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Heart Specialist

Centre of Excellence
What are the symptoms of atherosclerosis?

Atherosclerosis may be present for years without causing symptoms. This slow disease process can begin in childhood. In some people, the condition can cause symptoms by the time they reach their 30s. In others, they do not have symptoms until they reach their 50s or 60s. But, as the blockage gets worse, the slowed blood supply to the heart may begin to cause something called angina pectoris, a Latin phrase that means, "strangling in the chest." Patients often say that angina is like a squeezing, suffocating, or burning feeling in their chest. The pain usually happens when the heart has an extra demand for blood, like during exercise or times of emotional stress.
Angina tends to start in the center of the chest but may move to your arm, neck, back, throat, or jaw. Some people say they feel numbness or a loss of sensation in their arms, shoulders, or wrists. An episode usually lasts no more than a few minutes and goes away with rest.
For certain patients with CAD, angina may not be present. Sometimes the lack of oxygen to the heart (called ischemia) does not cause any pain. In these cases, people are said to have silent ischemia.

How is CAD diagnosed?

Your doctor will take a medical history, ask about your symptoms, listen to your heart with a stethoscope, and perform certain tests, often including a chest x-ray. Here is a list of other tests that your doctor may order.

A baseline electrocardiogram (ECG or EKG), which records your heart's electrical activity while you sit quietly. An exercise ECG, also known as a stress test, will show how your heart responds to increasing exercise. Both tests are designed to show if your heart is not working properly, most likely due to a lack of oxygen.

An exercise thallium test, also called a nuclear stress test, which uses a radioactive substance that is injected into your bloodstream to show how blood flows through your arteries. Doctors can see if your heart muscle is damaged or dead, or if you have a serious narrowing in an artery. For people who cannot take an exercise test, medicines can be given that make your heart beat as if you were exercising.

Echocardiography, which uses sound waves to produce an image of the heart to see how it is working

Coronary angiography, which is performed in the cardiac catheterization laboratory. After you are given medicine to relax you, dye is injected into your bloodstream to give doctors an x-ray "movie" of heart action and blood flow through your valves and arteries (called an angiogram). Doctors can see the number of blockages that you have and how serious those blockages are. Doctors often use this test to find out which treatment option may be best for you.

Positron emission tomography (PET) scanning, which uses information about the energy of certain elements in your body to show whether parts of the heart muscle are alive and working. A PET scan can also show if your heart is getting enough blood in order to keep the muscle healthy.

What are the major risk factors for heart disease?

The major risk factors for heart disease are smoking, high cholesterol levels, high blood pressure, physical inactivity, obesity, diabetes, age, gender, and heredity (including race).

What is high blood pressure and how is it treated?

Your heart pumps blood through a network of arteries, veins, and capillaries. The moving blood pushes against the arterial walls, and this force is measured as blood pressure

High blood pressure results from the tightening of very small arteries (arterioles) that regulate the blood flow through your body. As these arterioles tighten (or constrict), your heart has to work harder to pump blood through the smaller space, and the pressure inside the vessels grows.

High blood pressure is so dangerous because it often has no symptoms. High blood pressure tends to run in families. Men are at higher risk than women, and blacks are at greater risk than whites.

In most cases, high blood pressure can be controlled by eating a low-fat and/or low-salt diet; losing weight, if necessary; beginning a regular exercise program; learning to manage stress; quitting smoking; and drinking alcohol in moderation, if at all. Medicines, called antihypertensives, are available if these changes do not help control your blood pressure within 3 to 6 months.

What is cholesterol and why is it so important?

Cholesterol is a fat-like substance (lipid) found in all body cells. Your liver makes all of the cholesterol your body needs to form cell membranes and make certain hormones. Extra cholesterol enters your body when you eat foods that come from animals (meats, eggs, and dairy products). Although we often blame the cholesterol found in foods that we eat for raising blood cholesterol, the main culprit is saturated fat, which is also found in our food. So, we should limit foods high in cholesterol or saturated fat. Foods rich in saturated fat include butter fat in milk products, fat from red meat, and tropical oils such as coconut oil.

Cholesterol travels to cells through the bloodstream in special carriers called lipoproteins. Two of the most important lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Doctors look at how LDL and HDL relate to each other and to total cholesterol.

LDL particles deliver cholesterol to your cells. LDL cholesterol is often called "bad cholesterol" because high levels are thought to lead to the development of heart disease. Too much LDL in the blood causes plaque to form on artery walls, which starts a disease process called atherosclerosis. When plaque builds up in the coronary arteries that supply blood to the heart, you are at greater risk for having a heart attack.

HDL particles carry cholesterol from your cells back to your liver, where it can be eliminated from your body. HDL is known as "good cholesterol" because high levels are thought to lower your risk for heart disease.

What are triglycerides?

Triglycerides are fats that provide energy for your muscles. Like cholesterol, they are delivered to your body's cells by lipoproteins in the blood. If you eat foods with a lot of saturated fat or carbohydrates, you will raise your triglyceride levels. Elevated levels are thought to lead to a greater risk for heart disease, but scientists do not agree that high triglycerides alone are a risk factor for heart disease.

Although triglycerides serve as a source of energy for your body, very high levels can lead to diabetes, pancreatitis, and chronic kidney disease. As triglyceride levels rise, HDL levels fall, which may help explain why people with high triglycerides appear to have an increased risk for heart disease.

What is atherosclerosis?

Atherosclerosis is a condition where a waxy substance forms inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and fibrin (a blood-clotting material). Scientists think atherosclerosis begins when the very inner lining of the artery (the endothelium) is damaged. High blood pressure, high levels of cholesterol, fat, and triglycerides in the blood, and smoking are believed to lead to the development of plaque.

What is coronary bypass surgery?

Bypass surgery improves the blood flow to the heart with a new route, or "bypass," around a section of clogged or diseased artery.

The surgery involves sewing a section of vein or artery from the leg or chest (called a graft) to bypass a part of the diseased coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly.

Coronary bypass surgery has proved safe and effective for many patients who have the procedure. You can expect to stay in the hospital for about a week after surgery, including at least 1 to 3 days in the Intensive Care Unit (ICU). Your doctor may also recommend that you participate in a cardiac rehabilitation program. These programs are designed to help you make lifestyle changes like starting a new diet and exercise program, quitting smoking, and learning to deal with stress.

What is arrhythmia?

Arrhythmias are irregular heartbeats caused by a disturbance in the electrical activity that paces your heartbeat. Arrhythmias cause nearly 340,000 deaths each year. Almost everyone's heart skips a beat at one time or another. These mild, one-time palpitations are harmless. But there are more than 4.3 million Americans who have recurrent arrhythmias, and these people should be under the care of a doctor.

Arrhythmias can be divided into two categories: ventricular and supraventricular. Ventricular arrhythmias happen in the heart's two lower chambers, called the ventricles. Supraventricular arrhythmias happen in the structures above the ventricles, mainly the atria, which are the heart's two upper chambers.

Arrhythmias are further defined by the speed of the heartbeats. A very slow heart rate, called bradycardia, means the heart rate is less than 60 beats per minute. Tachycardia is a very fast heart rate, meaning the heart beats faster than 100 beats per minute.

What is atrial fibrillation?

Atrial fibrillation is a fast, irregular rhythm where single muscle fibers in your heart's upper chambers twitch or contract. According to the American Heart Association (AHA), atrial fibrillation is a major cause of stroke, especially among older people. This irregular rhythm may cause blood to pool in the heart's upper chambers. The pooled blood can lead to clumps of blood called blood clots. A stroke can occur if a blood clot travels from the heart and blocks a smaller artery in the brain (a cerebral artery).

What is a pacemaker and how does it work?

A pacemaker is a surgically implanted device that helps to regulate your heartbeat. Pacemakers use batteries to produce electrical impulses that make the heart pump. The impulses flow through tiny wires (called leads) that are attached to the heart. The impulses are timed to flow at regular intervals.

Most pacemakers work only when they are needed. These are called demand pacemakers. They have a sensing device that either shuts off the pacemaker if the heartbeat is above a certain rate or turns the pacemaker on when the heart is beating too slowly.

Pacemaker batteries can last up to five years or longer. Pacemakers and batteries can be replaced during a minor surgical procedure.

What is mitral valve prolapse?

The mitral valve regulates the flow of blood from the upper-left chamber (the left atrium) to the lower-left chamber (the left ventricle). Mitral valve prolapse (MVP) means that one or both of the valve flaps (called cusps or leaflets) are enlarged, and the flaps' supporting muscles are too long. Instead of closing evenly, one or both of the flaps collapse or bulge into the atrium. MVP is often called click-murmur syndrome because when the valve does not close properly, it makes a clicking sound and then a murmur.

MVP is one of the most common forms of valve disease. It happens more often in women and tends to run in families. Most of the time, MVP is not a serious condition. Some patients say they feel palpitations (like their hearts skip a beat) or sharp chest pain. If you have MVP, you should talk to your doctor about taking antibiotic medicine before dental procedures or general surgery, especially if you have mitral regurgitation or thickened valve leaflets. This medicine will prevent infection of the valve.

What is congestive heart failure?

Heart failure means your heart is not pumping as well as it should to deliver oxygen-rich blood to your body's cells.

Congestive heart failure (CHF) happens when the heart's weak pumping action causes a buildup of fluid (called congestion) in your lungs and other body tissues. CHF usually develops slowly. You may go for years without symptoms, and the symptoms tend to get worse with time. This slow onset and progression of CHF is caused by your heart's own efforts to deal with its gradual weakening. Your heart tries to make up for this weakening by enlarging and by forcing itself to pump faster to move more blood through your body.

Many therapies can help to ease the workload of your heart. Treatment options include lifestyle changes, medicines, transcatheter interventions, and surgery.

What does the term "enlarged heart" mean?

An enlarged heart means the heart is larger than normal because of heredity or disorders and diseases such as obesity, high blood pressure, and viral illnesses. Sometimes doctors do not know what makes the heart enlarge.

What is cardiac catheterization?

Cardiac catheterization is the method doctors use to perform many tests available for diagnosing and for treating coronary artery disease. Cardiac catheterization is used with other tests such as angiography and electrophysiology studies (EPS).

The method involves threading a long, thin tube (called a catheter) through an artery or vein in the leg or arm and into the heart. Depending on the type of test your doctor has ordered, different things may happen during cardiac catheterization. For example, a dye may be injected through the catheter to see the heart and its arteries (a test called angiography), or electrical impulses may be sent through the catheter to study irregular heartbeats (tests called electrophysiology studies).

What is a thallium stress test?

A stress test is a common test that doctors use to diagnose coronary artery disease. The test helps doctors see how the heart is working. A thallium stress test is a nuclear study in which a radioactive substance is injected into your bloodstream to show how blood flows through your arteries. Doctors can see if parts of the heart muscle are damaged or dead, or if there is a serious narrowing in an artery.

What is an EPS?

Electrophysiology (EPS) studies use cardiac catheterization techniques to study patients who have irregular heartbeats (called arrhythmias). EPS shows how the heart reacts to controlled electrical signals. These signals can help doctors find out where in the heart the arrhythmia starts and what medicines will work to stop it. EPS can also help doctors know what other catheter techniques could be used to stop the arrhythmia.

EPS uses electrical signals to help doctors find out what kind of arrhythmia you have and what can be done to prevent or control it. Doctors will perform a cardiac catheterization procedure in which a long, thin tube (called a catheter) will be put into an artery in your leg and threaded into your heart. This catheter can be used to send the electrical signals into your heart. Stimulating the heart will cause an arrhythmia, and doctors can record where in the heart it started. In some cases, you might be given a medicine to cause an arrhythmia. Certain medicines can also be given through the catheter to see which ones will stop the arrhythmia.

What is the difference between a "beta-blocker" and a "clot buster"?

A beta-blocker is a medicine that limits the activity of a hormone called epinephrine. Epinephrine increases blood pressure and heart rate. So, beta-blockers work by limiting the activity of epinephrine, which, in turn, lowers your blood pressure and decreases your heart rate.

Clot busters are thrombolytic agents that may be given if you are having a heart attack or an ischemic stroke (a stroke caused by a blood clot). The term thrombolysis means to dissolve a clot, and that is exactly what these medicines do. In some cases, these medicines can dissolve a clot within minutes.

Clot busters work best when given right away. Some studies have shown that the medicines may offer little benefit if they are given more than a few hours after the first symptoms of a heart attack or ischemic stroke.

What is carotid artery disease?

Carotid artery disease is a form of disease that affects the vessels leading to the head and brain (cerebrovascular disease). Like the heart, the brain's cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck. If these arteries become clogged or blocked, you can have a stroke.

Carotid artery disease is usually caused by atherosclerosis, which is a hardening and narrowing of the arteries. As we age, fat deposits, cholesterol, calcium, and other materials build up on the inner walls of the arteries. This build-up forms a wax-like substance called plaque. As the plaque builds up, the arteries become narrower, and the flow of blood through the arteries becomes slower.

Lifestyle changes, medicines, transcatheter interventions, or surgery can be used to treat carotid artery disease and lower your risk of a stroke.

What is an aneurysm and how is it treated?

An aneurysm is a balloon-like bulge in a blood vessel that can affect any large vessel in your body. An aneurysm happens when the pressure of blood passing through part of a weak blood vessel forces the vessel to bulge outward, forming what you might think of as a thin-skinned blister. Not all aneurysms are life threatening, but those found in the arteries in our bodies often need to be treated. If the bulging stretches the artery too far, this vessel may burst, causing a person to bleed to death.

Aneurysms can occur in blood vessels anywhere in the body. They usually form in the brain or in the aorta (the main artery carrying blood from the heart). In many cases, aneurysms are associated with other types of cardiovascular disease, especially high blood pressure and atherosclerosis. Traumatic injuries, infections, and congenital conditions can also lead to an aneurysm.

Treatment depends on the size and location of your aneurysm and your overall health. Aneurysms in the upper chest (ascending aorta) are usually operated on right away. Aneurysms in the lower chest or the area below your stomach (descending thoracic and abdominal portions of the aorta) may not be as life-threatening. Aneurysms in these locations are watched regularly. If they become about 5 cm (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, your doctor may want you to have surgery to stop the aneurysm from bursting.

Doctors also may prescribe medicine, especially medicine that lowers blood pressure (such as a beta-blocker), to relieve the stress on the arterial walls. Medicine to lower blood pressure is especially useful for patients where the risk of surgery may be greater than the risk of the aneurysm itself.

Cardiologists at the Texas Heart Institute have been using a nonsurgical technique to treat high-risk patients with aortic aneurysms. This technique is useful for patients who cannot have surgery because their overall health would make it too dangerous. The procedure uses a balloon-tipped catheter to insert a spring-like device called a stent at the site of the aneurysm. The balloon is inflated to open up the stent, and once the catheter and deflated balloon are removed from the artery, the stent acts as a barrier between the blood and the arterial wall. The blood flows through the stent, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from bursting.

What is a stroke and what are the warning signs of stroke?

A stroke is an injury to the brain that may also severely affect the body. A stroke happens when blood supply to part of the brain is cut off or when there is bleeding into or around the brain. This can happen if a blood clot blocks an artery in the brain or neck or if a weakened artery bursts in the brain.

Risk factors for stroke include high blood pressure, smoking, heart disease, diabetes, and a high red blood cell count. The risk of stroke also increases with age. Heavy alcohol use increases your risk of bleeding (hemorrhagic) strokes.

The warning signs for stroke may include a sudden, temporary weakness or numbness in your face or in your arm or leg; trouble talking or understanding others who are talking; temporary loss of eyesight, especially in one eye; double vision; unexplained headaches or a change in headache pattern; temporary dizziness or staggering when walking; or a transient ischemic attack (TIA).

What is stem cell therapy for heart failure?

Stem cell research could be used to develop new procedures and techniques to reverse the effects of cardiovascular disease. For example, this technology may be used to help generate new, healthy heart tissue, heart valves, blood vessels, and other important tissues and structures.

The Texas Heart Institute is dedicated to the study of adult autologous stem cells (stem cells taken from the patient's own body) and the role of those stem cells in treating cardiovascular disease. In fact, clinical trials are underway here to study how stem cell therapy can benefit patients with coronary artery disease and congestive heart failure.

What is an angioplasty?

An angioplasty is a technique used to dilate a stenosed artery with a balloon catheter. The angioplasty balloon (deflated) is placed across the area of arterial narrowing and then inflated to dilate the blood vessel. This technique has been used in various vascular beds throughout the body, one of the most common is the coronary arteries (heart) and the iliac arteries (arteries to the legs).

Angiolasty is a surgical procedure performed usually on the arteries and occasionally on the veins. A small tube (cather) is inserted in the groin which is then maneuvered into the heart and coronary arteries. A balloon is then inserted through the catheter. The balloon is inflated inside a blood vessel to flatten any plaque that blocks it and cause it to become narrowed, decreasing the blood flow. Inflating the balloon dilates the artery by breaking apart the atherosclerotic plaque.

Angioplasty opens blocked arteries that supply blood to your heart, the coronary arteries. Angioplasty relieves symptoms of coronary artery disease by improving blood flow to your heart. In angioplasty, a tiny balloon in inflated in the clogged artery to reopen the artery. See also: What is Coronary Angioplasty or P.T.C.A?

Angioplasty is a procedure in which a tiny balloon is inflated and used to widen a blocked artery narrowed from the buildup of cholesterol-laden plaque. After the obstruction is relieved by the balloon dilation, most patients then immediately receive a stent. Stents are small, metal mesh cylinders that are delivered to the site of obstruction and expanded in the artery. Stents act as scaffolds to hold the artery open so itcan heal with a normal diameter to allow blood to flow freely. Primary (or emergency) angioplasty is performed on a patient who is in the throes of an acute myocardial infarction (heart attack). Elective angioplasty is performed on patients who are not experiencing a heart attack, but have blockages significant enough to require an interventional procedure.

What is Coronary artery disease (CAD)?

Coronary artery disease (CAD) affects more than 17 million Americans, making it the most common form of heart disease. CAD and its complications, like arrhythmia, angina pectoris, and heart attack (also called myocardial infarction), are the leading causes of death in the United States. CAD most often results from a condition known as atherosclerosis, which happens when a waxy substance forms inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and a blood-clotting material called fibrin. Doctors have found that there are 2 kinds of plaque: hard and soft.

Most people know about hard plaque and how it can cause a heart attack. If hard plaque builds up in the arteries that supply blood to your heart, the blood flow slows or stops. This decreases the amount of oxygen that gets to the heart, which can lead to a heart attack.

But doctors have now found that even though some heart attacks are caused by hard plaque, most heart attacks are caused by soft or vulnerable plaque. A vulnerable plaque is an inflamed part of an artery that can burst. This can lead to the formation of a blood clot, which can lead to heart attack.

What causes atherosclerosis?

Scientists think the disease starts when the very inner lining of the artery (the endothelium) is damaged. High blood pressure, high levels of cholesterol and triglycerides in the blood, and smoking are believed to lead to the development of plaque.

What is cardiac catheterization?

This is a procedure done on the heart. In it, a doctor inserts a thin plastic tube (catheter) (KATH'eh-ter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries.

Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography (an"je-OG'rah-fe) or coronary arteriography (ar-te"re-OG'rah-fe). This is done to see if the arteries have blockage that could cause a heart attack. This test can measure blood pressure within the heart and how much oxygen is in the blood. It's also used to get information about the pumping ability of the heart muscle. Catheters with a balloon on the tip are used in the procedure called percutaneous transluminal coronary angioplasty (per"ku-TA'ne-us tranz-LU'min-al KOR'o-nair-e AN'je-o-plas-te) (PTCA). Catheterization is also done on infants and children to examine or treat congenital (kon-JEN'ih-tal) heart defects.

What Is Coronary Angioplasty?

Coronary angioplasty is a procedure that opens blocked arteries and allows blood to flow to your heart muscle. Angioplasty is not surgery. It opens a clogged coronary artery by inflating a tiny balloon in it. This information sheet discusses what the procedure is, who needs it, how it is done, and recovery afterwards.

What is a stent and how is one used?

A stent is a wire mesh tube used to prop open an artery that's recently been cleared using angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).

When are stents used?

A stent may be used instead of -- or along with -- angioplasty. Stents are used depending on certain features of the artery blockage. This includes the size of the artery and where the blockage is. Stenting is a fairly common procedure; in fact, it now represents 70-90 percent of procedures.

What are the advantages of using a stent?

In certain patients, stents reduce the renarrowing that occurs after balloon angioplasty or other procedures that use catheters. Stents also help restore normal blood flow and keep an artery open if it's been torn or injured by the balloon catheter.

Can stented arteries reclose?

Yes. Reclosure (restenosis) is also a problem with the stent procedure. In recent years doctors have used new types of stents called drug-eluting stents. These are coated with drugs that are slowly released and help keep the blood vessel from reclosing. These new stents have shown some promise for improving the long-term success of this procedure.

What precautions should be taken after a stent procedure?

Patients who've had a stent procedure must take one or more blood-thinning agents. Examples are aspirin and ticlopidine or clopidogrel. Aspirin is used indefinitely; one of the other 6 - 12 months. For the next four weeks a magnetic resonance imaging (MRI) scan should not be done without a cardiologist's approval. But metal detectors don't affect the stent.

Can having a stent cause problems later?

To date there's no evidence of long-term complications from having a permanent stent.

What is Rotoblator?

Atherectomy (ath"er-EK'to-me) is a procedure to remove plaque from arteries. Plaque is the buildup of fat, cholesterol and other substances in an artery's inner lining.

Coronary atherectomy removes plaque from the arteries supplying blood to the heart muscle. It uses a laser catheter, or a rotating shaver ("burr" device on the end of a catheter). The catheter is inserted into the body and advanced through an artery to the area of narrowing. Other devices are dissectional catheterectomy, catheters that shave off the plaque, or laser catheters that vaporize the plaque. Balloon angioplasty or stenting may be used after an atherectomy.

Persons with plaque buildups in the carotid (kah-ROT'id) arteries or major arteries of the neck are at higher risk for stroke. Carotid endarterectomy (end"ar-ter-EK'to-me) is an effective surgical procedure that can help them. It removes the plaque to reduce the risk of stroke.

What is a heart attack?

A heart attack occurs when the blood supply to part of the heart muscle itself -- the myocardium -- is severely reduced or stopped. The medical term for heart attack is myocardial infarction. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis. The plaque can eventually burst, tear or rupture, creating a "snag" where a blood clot forms and blocks the artery. This leads to a heart attack. A heart attack is also sometimes called a coronary thrombosis or coronary occlusion.

If the blood supply is cut off for more than a few minutes, muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged.

Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of the heart muscle decreases or stops. We're not sure what causes a spasm. A spasm can occur in normal-appearing blood vessels as well as in vessels partly blocked by atherosclerosis. A severe spasm can cause a heart attack.

What is the normal heart?

The heart is located in the center of your chest, just beneath the breast-bone (sternum). It serves as a pumping system to take blood in from the body, sending it to the lungs for oxygen and returning the enriched oxygenated blood back to the body.

Valves, similar to one-way doors, control the continuous flow of blood through the four chambers of the heart. The cycle begins when blood from the body enters the top right chamber, the Right Atrium, and passes through the Tricuspid Valve into the Right Ventricle. The blood is pushed through the Pulmonic Valve and enters the lungs.Once the blood is re-supplied with oxygen, it re-enters the heart through the Pulmonary Veins into the Left Atrium. The blood then passes down through the Mitral Valve into the Left Ventricle. As the powerful left ventricular muscle of the heart contracts, the oxygen-rich blood rushes through the Aortic Valve and is circulated throughout the body via the Aorta.

When is Valve Surgery needed?

When heart valves are seriously harmed by birth defects, inflammation, degeneration or infection, surgery may be required to repair or replace them. Damage to these one-way valves can place excessive strain on the heart muscle and interfere with efficient blood flow to the organs of the body.

Some common problems that are treated by surgery include valves that "leak" (regurgitation) and valves that are constricted by scar tissue, a condition known as stenosis. When replacement of a valve is called for, your doctor will discuss with you which type of valve you will receive, and describe how it works.

How the Coronary Arteries supply blood to the heart?

Your heart requires its own system of blood and oxygen, which is supplied through a network of vessels known as the Coronary Arteries. These vessels originate at the Aorta and run across the surface of the heart.

The Right Coronary Artery supplies blood to the right side of the heart and to a portion of the back side. Two of the major vessels off the Left Main Coronary Artery are the Left Anterior Descending (LAD) and the Circumflex. The LAD provides blood and oxygen to the front of the heart and to the bulk of its muscle tissue, while the Circumflex supplies the left wall and part of the back of the heart.

How long will a porcine valve last?

A porcine valve usually lasts about 10 to 15 years.

When is Bypass Surgery necessary?

The inner surfaces of the healthy arteries are smooth and flexible, which permit blood to flow freely and reach the muscle of the heart. When walls become clogged with scar tissue which includes fatty materials, the result is a condition known as atherosclerosis.

Many factors can contribute to atherosclerosis - some of which are: high blood pressure, elevated blood cholesterol, smoking, diabetes, a family history of atherosclerosis and lack of regular physical activity. In some cases the reduced flow of blood to the heart can cause angina (chest pain, arm or throat discomfort), shortness of breath, or a heart attack. When blockage is severe, surgery may be required to reroute the blood supply around a damaged or blocked coronary artery, a process known as "bypass grafting."

The purpose of coronary bypass surgery is to circumvent the blockages in your coronary arteries. Surgeons use an artery in your chest, the internal mammary artery, and/or segments of leg veins called the saphenous veins. When the internal mammary artery is utilized, one end is usually left attached to the subclavian artery supplying blood to your arms and the cut end is connected just beyond the blockage in the coronary artery. When veins are used, one end of the vein is attached to the Aorta and the other end is connected just beyond the blocked area of the artery to "bypass" the obstruction. Other conduits that can be used include the radial artery from either forearm or veins from the upper arm (cephalic veins). The resulting improvement in blood flow through the arteries can reduce or eliminate angina, prevent heart attacks, and improve long-term survival.

How does the surgeon get to my heart?

WSurgery may also be needed to correct other types of heart problems. An aneurysm is an irregular bulge due to heart muscle wall weakness that sometimes appears after a major heart attack. In surgery, the bulge is cut out or patched. Atrial Septal Defect occurs when the wall that divides the heart's upper chambers does not close all the way. Ventricular Septal Defect results from a hole in the wall between the heart's lower chambers. Surgery is sometimes required to close these openings.The surgeon can reach the patient's heart through several different types of incision. A full or median sternotomy involves an incision through the breastbone (sternum), which is then spread apart. After the operation is complete, the breastbone is closed with stainless steel wires and the skin is sutured. The stretching of the muscles, bones and ligaments during surgery usually results in some pain and discomfort following the operation; however, the breastbone will heal back to full strength.Minimally invasive and robotic operations use a series of smaller incisions placed between the ribs. Surgical instruments and a camera are placed through these incisions and the surgeon views the operative field on a monitor. Since the breastbone remains intact, minimally invasive and robotic procedures typically reduce postoperative pain and require less recovery time.

How long will a mechanical valve last?

A mechanical valve usually lasts forever.

What is op-CAB?

Op-CAB refers to off-pump coronary artery bypass grafting. Ordinarily when performing a CABG (coronary artery bypass graft), the patient has to be placed on a heart-lung machine and the heart stopped during part of the operation. In Op-CAB, neither step is undertaken. The potential advantages, which are still being studied, include less bleeding, less need for blood transfusion, fewer strokes, and a faster recovery. However, Op-CAB is not suitable for every patient.

How can I prevent infection of my new heart valve?

Infection of a heart valve can be reduced with antibiotic taken before any invasive procedures, such as a dental procedure.

How long will my coronary bypass last?

A coronary bypass will last a very long time, although the exact time varies from individual to individual. In general, the mammary artery bypass will last much longer than the vein bypass. Most individuals will require only one operation, although some will require a second or even a third one.

What is the internal mammary artery?

The internal mammary artery is located behind the chest wall. This artery is frequently used in one of the bypasses because it lasts longer than a vein bypass.

Why is an IM artery different from a vein graft?

The internal mammary artery is an artery, whereas the vein graft is a vein. There are other properties unique to the internal mammary; for example, it seems to be protected from atherosclerosis.

What is post-pericardiotomy syndrome?

Post- pericardiotomy syndrome is an inflammation of the tissues around the heart and is seen after an open-heart operation. Symptoms include fatigue, a sensation of not feeling well, and fever. Blood tests may show an elevated white count or inflammation.

Do I need to quit smoking before surgery?

If you smoke, quit. Smoking makes you more prone to developing pneumonia and pulmonary complications after surgery. It also makes your heart work harder, and accelerates the atherosclerotic process. You must quit smoking at least 3 weeks prior to surgery.

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