If you are diagnosed with heart disease, your doctor may recommend that you take immediate action to avoid a heart attack. The treatment for coronary artery disease varies depending on individual needs. St. Joseph's Heart and Vascular Institute offers the latest interventional approaches.

Cardiac Catheterization

Cardiac catheterization is a special x-ray study of the heart and coronary arteries (vessels that supply oxygen-rich blood to the heart muscle). The purpose of cardiac catheterization is to help your doctor check the pumping function of the heart and to examine the coronary arteries and heart valves.

The information your doctor obtains during catheterization helps to identify the problem accurately and enables your doctor to choose the most effective treatment.

The night before the catheterization, you may be asked not to eat or drink anything after midnight.

During the procedure, your doctor inserts a flexible, narrow plastic tube called a catheter into an artery in your arm or upper leg (groin) and gently guides it toward your heart. A contrast dye is injected into the catheter to reveal the blood flow through your coronary arteries. A series of "moving x-rays" is taken so your doctor can see:

• If the blood vessels in your heart are clogged.
• If your heart is pumping normally and the blood is flowing correctly.

The cardiac cath usually takes between thirty minutes to an hour. You will remain awake because your responses to the doctor’s questions may be needed during the procedure. If necessary, you may receive medication to help you relax. You may watch portions of the procedure on a television screen, if you wish.

Cardiac catheterization usually is not painful. You will experience mild discomfort at the insertion site when you are given the local anesthetic. The injection feels like a bee sting and is probably the most uncomfortable part of the procedure. You may feel a hot or flushing sensation when the contrast dye is introduced into your heart. You will not be able to feel the catheter moving through your blood vessels or into your heart. After the catheterization, to prevent bleeding, you will need to remain lying down for two to six hours, with the affected leg straight. Most people have no pain after the procedure. Once you go home, you will be advised to restrict your activity for the first 24 hours.

Because catheterization is an invasive procedure, it has some risk. The risk is small, however, and the procedure is considered relatively safe. Complications associated with catheterization can include bleeding from the site, hematoma (collection of blood under the skin), irregular heartbeat, and/or bruising. You and your doctor should discuss specific concerns before you choose to have the procedure.

Open Heart Surgery

Whether you have coronary artery disease, valve disease or both, the purpose of your upcoming surgery is the same—to make you healthier by helping your heart work more effectively.

You've probably known someone who has had a coronary bypass. In this operation, the surgeon takes a piece of vein from the inner thigh or calf area and uses this vein to bypass the portion of cardiac artery that has become blocked by fatty deposits or plaque. With a bypass graft, your surgeon literally reroutes blood flow around the blockage.

Your surgeon may elect to use an internal mammary artery as a bypass graft. You have two such arteries beneath your breastbone that help supply blood to your chest wall. Your doctor will decide which graft -- leg or chest or both -- will be best in your case.

The number of individual bypass grafts your surgeon performs on your heart accounts for the familiar name of the bypass procedure -- single, double, triple, quadruple, or quintuple.

Repairing Heart Valves

When one or more of your heart valves is damaged or diseased, your doctor may decide to repair or replace it with a new one. Sometimes, valve surgery and coronary bypass are performed at the same time.

The four valves of your heart act like one-way doors, letting blood in and out of the heart’s chambers with each heartbeat. Sometimes, due to scarring or disease, heart valves cannot open or close correctly. This can weaken the heart muscle, causing pain, shortness of breath, and other symptoms. During valve repair, the surgeon may cut or separate the flaps of a narrowed or damaged valve. A valve that is leaking may be strengthened and shortened to help it close more tightly.

If a valve cannot be repaired, it may be replaced with a mechanical or tissue valve. You and your surgeon will discuss which type of valve is best for you.

For a physician referral to a cardiologist, call 410.337.1216.