Cardiovascular Conditions - Diagnosis and Treatment

You may experience angina when your heart doesn’t receive as much blood and oxygen as it should, often due to plaque buildup in your coronary arteries. Treatment options your cardiologist may recommend include:

• Lifestyle changes
  If heart disease is the underlying cause of your chest pain, your cardiologist will recommend lifestyle changes you can make to improve your heart health. These can include:
  - Quitting smoking
  - Eating better to reduce your cholesterol and blood pressure levels
  - Losing weight
  - Exercising
  - Managing your stress

• Medication
  For stable angina, your cardiologist may recommend treating your symptoms with medication, including aspirin, nitrates, beta-blockers, statins, ranolazine, or others.

• Enhanced external counterpulsation therapy (EECP)
  This therapy involves applying air pressure to your legs in rhythm with your heartbeat to increase blood flow to your heart.

• Angioplasty and stenting
  Using a catheter (a small tube), your cardiologist will place a small balloon into the narrowed artery. The balloon is inflated to expand the artery so a tiny mesh tube, called a stent, can be inserted to support the artery walls, restoring blood flow to blocked areas.

Aortic stenosis occurs when the heart’s aortic valve narrows and inhibits blood flow to the body. Usually due to aging, severe aortic stenosis can become life-threatening in as few as two years. Treatment options may include transcatheter aortic valve replacement; surgical “open-heart” aortic valve replacement; balloon valvuloplasty, a catheter-based procedure to open the valve temporarily; or medical management.

• Blood thinning medications - Your provider may prescribe antiplatelet or anticoagulant medication to treat related heart conditions or reduce the risk of blood clots and stroke. In some cases, the side effects of blood thinners may be deemed unsuitable. In this case, your physician may recommend a left-atrial appendage closure procedure.
    

• Heart rhythm controlling medications - Abnormal heart rhythms can be treated with special medications called antiarrhythmics that suppress the abnormal rhythm.
    

• Catheter ablation - In this procedure, a thin tube called a catheter is inserted into a vein and guided to your heart muscle. Through the catheter, the ablation process destroys a small area of heart tissue that’s causing the abnormal heartbeat.
    

• Left atrial appendage (LAA) closure device - If you have nonvalvular AFib, and are not a suitable candidate for warfarin, a common blood thinner, your cardiologist may recommend a left atrial appendage (LAA) closure device. It blocks off an area of your heart (left atrial appendage) where blood clots are much more likely to form, effectively preventing clots from entering your bloodstream. The device is implanted via a catheter (thin tube), which is threaded into a blood vessel in your upper leg and guided to your heart.
    

• Maze procedure - Used to treat AFib, a doctor will create a pattern of scar tissue in the atria to block faulty electrical signals that can cause your arrhythmia. Scar tissue can be made using lasers, heat (radiofrequency energy), cold (cryoablation), or by making incisions with a scalpel.
    

• Percutaneous left ventricular assist device - A mechanical pump that helps your heart pump more effectively. We monitor and care for patients who have these devices.
    

• Pacemaker - A small device is implanted in your chest to help regulate your heart rhythm by sending electrical signals when it beats too fast, too slow or irregularly.
    

• Implantable cardioverter defibrillator (ICD) - Like a pacemaker, ICDs are implanted under the skin and use electric shocks to regulate your heart. The device monitors your heart rate, and when it senses dangerous rhythms, it sends a shock to correct the heart’s rhythm.
    

• Coronary bypass surgery - If your arrhythmia is related to coronary artery disease (CAD), your cardiologist may recommend a coronary bypass surgery or a percutaneous coronary intervention. When blood vessels become severely narrowed or clogged with plaque, less blood flows to the heart muscle. If your heart muscle isn’t receiving enough blood, it can’t pump effectively, and can cause an irregular heartbeat, an increased risk of heart attack or heart failure. Coronary bypass surgery can help restore blood flow to the heart and a healthy heart rhythm. A blood vessel is taken from a donor site in your body to bypass the blocked artery, rerouting blood flow around it.
   

Coronary artery disease occurs when cholesterol deposits called plaque build up on the walls of the arteries that supply blood to the heart. As these walls get thicker with deposits, the inside of the arteries becomes narrower.

Over time, less and less blood can flow through the arteries. Sometimes, they become completely blocked. This process, called atherosclerosis, can lead to heart attack, stroke, arrhythmia or heart failure.

Treating coronary artery disease can involve lifestyle changes, medications or medical procedures. The type of treatment depends on how far the disease has progressed. 

Lifestyle changes include:

• Following a heart-healthy diet
• Losing excess weight
• Managing stress
• Quitting smoking
• Getting enough exercise

Medications can include:

• Aspirin to reduce the risk of blood clots
• Enzyme inhibitors to lower blood pressure
• Beta blockers to slow the heartbeat
• Calcium channel blockers to widen the arteries
• Cholesterol medications, such as statins, to help lower cholesterol

Procedures to restore blood flow to the heart include balloon angioplasty, coronary atherectomy, and coronary artery bypass grafting.

Noninvasive procedures for coronary artery disease

Noninvasive procedures aimed at opening blocked or partially blocked arteries are done in the cardiac catheterization labs at Virginia Mason Franciscan Health. Interventional cardiologists choose which procedure to use based on the size, location and characteristics of the blockage.

Balloon angioplasty involves using a thin catheter gently maneuvered to the blocked artery. The balloon is inflated within the blockage to restore blood flow. Percutaneous coronary intervention (PCI) is usually performed after the balloon is removed. PCI involves inserting a mesh coil called a stent into the artery to keep it open. A drug-eluding stent—one coated with a slowly releasing drug—may be used to help prevent future blockages in the artery.

Coronary atherectomy involves shaving or cutting the blockage within the artery. As with balloon angioplasty, a thin catheter is maneuvered into the blocked artery. In addition to a balloon used to hold open the artery, a tiny drill is also inserted to shave off parts of the blockage. The shavings are sucked into the catheter and removed when the procedure is complete.

Coronary artery bypass surgery 

A minimally invasive procedure to reduce or remove a blockage may not be possible or appropriate if:

• The blockage cannot be easily fixed by angioplasty
• You have blockages in multiple vessels
• You have blockage in the main artery supplying blood to the heart
• Your heart muscle is weak

If one or more of these conditions are present, coronary artery bypass surgery has long been the solution for restoring blood flow to the heart muscle. In fact, coronary artery bypass surgery is the most common heart surgery performed in the U.S.

Bypass surgery involves using an artery or vein from the chest or leg to create a detour around the clogged artery. The new artery is grafted into place to restore blood flow to the heart.

Heart valve disease refers to problems such as “leaking” (valvular insufficiency) or narrowed (valvular stenosis) heart valves. When the mitral valve doesn’t function properly, we offer a range of treatments for mitral valve diseases. If the problem is aortic stenosis, you may be a candidate for transcatheter aortic valve replacement or implantation (TAVR/TAVI), a minimally invasive procedure that replaces a diseased valve with a mechanical or biological tissue valve.

While no medicines cure heart valve disease, they can treat many of its symptoms and reduce the risk of complications. Medication may be the best choice if your condition is mild or you’re not a candidate for surgery.

Your provider may recommend surgery to either repair the existing valves or replace them entirely. Repairing heart valves can involve patching holes with added tissue; reshaping the valves; fusing separated flaps; or widening the valves using a balloon on the end of a thin tube, called a catheter (balloon valvuloplasty).

In cases when your valve can’t be repaired, your surgeon will replace it with a new biological or mechanical heart valve. Your doctor will discuss these options with you so together, you make the best decision for you. A biological valve may need to be replaced in 10 to 15 years. A mechanical valve may never need to be replaced but can also require you to take blood thinning medication for the rest of your life, and it may be more prone to infection.

A heart attack occurs when your heart doesn’t get enough blood and oxygen due to a blockage or narrowing of the coronary arteries. This is usually caused by a buildup of plaque.

If you or your loved one experiences a heart attack, knowing what to expect can help you stay calm and focused. Here’s what will happen if you come to a Virginia Mason Franciscan Health Emergency Services department with heart attack symptoms:

• You’ll be taken to a specially equipped room called a cardiac catheterization suite, where you’ll be treated by an interventional cardiologist, a heart specialist who treats heart attack patients and those at high risk.
• Your provider will study your vascular health (blood vessels) using catheters and imaging to determine whether you have blocked arteries.
• Your provider will decide whether to perform a procedure called an angioplasty. An angioplasty uses a balloon to open the blocked arteries supplying blood to your heart. We may also insert stents to help the arteries stay open, and refer you to a cardiac surgeon, if necessary.

After a heart attack, your cardiologist will recommend the best course of action to ensure your recovery and continued health. If you have any lingering heart issues, such as heart disease or valve disease, they can suggest treatment for your specific needs. Medications may include blood thinners to help prevent blood clots, diuretics to help your body get rid of excess fluid, and other drugs to lower your blood pressure and relieve the stress on your heart.

Your provider may recommend coronary bypass surgery, where a cardiac surgeon uses a healthy vein or an artery from a donor site in your body to create a new pathway for blood to move around a blockage.

Heart disease is a term used to categorize a range of abnormal heart conditions, including arrhythmias, heart valve diseases, infections and more. Some people don’t experience signs or symptoms of heart disease—that’s why it’s often called “the silent killer.” You may not be diagnosed until you have more severe symptoms, like those of a heart attack or irregular heartbeat. You may also experience symptoms such as:

• Chest pain (angina)
• Shortness of breath
• A numb, cold or weak feeling in your arms or legs
• Pain in your back, abdomen, throat, jaw, or neck

At Virginia Mason Franciscan Health, we take heart disease very seriously and will help you manage your health with individualized care. Together, we can help you recover through medication, lifestyle changes and, in some cases, surgery. Treatment options may include:

• Medications - Your provider will prescribe medications based on the type and severity of your heart disease. Medications can include drugs to dilate your blood vessels to relieve chest pain or those designed to lower your cholesterol or blood pressure levels.
   

• Surgery - Your provider may recommend surgery to address heart disease and reduce your risk of heart attack or heart failure. Recommended procedures may include:

-  Angioplasty and stenting – Sometimes called a percutaneous coronary intervention, this is a minimally invasive surgery that can widen the blocked area in your artery. A thin tube (catheter) is threaded into a blood vessel and guided into the blockage. A balloon on the end of the catheter is inflated to push the plaque against the walls of the artery. Then, a small tube called a stent is implanted to keep the passage open and help you regain a healthy blood flow.

- Coronary artery bypass grafting (CABG) – A blood vessel is taken from a donor site in your body to create a new pathway so your blood can flow around the blocked or narrowed artery. CABG is performed as open-heart surgery, so it may be reserved for people with more serious heart disease, such as those who have multiple blockages.

- Lifestyle changes – You can make a big difference in your heart health through managing your lifestyle and making smart choices, such as eating healthy, exercising, managing stress and quitting smoking. 

Heart failure is a condition that affects your heart’s ability to pump blood effectively, keeping it from delivering enough blood to meet your body’s needs.

Caring for heart failure requires an individualized approach. Our cardiologists will work closely with you to monitor your symptoms and overall health, including diet, weight, fluid retention, medications, physical activity, and home and family support to ensure the best care possible. Your provider will also help you identify worsening symptoms so you know when to act.

Your cardiologist may recommend visiting our heart failure clinic and participating in cardiac and pulmonary rehabilitation, a structured cardiac rehabilitation program. People who are treated in heart failure clinics often have more energy for the things they love to do, increase their feeling of control over their disease, are healthier and experience fewer hospitalizations.

An accelerated heart rhythm that begins in your heart’s lower chambers (ventricles), ventricular tachycardia is caused by a malfunction in your heart’s electrical system. Our interdisciplinary team of heart specialists offers several treatments for VT, from medications to help control your irregular heartbeats to procedures in more severe cases. Specialized treatments may include:

• Ablation - During ablation, a specially trained doctor will guide a thin, flexible tube (catheter) inserted into a blood vessel to your heart. Using small electrical charges, the catheter is used to burn small sections of tissue to cut off faulty electrical signals.
    

• Implanted devices - Many types of heart rhythm disorders benefit from having small devices implanted to regulate your heart. For VT, this will most likely be an implantable cardioverter-defibrillator (ICD). When the ICD senses a rapid heartbeat, it sends a small electric impulse to bring your heartbeat back to normal.
    

• Emergency care - When VT leads to severe complications, our experts are ready to provide immediate care. Using defibrillators,  medication, and sometimes emergent catheter ablation, we can help restore your heart to a normal rhythm. After you’re stabilized, our doctors can recommend the best course of action to help treat your condition and prevent dangerous episodes from happening again.