Fiorinal, etc. Please read the labels. If you have any additional questions about caffeine, please call. Caffeine can impact the accuracy of your test.
  • You are asked not to eat solid foods for four hours prior to your test. Please come well hydrated. You may have water, apple juice, cranberry juice or other clear, non-caffeinated liquids up to the time of your test.
    • Diabetic patients: If you take insulin to control your blood sugar, discuss with your doctor to determine how much insulin you should take the day of the test.
    • Please bring a light snack with you. Once the stress portion of the test is completed, you may eat.

Heart disease and stress tests

Stress testing provides information about how well your heart works during physical stress. Some heart problems are easier to diagnose when your heart is working hard and beating fast.

Stress testing at St. Charles Heart and Lung Center is conducted under the supervision of a cardiologist and performed by a registered nurse and trained technicians.

Why do you need a stress test? Your doctor uses the stress test to:

• Determine if there is adequate blood flow to your heart during increasing levels of activity
• Evaluate the effectiveness of your heart medications to control angina and ischemia
• Determine the likelihood of having coronary heart disease and the need for further evaluation
• Check the effectiveness of procedures done to improve blood flow within the heart vessels in people with coronary heart disease
• Identify abnormal heart rhythms
• Help you develop a safe exercise program

There are many different types of stress tests, including:

• Treadmill Stress Test: For this test, you walk on a treadmill at increasing levels of difficulty, while your electrocardiogram, heart rate and blood pressure are monitored.
• Dobutamine Stress Echocardiogram: This test is used in people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required.
• Stress Echocardiogram: This test is similar to a Treadmill Stress Test. You will have echocardiogram images of your heart before and after you walk on the treadmill.
• Nuclear Exercise Stress Test: This test is similar to a Treadmill Stress Test, with the addition of an injection of a small amount of a radioactive substance to better visualize the heart tissue at rest and after exercise.
• Nuclear Lexiscan Stress Test: This test is similar to a Nuclear Exercise Stress Test, and is used for people who are unable to exercise. Lexiscan, is used to chemically stress the heart in a way that mimics actual exercise.

Cardiac ablation helps treat arrhythmia

Cardiac ablation is a procedure using either heat or extreme cold to correct an abnormal heartbeat, also known as an arrhythmia. 

Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart -- stopping the arrhythmia altogether.

How does cardiac ablation treat my arrhythmia?

Your cardiovascular care team at St. Charles Heart and Lung Center will work together to determine if a cardiac ablation procedure is right for you. 

During the procedure, your electrocardiologist at St. Charles guides long, flexible tubes inserted through a vein or artery in your groin to your heart to deliver energy in the form of heat or extreme cold (known as cryoablation) to correct the tissues that are causing the arrhythmia.

Although cardiac ablation can be done during open-heart surgery, it’s often performed using catheters, making the procedure less invasive and shortening recovery times. You may be able to go home the same day as your procedure, or you may need to stay in the hospital.

To learn more about St. Charles Heart and Lung Center in Bend or to schedule an appointment, please call us at 541-388-4333.

What is WATCHMAN?

The WATCHMAN device is a small implant placed into the heart that can reduce the risk of stroke in patients with atrial fibrillation. Patients with atrial fibrillation are at increased risk of stroke, mainly due to clots that form in a small chamber in the top of the heart known as the left atrial appendage (LAA).

Concerned about your bleeding risk?

If you have atrial fibrillation and you take a blood thinner to reduce your stroke risk, you’re probably aware of the bleeding risks that come with your medication. A procedure to seal off your LAA can reduce your risk of stroke and eliminate the need to take blood-thinning medication.

What can I expect during my WATCHMAN procedure at St. Charles?

Once you are referred to the St. Charles Structural Heart team by your cardiologist, our team works together to perform diagnostic and pre-procedure testing. We then collaborate on a multidisciplinary review of your case to determine if the WATCHMAN procedure your health and well-being. 

During a one-time procedure, the structural heart team at St. Charles will implant a parachute-shaped, self-expanding about the size of a quarter into the left atrial appendage of your heart via a small cut in your upper leg. 

The device is designed to permanently close the LAA, preventing blood clots from escaping and causing strokes. The implant procedure takes an hour and patients are typically released home the following day.

Restoring healthy hearts

When you need help with a heart valve replacement or repair, our team of structural heart experts is here to help restore your heart to good health, and a future filled with possibilities. 

If you think you may be suffering from a structural heart condition, please consult your cardiologist or primary care doctor right away and learn how St. Charles can help.

What is MitraClip?

MitraClip is a procedure for treating mitral regurgitation, a condition in which the mitral valve fails to close completely and blood leaks backward into your heart. Left untreated, mitral regurgitation places an extra burden on your heart and lungs, and your heart may have to work harder to function normally.

Do I have mitral regurgitation?

Symptoms of mitral regurgitation may include: 

• Fatigue or inability to exercise

• Decreased appetite

• Dry, hacking cough that is often worse lying down

• Shortness of breath

• Fainting

• Fluids accumulating in feet, ankles or lungs

Can the MitraClip procedure help me?

During a MitraClip procedure, a small device is attached to your mitral valve, allowing it to close completely and restore normal blood flow through your heart. Less invasive than traditional open-heart surgery, your cardiac surgeon will access the mitral valve with a thin tube that is guided through a vein in your leg. Most patients are released from the hospital within two to three days, and experience improvement in quality of life soon after. 

At the St. Charles Heart and Lung Center, our multidisciplinary group of medical and surgical heart specialists work together and with each individual patient in our care to determine if a MitraClip procedure is the best treatment option.