Zalecenia dla pacjentów
przyjmowanych do diagnostyki inwazyjnej układu krążenia
Types of procedures
performed in our cardiology departments:
Treatment of acute coronary syndromes (ACS) – a set of symptoms that occur over the course of acute myocardial ischemia. The symptoms are most commonly caused by advanced coronary atherosclerosis, but other factors may also be involved. Acute coronary syndromes are defined as myocardial infarctions (depending on the ECG result, a distinction is made between STEMI, NSTEMI and unspecified myocardial infarction), unstable angina and sudden cardiac death. Atherosclerotic plaque present in a coronary vessel is the most common cause of ACS. Atherosclerosis is a dynamic disease that may not produce any symptoms for many years and thus often goes unnoticed until the first episode of ACS occurs. The progression of vascular atherosclerosis is favored by, e.g.
- arterial hypertension,
ACS is usually caused by the rupture or erosion of an atherosclerotic plaque, resulting in a critical reduction in blood supply to the heart muscle. ACS can also be caused by, e.g. a progressive thrombotic process in a coronary vessel lumen or contraction of an artery that supplies blood to the heart.
Coronary artery angioplasty is a procedure that involves unblocking a narrowed or even completely closed coronary artery without opening the chest.
Permanent and temporary pacemaker implantations – A pacemaker is a miniature device that makes sure the heart does not beat too slowly; modern pacemakers also prevent and interrupt arrhythmias and improve heart contraction. The pacemaker is powered by a battery with an average life of 5 to 15 years. There are many types of pacemakers to suit different needs depending on the type of condition. A pacemaker is implanted in patients with a heart that is too slow (heart blocks, bradycardia, sinus node syndrome, intensive treatment of fast heart arrhythmias). A pacemaker implantation is a procedure where the device is sutured under the skin of the chest. A pacemaker connects to the heart with 1 or 2 wires called leads, which are inserted into the heart through a vein.
Coronary catheterization is the cornerstone of all percutaneous procedures for the treatment of ischemic heart disease. Devices inserted into the lumen of the coronary arteries are used to widen narrowed blood vessels, crush or remove atherosclerotic plaque or blockages causing ischemia (revascularization – restoration of blood flow to the area of the heart muscle affected by ischemia), and often a stent is inserted into the vessel, which is a miniature “spring” made of thin mesh, placed in the lumen of the narrowed vessel to increase and maintain its patency.
Indications for this procedure can be divided into urgent and elective. Urgent indications (usually with stent implantation) include acute coronary syndromes (myocardial infarction). Percutaneous angioplasty is used as a first-line treatment or as part of the so-called rescue intervention. Virtually every patient with a heart attack should undergo coronary angioplasty.
An implantable cardioverter defibrillator (ICD) is a device that has the ability to recognize life-threatening heart rhythm disturbances and interrupt these arrhythmias with an electrical pulse.
This device is implanted in patients with advanced heart failure who are at risk of sudden death due to complex ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation).
A classic ICD consists of a so-called “can”, which contains the electrical impulse generator and energy source (battery), and a defibrillating electrode. During the implantation, the electrode is introduced transvenously into the right heart cavities, while the device itself is usually implanted in the left subclavian region, subcutaneously, in a specially prepared place, the so-called bed.
The defibrillator battery typically lasts for 4 to 5 years, and the condition of the ICD should be checked every few months at the hospital where it was implanted.
Coronarography is a test that allows to see the course of the coronary arteries (the arteries that supply blood to the cardiac muscle) on an X-ray film. The test allows assessment of the size and course of the coronary arteries, as well as locating areas where the arteries have become narrowed or completely occluded.
The coronary angiography procedure involves inserting a thin plastic tube (called a catheter) through a puncture in an artery (in the groin or wrist area) up to where the coronary arteries branch off from the main artery (aorta). The catheter insertion site is locally anesthetized; coronary angiography does not require general anesthesia (sedation). During the examination, a contrast agent is injected sequentially into both coronary arteries (right and left) (visible on the X-ray film), the course of the examination is recorded on a CD.
A cardiac resynchronization therapy (CRT) involves an electronic device (pacemaker) permanently implanted in a patient to improve the heart’s function as a pump. A resynchronization pacemaker reduces heart failure symptoms such as edema, shortness of breath, and reduced exercise tolerance. In a damaged heart, part of the ventricle contracts with a delay. The purpose of CRT is to restore the synchrony of heart contraction. This synchrony involves the simultaneous contraction of all the walls of the heart. The procedure to implant a CRT is very similar to implanting a “regular” pacemaker.
The electrode tips are inserted into the right atrium and both ventricles of the heart through veins in the clavicle region (without opening the heart – the so-called percutaneous method), their proper function is tested, and then the free ends of the leads are connected to the pacemaker. The pacemaker connected to the electrodes is placed in a pocket created subcutaneously, under the clavicle (left side in right-handed people.
The additional electrode that delivers pulses to the second ventricle is a feature that distinguishes a CRT from a pacemaker. A resynchronization pacemaker is supposed to improve the systolic function of the heart and not just protect against a heart that is too slow. An automatic implantable cardioverter defibrillator (ICD) is an implantable device that (while also being a pacemaker if needed) is supposed to recognize life-threatening arrhythmias and interrupt them, protecting the patient from sudden arrhythmic death.
FFR testing is a modern and highly accurate method of assessing the degree of coronary artery stenosis behind an atherosclerotic lesion.
It involves inserting a special, disposable, pressure microsensor through a catheter into a coronary artery of the heart. The use of FFR in invasive cardiology allows to assess the significance of stenosis and undertake an appropriate treatment strategy.
After the application of certain drugs and measurements, it currently allows the most accurate way to measure the severity of coronary stenosis. It is particularly applicable in some cases of multivessel coronary artery disease (stenosis of multiple vessels). In many cases, after assessment in FFR, the patient avoids invasive treatment (PCI) remaining on equally long-term effective drug therapy stabilizing the atherosclerotic process.
Percutaneous closure of atrial septal defect is a minimally invasive method of treating heart defects, such as:
- ASD-type atrial septal defect, the so-called “true hole” in the septum between the atria of the heart,
- Patent Foramen Ovale (PFO – that is, a developmentally undersized “valve” in the septum between the atria).
The standard method for closing atrial septal defects involves percutaneous implantation of a special occluder made up of two flexible discs (“umbrellas”). After local anesthesia of the inguinal area, the femoral vein is punctured and a diagnostic catheter is inserted through the inferior vena cava into the right atrium of the heart. The doctor passes its tip through an existing defect in the atrial septum into the left atrium of the heart. An occluder is then inserted through this catheter to close the defect. Half of the system (one disk) is opened and adjusted in the left atrium of the heart. Next, the second part of the system (the second disk) is opened on the right side of the septum. After verification of proper implantation by transesophageal echocardiography, the system is disconnected with an appropriate release mechanism. The catheter is removed and the venipuncture site is closed.
The procedure is performed under X-ray guidance and requires the administration of a contrast agent (a fluid visible under X-rays). Positioning of the occluder is performed under echocardiographic guidance.
After a successful procedure, patients can leave the hospital even the next day. After discharge from the hospital, follow-up visits are needed at one month, three months, six months and twelve months. Follow-ups after the procedure evaluate the correctness of the implantation and detect any complications.
Myocardial ablation procedures – an invasive procedure performed to eliminate arrhythmias. It is based on creating a small scar in the heart (e.g.: at the location of the so-called accessory pathway) at the site of the arrhythmia. The heart tissue at the site of application loses its electrical properties and ceases to be the source of the arrhythmia, resulting in complete removal of the arrhythmia in approximately 90% of cases. Ablation is usually performed immediately after an electrophysiological examination. One of the catheters used during the electrophysiological examination is removed and an ablation catheter is inserted in its place and positioned in the heart. Next, thanks to the high-frequency current flowing through the catheter, it heats up (up to several dozen degrees) the tissue, resulting in a small scar in the heart. Several scars are sometimes necessary to remove arrhythmias. Like the electrophysiological examination, the ablation is performed in a conscious patient. The procedure is usually painless, although some patients experience a transient sensation of warmth, burning, or minor pain. The duration of ablation is highly variable, it can take from several dozens of minutes to several hours (not including the preceding electrophysiological examination).
Intravascular ultrasound (IVUS) is one of the techniques for invasive diagnostics and treatment of the heart and coronary vessels, allowing imaging of the anatomy of the coronary arteries. A microtransducer that emits waves is inserted into the arterial lumen during heart catheterization – coronary angiography. The image obtained allows assessment of the morphology of atherosclerotic lesions in the coronary artery wall, helping physicians to decide on surgical treatment. After stent implantation, it also allows for monitoring the effect of the intervention – optimal expansion of the stent in the arterial lumen, whether it is properly expanded, whether the drug contained in the stent wall adheres to the diseased vessel wall, and visualizing any thrombus in the vessel lumen.
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