Options for treating coronary artery disease

PTCA (angioplasty)
A PTCA or angioplasty, as it is commonly referred to, is a nonsurgical way to clear a blocked coronary artery. During this procedure, a thin plastic tube (catheter) is passed from a puncture site in your groin or arm to the blocked artery in your heart. With the aid of an X-ray technique called fluoroscopy, your doctor is able to see on a television monitor the progression of the catheter through your artery. Once it reaches the blocked area, a tiny balloon attached to the catheter is inflated to open up the blockage. When the obstruction is opened enough to allow a sufficient amount of blood to pass through, the catheter is removed. See answers to common questions about angioplasty at Yale-New Haven

Stent
A stent is a small, stainless-steel tube that can be placed in a coronary artery at the point where it's blocked during an angioplasty. It helps keep the artery open so the blood may flow freely. A stent remains in the artery permanently, holding it open to improve blood flow to the heart muscle and relieve symptoms such as chest pain. See answers to common questions about stent procedures at Yale-New Haven

Drug-eluting stent
Drug-eluting, or drug-coated, stents were developed to address the problem of reblockage in coronary arteries, which can occur in as many as 15 to 30 percent of patients who receive a bare metal stent. Drug-eluting stents represent a revolutionary breakthrough that helps to ensure the sustained benefit of angioplasty in patients with coronary artery obstructions. The key ingredient is a drug called rapamyacin, which is slowly released into the vessel lining. It helps prevent scar tissue growth through the openings in the stent mesh, which can prevent reblockage. Drug-eluting stents have been shown in clinical trials to reduce reblockage by more than two-thirds and reduce the need for repeat angioplasties to less than 5 percent. See answers to common questions about stent procedures at Yale-New Haven

Atherectomy
Atherectomy is a procedure to open coronary arteries by removing plaque (cholesterol and other fatty substances) from the arteries. Directional coronary atherectomy (DCA) is a surgical technique that uses a catheter with an inflatable balloon to push a cutting device against the blockage. A motor turns the device which cuts out the plaque. Rotoblation uses a catheter with a rotating shaver on its end. The high-speed rotating device grinds the material blocking the artery into minute particles. Balloon angioplasty may then be used on the artery.

Coronary Artery Bypass Surgery (CABG)
When one or more of your coronary arteries is blocked or severely narrowed, your physician may recommend coronary artery bypass surgery. A leg vein, chest artery or arm artery can be attached to the affected artery to bypass the blocked heart area and increase blood flow to the heart muscle. See answers to common questions about bypass surgery at Yale-New Haven

Treating valvular heart disease

Cardiac valve surgery
Cardiac valve surgery repairs or replaces heart valves that do not properly control the blood flow through the main pumping chamber of the heart (the ventricle). The valve may be repaired or replaced either with a mechanical or tissue valve. See answers to questions about valve/bypass surgery at Yale-New Haven

Treating electrical disturbances of the heart

Medications
There are many medications prescribed to treat abnormal electrical activity within the heart. Often several drugs must be tried until a satisfactory one is found.

Digitalis has been used for years for atrial fibrillation and it is a very effective drug. It can slow the abnormally fast beating of the heart's upper two chambers.
Other anti-arrhythmic medications such as quinidine, procainamide and disopyramide can help stabilize the heart's rhythm.
Aspirin and other bloodthinners (anticoagulants) such as warfarin are often suggested for patients with atrial fibrillation who are at increased risk of stroke.
Beta blockers are a family of drugs used to treat arrhythmias and other cardiac diseases. They reduce the force and rate of the heartbeat by blocking nerve receptors. Propranolol is a commonly used beta blocker.
Calcium channel blockers are another class of drugs frequently prescribed for arrhythmias. By interfering with the flow of calcium in and out of the cells of heart tissue, they change the heart's electrical properties. Cardizem is one of the most frequently prescribed channel blockers for arrhythmia.
Amiodarone is used to treat very serious arrhythmias that do not respond to other drugs. It suppresses almost all kinds of arrhythmias but is associated with some severe side effects.

Pacemakers
Pacemakers are used to take over the control of electrical signals to make the heart beat if the heart's natural pacemaker is not working properly. During a simple surgical procedure, a pacemaker is placed under the skin. A lead connects the device to the heart's right side where it's permanently anchored.

Cardioversion
Cardioversion is a treatment for irregular heart rhythms. A machine called a defibrillator delivers a mild electric shock to the heart muscle via paddles placed on the chest to restore its normal rhythm. Cardioversion may be used to treat many types of fast and/or irregular heart rhythms. It is often used on an emergency basis, but it may be scheduled as an elective procedure for atrial fibrillation.

ICD (implantable cardioverter/defibrillator)
This device is an electronic sensor that constantly monitors heart rhythm. It is surgically implanted in arrhythmia patients under the abdominal skin and connected to the heart with electrode leads. The ICD automatically senses life-threatening arrhythmias and delivers a shock to interrupt the abnormal rhythm and restore normal heart rate.

• YNHH Health Library: Cardiac procedures

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Last revised: May 23, 2007 (dh)

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