What happens during a cath procedure and a surgical procedure?
During a catheter procedure, a catheter (small tube) is inserted in the artery in the groin which is then maneuvered into the heart and coronary arteries. A dye is then inserted through the tube to show the cardiologist where the blockage is in the coronaries.
A surgical procedure involves an incision made in the chest, usually to sew in permanent bypass repair and/or replace valves.
What is an angioplasty?
Angioplasty is a surgical procedure performed usually on the arteries and occasionally on the veins. A small tube (catheter) 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.
What is an intervention?
An intervention generally refers to a procedure that opens up a blocked artery, such as a balloon angioplasty or stent.
What is a stent?
A stent is a circular screen cage-like device which is placed inside a blockage after some balloon procedures to prevent the blockage from collapsing and blocking the artery again.
If I have a catheter procedure will I have to spend the night?
It depends on the findings of the cath procedure and how much disease/blockage there is in the heart. Several things could happen. The physician may let you go home and ask that you follow up with an office visit. There may be further intervention required by the cardiologist which would require you to stay overnight or you may have a consult with a cardiac surgeon for a surgical procedure.
How will I know what the results are of the procedure?
Families are informed immediately after the cath procedure and as soon as your medication has worn off the physician will speak with you directly about the results of the procedure, usually while you are in the holding area or in your room. Families for surgical procedures will be informed after the procedure ends and be able to see you within the hour after they talk with the surgeon.
How often will I need to see a cardiologist or cardiac surgeon after my procedure?
It depends on the level of intervention. If you undergo a cath procedure, you may see the cardiologist once or twice after discharge and then you go back to yearly visits given no other complications.
If you undergo a surgical procedure, you will probably have to see the surgeon at least once and the cardiologist once or twice every month for one to three months. The surgeon releases you to be followed by the cardiologist. Once the cardiologist feels you have recovered, you are released to your primary care physician.
Does Medicare pay for cath interventions?
Yes, at least 80 percent.
The heart is an amazing organ. Every part of your body depends on it. It speeds up when you exercise, are excited or scared. It slows down when you are relaxed or resting. On average, it beats about 70 times a minute, every minute of your life – more than 2.5 billion times over an average lifetime.
But sometimes the heart doesn’t beat the way it should. It may beat too fast, as if you were running for your life instead of just sitting on the sofa. It may beat too slowly. It may skip beats. It may beat at the right speed, but pound like a sledgehammer. It may do any or all of these things, then settle down as if nothing were wrong.
Irregular heartbeat is called cardiac arrhythmia. An arrhythmia can be a serious, life-threatening event, or it can be an inconvenience that interrupts the activities of daily living.
Appalachian Regional Healthcare System comprehensive line of EP services and procedures includes:
• Holter and event monitoring
• Tilt table testing
• Implantable Devices
• Resynchronization therapy for heart failure
Signs & symptoms
• Palpitations (the feeling like your heart is “running away”), fluttering, skipping beats
• Dizziness, feeling light-headed, fainting
• Pounding in your chest, chest discomfort, shortness of breath, weakness or fatigue
*** Severe symptoms may be a medical emergency: Call 911 ***
Heart Failure FAQs:
What is heart failure?
Heart failure is a condition in which your heart becomes too weak to pump blood as effectively as it should. It may come on suddenly, after a heart attack for example, or it may develop slowly as you age or in response to a variety of diseases and conditions, especially high blood pressure. Symptoms may develop so slowly that your body at first is able to compensate. As the disease progresses, however, symptoms will become noticeable and may eventually interfere with your enjoyment of life.
Is heart failure a “death sentence”?
Definitely not. Heart failure can be controlled and managed. Modern treatments such as those available through St. Mary’s and Athens Cardiac Arrhythmia Center can help most heart failure patients continue to lead active, meaningful lives for many years. Talk to your cardiac specialist to develop the treatment plan that is right for you. Common treatment options include:
Weight loss and management – Because the swelling, fatigue and shortness of breath that often come with heart failure can make exercise difficult, many heart failure patients become overweight. Excess weight increases the strain on all parts of your body, including your heart, and also makes exercise harder and more uncomfortable. Safe, supervised weight loss can reduce symptoms, improve heart function, and help other organs such as the lungs, brain and kidneys.
Medication therapy – Medicines such as ACE-inhibitors and diuretics can reduce the workload on the heart and relieve the build-up of fluids in the body
ICRDs – Implantable cardiac resynchronization devices help the chambers of the heart contract at the right time and can boost the strength of heart contractions. Improved strength and timing boosts the heart’s efficiency and helps move more blood through the heart.
Cardiac Rehabilitation – Carefully monitored and supervised exercise can strengthen your heart while improving your overall fitness and lifestyle.
More about ICRDs…
Appalachian Regional Healthcare System makes it possible for cardiac specialists to implant the newest, most sophisticated ICRDs available. Features of this new generation of implantable devices include:
Defibrillation. For patients at risk of fibrillation, in which the heart loses its normal rhythm and quivers without pumping, these ICRDs can deliver a life-saving electrical jolt to restart the heart.
Pacemaking/Resynchronization. For patients whose hearts beat irregularly or in poor synchronization, these devices can set a steady beat and cause chambers of the heart to contract together at the right moment.
Wireless monitoring. The ICRD monitors and records its own activity. When the patient goes to bed at night, a small unit by the bedside automatically uses wireless technology to download information from the ICRD. This information, along with other information the patient can manually enter (especially each day’s weight), can be transmitted directly to the physician anywhere in the world via the Internet.
Miniature size. Thanks to rapidly evolving technology, new ICRDs are smaller than a credit card and not much thicker. They can now be implanted under the skin near the collarbone in a fast, minimally invasive procedure performed under mild sedation. Improved battery technology allows them to work for many years before replacement is necessary.
What causes heart failure?
The leading cause of heart failure is coronary heart disease, in which the arteries providing blood to the tissues of the heart become narrowed by accumulations of plaque on the inside of artery walls. The heart, like all other muscles, must have its own blood supply to work; it cannot absorb the oxygen and nutrients it needs from the blood in its chambers.
When a spot in a coronary artery becomes too narrow, blood can’t pass freely through it and may form a clot, entirely blocking the artery. Just like closing a dam on a river, blood stops flowing to tissues “downstream” of the blockage. Within minutes, the muscle tissue that depends on that artery for its blood supply begins to die. The sudden distress and death of this tissue is what causes the pain and disability of a heart attack, technically known as a myocardial infarction, or MI).
If the blocked coronary artery is small, serving only a small amount of heart muscle, the damaged area is small. While immediate risk of death is not great, the damaged area will have a mild but permanent affect on the heart’s ability to function. Multiple “mild” MI’s can cause severe heart failure.
If the blocked coronary artery is large, serving a significant part of the heart muscle, the damaged area potentially is very large. The risk of immediate death is high, and the damage could have a serious effect on heart function
Can a heart attack be stopped once it starts?
The clot-busting drug TPA, available at Appalachian Regional Healthcare System, can dissolve clots, which restores blood flow and can save tissues that are in distress but have not yet died. However, TPA is effective only if given soon after the onset of symptoms. No drug can restore life to dead tissues. This is why is essential that people who suspect they may be having a heart attack should get medical care immediately. Time is muscle! Call 911!
What are the symptoms of a Heart Attack?
Pressure, squeezing, fullness or pain in the chest
Pain or discomfort in other areas of the upper body, including the arms, jaw, neck, back or stomach
Shortness of breath
Nausea, lightheadedness, breaking out in a cold sweat
While some heart attacks produce sudden, severe symptoms, most come on with mild symptoms that many people ignore or think will go away. Women are especially likely to experience mild, ambiguous symptoms. Remember, delaying treatment increases your risk of death and disability.
What other factors can cause heart failure? In addition to coronary heart disease, other causes of heart failure include:
high blood pressure
high cholesterol levels
alcohol and drug abuse
certain infectious diseases
congenital heart disease
heart valve damage
some genetic disorders
How is heart failure diagnosed? Usually, the appearance of symptoms is the first clue. If your symptoms point toward heart failure, your regular physician may order a diagnostic test such as an echocardiogram or refer you to a cardiac specialist. An echocardiogram uses safe, painless sound waves to determine how well the heart is functioning, including providing your ejection fraction. This is the percentage of blood that is pumped out of the heart with each contraction. An EF of 50 percent is below normal. (see related article, Ejection Fraction).
Computed tomography (CT)
Appalachian Regional Healthcare System features a 64-slice CT scanner, the only kind of CT scanner available today fast enough to capture detailed 3-D images of the heart between beats. With these images, physicians can diagnose potential blockages in coronary arteries, study valve and chamber structure, assess pumping efficiency and measure ejection fraction. CT studies are fast and non-invasive, usually lasting just a few minutes and requiring a low dose of x-rays and the injection of a medically approved dye, called contrast, that highlights blood vessels in x-ray images.
Appalachian Regional Healthcare System, state-of-the-art cardiac cath lab allows cardiologists to diagnose problems with the heart and its blood vessels. While the patient rests under mild sedation, the cardiologist carefully guides a wire into the heart and injects contrast solution. X-ray images highlight the heart’s blood vessels and can reveal a wide array of potentially dangerous conditions, including coronary artery disease.
Appalachian Regional Healthcare System Cardiac/Vascular Services Department provides inpatient and outpatient EKG, echocardiogram and stress echocardiogram testing. St. Mary’s Doppler ultrasound systems use safe, painless sound waves to create images of the heart in action. “Echoes” are done on patients as they lie comfortably in a darkened room; “stress echoes” are performed on patients as they exercise on a treadmill, which provides information on how well the heart functions as the body’s needs increase.
Pulmonary function testing
Many heart failure patients have trouble with shortness of breath due to fluid build-up in and around the lungs and from the heart’s reduced ability to provide enough blood for gas exchange (giving up waste carbon dioxide and absorbing needed oxygen). Appalachian Regional Healthcare System pulmonary function lab provides accurate, detailed information that can help your physician assess lung capacity and function.
Treatment & Continuing Care:
The Heart & Vascular Center
Our facility provides a “one-stop shop” where patients can receive all phases of care – from diagnosis to treatment – under one roof. TCC provides all levels of arrhythmia care, including initial assessments, medication management, patient education, and device therapy.
Several types of devices can be implanted at Appalachian Regional Healthcare to improve heart function and return the heart to a normal rhythm. Broadly, these devices fall into three types. All can be implanted under the collarbone and linked to the heart with tiny wires in a simple surgical procedure that is performed under mild sedation.
Pacemakers – Help hearts keep a steady and appropriate pace
ICDs – Implantable Cardioverter Defibrillators constantly monitor heart rhythm and can deliver a life-saving shock if the heart begins fibrillating.
ICRDs – In addition to helping the heart maintain an appropriate pace and delivering a shock if the heart begins fibrillating, implantable cardiac resynchronization devices help the appropriate chambers contract at the same time. Simultaneous contractions help improve heart function and boost the ejection fraction.
Appalachian Regional Healthcare Cardiac Rehabilitation Program helps people across High Country prevent and recover from heart problems by focusing on creating healthy lifestyles. The program features exercise, dietary changes and other lifestyle improvements, with one-on-one care provided by specially trained personnel and provides ongoing exercise in a class setting at the Paul H. Broyhill Wellness Center to help the patient continue to make progress and reduce the risk of further heart problems. Exercise, camaraderie and dietary education are the cornerstones of Phase III.
Paul H. Broyhill Wellness Center provides a wide variety of group fitness classes and equipment to help people of all ages and fitness levels improve and maintain their strength, flexibility and cardiovascular fitness. Membership includes fitness assessment and body composition analysis; assistance with goal-setting; access to all equipment and classes, including Yoga,, Spin, Zumba and many others. In addition, the highly qualified fitness staff can help you move through your Wellness journey, regardless of what step you’re on.
For more information, call (828)-266-1060 or come by and tour the facility and talk to the staff. We feel certain we can find the right program for you.
How can I prevent Heart Failure?
Most of the factors that cause heart failure also cause heart attack, stroke and other serious health problems. The good news is that many of the most important factors are within your control. They include:
Hypertension (high blood pressure). Experts recommend a BP of 120/80 or lower
Diabetes (“blood sugar”). Experts recommend a fasting blood sugar level of 99 or less
Cholesterol. Experts recommend a fasting LDL (“bad” cholesterol) of 100 or less and HDL (“good” cholesterol) of 40 or more
Tobacco use. Smoking is the leading cause of preventable death and disability. If you don’t smoke, don’t start. If you do smoke, talk to your doctor about effective ways to end your tobacco addiction
Maintain a healthy weight. Obesity is the second leading cause of preventable death and disability, exceeded only by smoking. A good general rule of thumb is the Body Mass Index. A healthy BMI is 19-25
Exercise. Exercise is a key factor in managing your weight, enhancing the health of your heart and lungs, and controlling other factors such as blood pressure, blood sugar and cholesterol. Get at least 30 minutes of cardiovascular exercise a day, at least five days a week
Watch what you eat. Choose a diet rich in whole grains, vegetables, and fruits, low in fats, sugars and processed foods. For most heart failure patients, it is especially important to control sodium intake, especially salt or foods high in salt. Cut back on portion sizes. A registered dietitian can help you make the transition from an unhealthy diet to a healthy one; ask your doctor for a referral.
Use alcohol in moderation or not at all. Some research indicates that a glass of wine now and then may actually be helpful, but too much alcohol damages your blood vessels, brain and other internal organs.
Don’t use cocaine. Cocaine and certain other illegal substances can cause serious damage to the heart, sometimes on the first use.
Some factors are not in your control. These include:
Age. Your risk of heart problems increases as you get older.
Family history of heart disease. You are at higher risk if a parent or sibling had cardiovascular disease, especially at an early age.
Congenital defects. Birth defects that affect the size, shape or function of the heart can cause heart failure and other cardiac problems.
Since some factors are beyond your control, it’s doubly important to focus on the factors you CAN control.
Find out more!
Your best source of information is your doctor. If you are concerned about your risk factors or believe you may be developing early symptoms, schedule an appointment with him or her. Be sure to write down your questions and bring them with you. It’s also good to bring a family member or friend to help you remember what the doctor says.
For even more details, there are many excellent articles, websites and books about heart health; ask your doctor for some recommendations. Be aware that not all materials are evidence-based, especially on the Internet. Be sure to note the credentials of the author and his or her sources; information about a field should come from people who are specialists in that field. Research papers should be peer-reviewed and articles and books should state that they have been reviewed by a medical specialist in the field. Look for endorsements by reputable organizations such as the Centers for Disease Control, the American Heart Association, or major research institutions such as the Mayo Clinic.
• Barnes-Jewish Hospital, “Understanding Ejection Fraction”
• MayoClinic.com, “Ejection fraction: What does it measure?”
• Guidant Corporation
• Discovery Hospital
• National Institutes of Health, Medline Plus
• “Managing Heart Failure,” Hospital Educators Resource Catalogue, Inc. (HERC Publishing)
What is Cardiac Electrophysiology?
Cardiac electrophysiology is the study of the heart’s electrical system. The term “electrophysiology study” or “EP study” applies to any procedure that requires the insertion of an electrode catheter into the heart. Electrode catheters are long, flexible wires that transmit electrical currents to and from the heart.
Some electrophysiology studies are done to diagnose abnormalities (see Heart Rhythm Problems and Conditions ), while others are done to access the heart for treatment or correction of certain conditions, such as Pacemaker Implantation, ICD Insertion, or Cardiac Ablation.
Electrical Impulses Keep Your Heart Pumping
The heart’s electrical system controls the rhythmic contractions that keep the blood pumping and circulating throughout your body. These electrical impulses are controlled by the sinus node, a group of specialized cells that act as the heart’s natural pacemaker.
Why is good blood circulation important?
Blood is rich with the oxygen and nutrients that keep our cells alive and functioning, so a strong circulation of blood throughout the body is a vital component of good health. Electrical signals from the sinus node keep the heart contracting at a healthy pace, which controls the rate of blood that is pumped to nourish and energize the body.
How does the heart control blood circulation?
The heart is a muscular pump that serves as the master control station for blood circulation. The heart is divided into four chambers. The upper chambers are called the right and left atrium, and the lower chambers are called the right and left ventricle.
Blood from all parts of the body drains into the right atrium, passes through a valve and reaches the right ventricle. The right ventricle contracts with each heartbeat and blood is pushed into the lungs, where it gives off carbon dioxide, takes up oxygen, and returns via the pulmonary veins to the left atrium. During relaxation of the left ventricle, the blood passes from the left atrium to the left ventricle where, with each heartbeat, it is ejected through the aortic valve into the aorta. From the aorta, blood flows through the circulatory system to nourish the organs and tissues of the body.
Why is the heart’s electrical system so important to good blood circulation?
The heart’s electrical system transmits signals throughout the heart that keep it pumping at a healthy pace. Beginning in the sinus node, these electrical impulses then travel through pathways of the heart’s upper chambers, which causes them to contract and squeeze blood into the ventricles. Electrical impulses then spread to the atrioventricular node, or AV node, which buffers them before they pass through the ventricles. Specialized muscle fibers running through the ventricles distribute the impulses that cause them to contract and pump blood.
How do problems with the electrical system affect blood circulation?
When there is a problem with the heart’s electrical system, its pumping power is diminished and blood does not circulate effectively. The body does not get the full supply of oxygen that it needs to thrive. This can cause irregular heart rhythms and conditions.
What is Coronary Calcium Scoring?
Coronary heart disease (atherosclerosis) is the nation’s leading killer, and is responsible for more deaths than all types of cancer combined. Every year, more than one million Americans will suffer a heart attack. More than 50% of the patients suffering their first heart attack this year will have no prior symptoms before their first coronary event or death.
Coronary calcium scoring (CCS) is a proven, non-invasive method that can directly identify plaque buildup in the coronary (heart) arteries. The coronary calcium scoring screen is a CT scan that only provides a small fraction of the dose of a routine chest CT. This test has been performed on tens of thousands of patients in the United States. More than 100 scientific articles proving the validity of this test have been published since 1998. In 2006, an international panel of leading cardiologists endorsed this technique.
Who should consider a Coronary Calcium Scoring Screening?
Useful in patients with risk for heart attack by other risk assessment methods. Calcium scoring has also been shown to be accurate in men and women in all age groups. Useful in asymptomatic patients with intermediate risk for heart attack (10%-20%-10 year risk of developing cardiovascular disease based on Framingham Risk Score.) Knowing your calcium score can help your provider direct medications to modify cardiovascular risk factors and help patients improve compliance with heart healthy habits.
Does Calcium Scoring predict a patient’s risk of heart attack or death?
Yes. Calcium scoring predicts a patient’s risk of heart attack or death over five years with higher sensitivity than stress testing or any other known risk factors. An individual with a calcium score in the highest quartile for age (greater than 75th% rank) is more than 6 times likely to have a heart attack than a patient with no coronary calcium. The risk of death in an individual with a calcium score greater than 1000 is more than 12 times higher than that of an individual with a calcium score less than 10.
Patient Prep – What do I need to know before my screening?
Refrain from caffeine for 24 hours before your exam. This will help maintain a slow steady heart rate, improving the quality of your examination. Typically, no medications and no IVs are needed for this examination. You will lie on your back in the scanner. X-rays of your heart will be made during a single breath hold. The examination should be completed within 5–10 minutes. Your examination will then be quality controlled for accuracy by a board certified radiologist, and your score calculated by computer analysis. The result will be sent to your physician.
How do I schedule a Coronary Calcium Scoring Screening?
Your physician will need to contact Central Scheduling at (828) 268-9037.
How much will it cost?
The cost of the procedure is $200.00. The technical portion is $125.00 and the professional portion is $75.00 Some insurance carriers will pay for this screening, but we require full payment for this exam at time of service. Upon request Watauga Medical Center will provide a UB billing form for the technical component so you can submit it to your insurance provider for reimbursement.
The Appalachian Cardiac & Pulmonary Rehabilitation Program (ACRP) is a physician referred medically supervised exercise program. Each patient is provided with multidisciplinary care from several healthcare professionals that include a medical doctor, exercise physiologist, registered nurse, respiratory therapist, behavioral health specialist, and clinical dietician.
The Cardiac Rehabilitation program is designed to restore the cardiac patient to an optimal physical, vocational, recreational and emotional status with the potential for prevention of further disease progression. The patients are strongly encouraged to make various lifestyle changes for the purpose of reducing coronary risk and improving quality of life.
The Pulmonary Rehabilitation program is designed to improve lung function, reduce symptom severity and improve quality of life. It is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.
A patient who has, or has had one or more of the conditions below may be an appropriate candidate for the program:
Conditions for Cardiac Rehabilitation
PTCA / Stent
Acute Myocardial Infarction (heart attack) within last 12 months
CABG (Coronary Artery Bypass Grafting)
Heart Valve Repair / Replacement
Stable Angina Pectoris (chest pain) with current symptoms
Heart / Heart-Lung Transplant
Heart Failure-Chronic (systolic), EF <35%, NYHA Class II-IV
Peripheral Arterial Disease (PAD with symptoms)
Other Cardiac Diagnoses would be based on the patient’s individual insurance approval
Conditions for Pulmonary Rehabilitation:
* Patient must have recent (within 1 year) PFT/Spirometry completed prior to starting rehab
COPD (Chronic Obstructive Pulmonary Disease) Moderate to Very Severe
Restrictive Lung Disease
Other Pulmonary Diagnoses would be based on the patient’s individual insurance approval
A comprehensive evaluation by the ACRP team and/or patient’s physicians and may include:
Support: A group with which to share success and encouragement, and in turn, be encouraged.
Clinical: Sessions will include supervision and monitoring by a team of multidisciplinary healthcare professionals. This team may include a Supervising physician, registered nurse, clinical exercise physiologist, respiratory therapist, clinical dietitian, and health coach specialist from our Behavioral Health department. These team members are available as resources to help teach, guide, and take the best possible comprehensive care of you on your journey of recovery. They are here to advocate for you as needed regarding other aspects of your care which may include communication with your other healthcare providers regarding keeping you as up to date as possible with your needs.
Exercise: Activity to improve heart and lung function, as well as increase muscular strength. Heart rate, blood pressure, oxygen saturation, EKG and blood glucose are monitored during the exercise sessions.
Education: Education is provided to patients about how to better cope with their disease, how to modify their lifestyle, and reduce risk factors for their disease.
For more information, call:
Cannon Memorial Hospital, Sloop Medical Building– (828) 737-7069 Fax (828) 737-7509
Watauga Medical Center, Broyhill Wellness Center– (828) 268-9054 Fax (828) 268-9055
The American Heart Association (AHA) Training Center at Appalachian Regional Healthcare System (ARHS) serves healthcare providers as well as people from the community by providing training in basic and advanced life support.
Training Center Contacts
To schedule a CPR class, contact the ARHS AHA Training Center at (828) 268-8971 or email email@example.com
Training Center Links
The following links are posted to assist healthcare providers and the community. If you have any questions regarding any of this material, please contact the Training Center Coordinator
Mission and Goals of the American Heart Association
The American Heart Association’s mission is to build healthier lives, free of cardiovascular diseases and stroke. Initiatives towards this mission include:
Go Red for Women
Power to End Stroke
Go Red Por Tu Corazon
My Heart My Life
Appalachian Regional Healthcare System Training Center supports the AHA mission and goals through administrative, educational, and quality assurance support of its AHA instructors. The ARHS Training Center also supports the healthcare system’s mission and vision through the provision of quality AHA classes to healthcare professionals, to the community, and by educating and informing the AHA instructors on new skills or AHA programs.