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What is it?

A catheterization, also called an “angiogram,” is an invasive procedure that allows Dr. Jamnadas to evaluate the hearts function.

A cardiac catheterization is used to determine the presence of heart structural defects, coronary artery disease, valvular disease, or disease of the aorta. This can show whether further cardiac treatment is needed.

Who needs it?

Cardiac catheterization is done in patients with:

  • Symptoms of Coronary Artery Disease (plaque build up in the cardiac blood vessels) including:
  • Angina- chest pain or discomfort which usually occurs on exertion or stress.
  • Dizziness
  • Heart attack- occurs when a coronary artery becomes completely blocked.
  • Heart failure – heart fails to pump adequately.
  • Heart Valve Disorders
  • Valvular Stenosis- narrowing of a heart valve, preventing it to open completely.
  • Valvular Regurgitation- known as a ‘leaky’ valve, preventing the complete closure of the valve.
  • Congenital Heart Defects- deformity in the heart starting from birth.
  • Cardiomyopathy- weakening of the muscles of the heart leading to the dilatation and enlargement of chambers within the heart.

Why do I need it?

A cardiac catheterization provides accurate and detailed information of how well your blood is flowing to the heart. This allows Dr. Jamnadas to diagnose a problem accurately and also allows him to choose the best treatment for you.

Catheterization is usually done to:

  • Evaluate or confirm coronary heart disease, valvular or aortic disease.
  • Evaluate heart muscle function
  • Determine whether further interventional procedure is necessary.
  • Determine how well blood flow is after interventional procedure is done.

How to prepare for the procedure:

 

Before the procedure:

You will be asked to have blood work done some time before the procedure.
Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

A standard orange prescription bottle full of yellow pills. The information on the label has been covered. A few pills sit outside the bottle, at its base.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

Be prepared with an overnight bag. If interventional procedure is needed during the diagnostic catheterization, you will be required to stay overnight.

Bring a list of the names and dosages of all the medications you are on.

Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.

You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out in the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

The radial approach may be better suited for you rather than the femoral approach for the transradialcathfollowing reasons:

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery. The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

A contrast dye will be given to view the arteries and seen under x-ray guidance. This allows Dr. Jamnadas to see any abnormalities in the arteries including blockages.

In the event that a severe narrowing or blockage is identified, Dr. Jamnadas will proceed with anstent interventional procedure are such as angioplasty and stenting.

Angioplasty is when a wire with a deflated balloon is passed through the catheter to the narrow area. The balloon is then inflated, compressing the plaque against the artery wall and widening it, so it no longer restricts blood flow.

A stent may be placed that acts as a scaffolding to keep an artery open and ensure blood flow and prevent re-narrowing.

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.

You need to remain lying down for several hours.

If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.

If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.

After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.

A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.

You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.

It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

Depending on the outcome of the procedure, you may be sent home about 6 hours after the procedure or may have to stay overnight in the hospital.

What are the risks?

Most of the complications if they occur, are minor and temporary.

These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site.
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery.

 

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What is it?

A catheterization, also called an “angiogram,” is an invasive procedure that allows Dr. Jamnadas to evaluate the blood flow in the peripheries.

These include arteries in the pelvis, legs, feet, kidneys, stomach, arms, and neck.angio1


These peripheral arteries may be narrowed or blocked due to a condition called atherosclerosis (plaque build up in the arteries).

This can lead to symptoms of peripheral vascular disease.

Who needs it?

Peripheral catheterization is done in patients with symptoms of atherosclerosis including:

  • Claudication
  • Buttock pain
  • Cold sensation, numbness or tingling in the legs feet
  • Slow heeling cuts or sores in the feet
  • Pale, shiny, bluish skin
  • Loss of hair over the limbs
  • Dry and brittle nails
  • Absent pulses
  • Impotence

Why do I need it?

A catheterization provides accurate and detailed information of how well your blood flow is working. This allows Dr. Jamnadas to diagnose your problem accurately and allows him to choose the best treatment for you.

A peripheral catheterization provides the exact number, size, and location of blockage. Blockage is due to the formation of plaque seen in atherosclerosis in the peripheries.

Catheterization is used diagnostically to determine the severity of blockage and whether further interventional procedures (angioplasty or stenting) is needed.

How to prepare for the procedure:

Before the procedure:

You will be asked to have blood work done some time before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

A standard orange prescription bottle full of yellow pills. The information on the label has been covered. A few pills sit outside the bottle, at its base.

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

Be prepared with an overnight bag. If interventional procedure is needed during the diagnostic catheterization, you will be required to stay overnight.

Bring a list of the names and dosages of all the medications you are on.

Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.

You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out in the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

The radial approach may be better suited for you rather than the femoral approach for the following reasons:transradialcath

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery. The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

A contrast dye will be given to view the arteries and seen under x-ray guidance. This allows Dr. stentJamnadas to see any abnormalities in the arteries including blockages.

In the event that a severe narrowing or blockage is identified, Dr. Jamnadas will proceed with an interventional procedure are such as angioplasty and stenting.

Angioplasty is when a wire with a deflated balloon is passed through the catheter to the narrow area. The balloon is then inflated, compressing the plaque against the artery wall and widening it, so it no longer restricts blood flow.

A stent may be placed that acts as a scaffolding to keep an artery open and ensure blood flow and prevent re-narrowing.

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.

You need to remain lying down for several hours.

If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.

If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.

After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.

A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.

You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.

It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

Depending on the outcome of the procedure, you may be sent home about 6 hours after the procedure or may have to stay overnight in the hospital.

What are the risks?

Most of the complications if they occur, are minor and temporary.

These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site.
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery.

What is it?

Angioplasty is an invasive procedure used to widen a narrowed or blocked artery using a thin catheter with a balloon at the end.

A blocked artery can occur anywhere in the body. Blockages are due to the formation of fatty plaques known as atherosclerosis. When this plaque ruptures, a clot will form leading to further obstruction of the artery. When this occurs in the peripheries it is known as peripheral vascular disease. The procedure for this is known as percutanteous transluminal angioplasty (PTCA).

The balloon catheter is positioned in the narrowed segment of the artery. Inflation of the balloon causes the balloon to push outward against the blockages and surrounding wall of the artery allowing blood to flow through more easily.

A metal mesh stent may be left in the artery after an angioplasty is done.


As plaque builds up in the arteries, it becomes more difficult for blood to reach the body’s tissues.  When the tissues are deprived of the oxygen rich blood it needs, symptoms may occur.peripangio

Who needs it?

Peripheral Angioplasty is used to treat symptoms caused by:

  • Peripheral Vascular Disease: symptoms of claudication, pain or cramping in the legs, or cold feet.
  • Carotid Artery Disease (narrowing of artery in the neck): symptoms of syncope or fainting, dizziness, or blurring of vision.
  • Renal Artery Disease (narrowing of arteries in kidney): symptoms of high blood pressure.

Why do I need it?

Angioplasty is useful in treating blockages in any of the blood vessels when medications or lifestyle changes are not enough to improve blood flow.

Angioplasty can be done to relieve any symptoms you may be having due to the decreased blood flow to the tissues.

How to prepare for the procedure: 

Before the procedure:

You will be asked to have blood work done some time before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

A standard orange prescription bottle full of yellow pills. The information on the label has been covered. A few pills sit outside the bottle, at its base.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.

You will be admitted into the hospital so be prepared with an overnight bag.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

Bring a list of the names and dosages of all the medications you are on.

Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.

You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out at the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

transradialcathThe radial approach may be better suited for you rather than the femoral approach for the following reasons:

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery.

The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

A contrast dye will be given to view the arteries and seen under x-ray guidance. This allows Dr. Jamnadas to see the exact number, location, and size of the blockage.

Once the blockage is located, the catheter is advanced through the artery to the narrowed segment. A balloon is then inflated, compressing the plaque against the artery wall.

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed which acts as a scaffolding to keep an artery open to ensure blood flow.angio1

 

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.

You need to remain lying down for several hours.

If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.

If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.

After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.

A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.

You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.

It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

What are the risks?

Angioplasty is a common interventional procedure, although with any medical procedure it carries risks. Most of the complications, if they occur are minor and temporary.

These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site.
  • Blockage may reoccur.
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery.

What are the benefits?

 

  • Angioplasty can restore blood flow in the artery without requiring a major surgery.
  • Does not require an incision.
  • General anesthesia is not required.
  • Recovery time is short.
  • Can be done within an hour of an emergency situation such as heart attack to reverse damage.
  • You may feel better than you have felt in a long time.

What is the disadvantage?

A disadvantage of angioplasty is that there is a high restenosis rate.

The artery re-narrows over time caused by the growth of new tissue at the site where the artery was widened or may block again.

This can be prevented by inserting a stent.

What is it?

A stent is a mesh wire which acts as a scaffolding to keep an artery open to ensure blood flow.

A blocked artery can occur anywhere in the body. Blockages are due to the formation of fatty plaques known as atherosclerosis. When this plaque ruptures, a clot will form leading to further obstruction of the artery. When this condition affects the peripheries vessels it is known as peripheral vascular disease.

Most blockages are treated with balloon angioplasty and stenting. Angioplasty is the stretching of an artery to widen it, followed by stent placement. This is known as percutanteous transluminal angioplasty (PTCA).

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed to ensure blood flow through the artery.

Peripheral stents come as bare metal stents.

As plaque builds up in the arteries, it becomes more difficult for blood to reach the body’s tissues. When the tissue is deprived of the oxygen rick blood it needs, symptoms may occur.periphstent

Who needs it?

Stenting is used to treat symptoms caused by:

  • Peripheral Vascular Disease: symptoms of claudication, pain or cramping in the legs, or cold feet.
  • Carotid Artery Disease (narrowing of artery in the neck): symptoms of syncope or fainting, dizziness, or blurring of vision.
  • Renal Artery Disease (narrowing of arteries in kidney): symptoms of high blood pressure.

 

Why do I need it?

Stenting is useful in treating blockages in any of the blood vessels when medications or lifestyle changes are not enough to improve blood flow.

How to prepare for the procedure:

Before the procedure:

You will be asked to have blood work done some time before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

A standard orange prescription bottle full of yellow pills. The information on the label has been covered. A few pills sit outside the bottle, at its base.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.

You will be admitted into the hospital so be prepared with an overnight bag.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

Bring a list of the names and dosages of all the medications you are on.

Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.

You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out at the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.Cardiovascular Interventions

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

The radial approach may be better suited for you rather than the femoral approach for the transradialcathfollowing reasons:

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery.

The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

A contrast dye will be given to view the arteries and seen under x-ray guidance. This allows Dr. Jamnadas to see the exact number, location, and size of the blockage.

Once the blockage is located, the catheter is advanced through the artery to the narrowed segment. A balloon is then inflated, compressing the plaque against the artery wall.

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed to ensure blood flow.restenosis2

Bare metal stents act as a scaffolding to keep an artery open, but suffer from a 30-40% restenosis rate. This is due to a process called intimal hyperplasia which is attributed to a keloid. A keloid is an overgrowth of the inner lining of the blood vessel that covers over the stent. However, this reparative process lasts no more than 6 minutes. After 6 minutes, if an artery has not re-narrowed at the site of the stent, it is unlikely to re-narrow.

If symptoms reoccur after one year, it is usually due to NEW blockage in a DIFFERENT part of the artery, therefore risk factor modification is needed to prevent new blockages. **

Many people have the misguided understanding that patients that have received multiple stents over the course of years have had stent failures.

In the vast majority of these cases, it is a stent in a New location that was needed.

Following stent placement in addition to atherosclerosis risk factor modification, patients need to be put on Plavix therapy for 1 month.

This also helps in preventing blood clots from forming.

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.

You need to remain lying down for several hours.

If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.

If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.

After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.

A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.

You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.

It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

What are the risks?

Stenting is a common interventional procedure, although with any medical procedure it carries risks.

Most of the complications, if they occur are minor and temporary.

These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site
  • Blood clot formation
  • Restenosis
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery

 

What are the benefits?

 

  • Stenting can restore blood flow in the artery without requiring a major surgery.
  • Does not require an incision.
  • General anesthesia is not required.
  • Recovery time is short.
  • You may feel better than you have felt in a long time.

What is it?
Angioplasty is an invasive procedure used to widen a narrowed or blocked artery in the heart by using a thin catheter with a balloon at the end.
The balloon catheter is positioned in the narrowed segment of the artery. Inflation of the balloon causes the balloon to push outward against the blockages and surrounding wall of the artery allowing blood to flow through more easily.
A metal mesh stent may be left in the artery after an angioplasty is done.
Blockages are due to the formation of fatty plaques known as atherosclerosis. When this plaque ruptures, a clot will form leading to further obstruction of the artery. When this condition affects the vessels of the heart it is called coronary artery disease. The procedure for this is known as percutaneous coronary intervention (PCI).
As plaque builds up in the arteries, it becomes more difficult for blood to reach the body’s tissues.  When the tissues are deprived of the oxygen rich blood it needs, symptoms may occur.stent

Who needs it?

Angioplasty is used to treat symptoms caused by coronary artery disease including symptoms of chest pain, shortness of breath, palpitations, or extreme weakness.
Why do I need it?
Angioplasty is useful in treating blockages in the coronary arteries when medications or lifestyle changes are not enough to improve blood flow.
Coronary angioplasty can be done to relieve any symptoms you may be having due to the decreased blood flow to the heart muscle.
In emergency situations such as a heart attack, an angioplasty can be done as soon as possible to retrieve blood flow back to the tissues.

How to prepare for the procedure: 

Before the procedure:
You will be asked to have blood work done some time before the procedure.
Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.
If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.
If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.
Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.
Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.
The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.
Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.
You will be admitted into the hospital so be prepared with an overnight bag.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.
Bring a list of the names and dosages of all the medications you are on.
Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.
You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out at the hospital in the Cardiac Catheterization Laboratory (Cath Lab).
During the procedure you will lay awake on a table on your back.
Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.
An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.
Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.
The radial approach may be better suited for you rather than the femoral approach for the following reasons:

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery. The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.
A contrast dye will be given to view the arteries and seen under x-ray guidance.

This allows Dr. Jamnadas to see the exact number, location, and size of the blockage.

Once the blockage is located, the catheter is advanced through the coronary arteries to the narrowed segment. A balloon is then inflated, compressing the plaque against the artery wall.
Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed which acts as a scaffolding to keep an artery open to ensure blood flow.

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.
You need to remain lying down for several hours.
If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.
If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.
After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.
A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.
You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.
It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

What are the risks?

Angioplasty is a common interventional procedure, although with any medical procedure it carries risks. Most of the complications if they occur, are minor and temporary.
These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site.
  • Blockage may reoccur.
  • Blood clot formation
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery.

What are the benefits?

  • Angioplasty can restore blood flow in the artery without requiring a major surgery.
  • Does not require an incision.
  • General anesthesia is not required.
  • Recovery time is short.
  • Can be done within an hour of an emergency situation such as heart attack to reverse damage.
  • You may feel better than you have felt in a long time.

What is the disadvantage?

A disadvantage of angioplasty is that there is a high restenosis rate.

The artery re-narrows over time caused by the growth of new tissue at the site where the artery was widened or may block again.

This can be prevented by inserting a stent.

What is it?

A stent is a mesh wire which acts as a scaffolding to keep an artery open to ensure blood flow.

Blockages are due to the formation of fatty plaques known as atherosclerosis. When this plaque ruptures, a clot will form leading to further obstruction of the artery. When this condition affects the vessels of the heart it is called coronary artery disease.

Most coronary blockages are treated with balloon angioplasty and coronary stenting. Angioplasty is the stretching of an artery to widen it, followed by stent placement. This is known as percutaneous coronary intervention (PCI).

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed to ensure the blood flow and patency of the artery.

Stents may either come as a bare metal stent or a drug eluting stent. Drug eluting stents slowly release a medication to prevent the artery from becoming blocked again.stent

Why do I need it?

Angioplasty is useful in treating blockages in the coronary arteries when medications or lifestyle changes are not enough to improve blood flow.

Stenting is used to treat symptoms caused by coronary artery disease including symptoms of chest pain, shortness of breath, palpitations, or extreme weakness.

In emergency situations such as a heart attack, stenting can be done as soon as possible to retrieve blood flow back to the heart.

How to prepare for the procedure: 

Before the procedure:

You will be asked to have blood work done some time before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning.

If taking anticoagulants such as Coumadin, you may be asked to stop 5 days before the procedure.

A standard orange prescription bottle full of yellow pills. The information on the label has been covered. A few pills sit outside the bottle, at its base.

If you are diabetic and taking oral medications, you may be asked not to take it the morning of your procedure. If you are taking insulin, you may be asked to take half the dose you normally take.

Avoid using any medications used for erectile dysfunction including Viagra, Cialis, and Levitra) 4 days before the procedure.

Check with Dr. Jamnadas several days before the procedure to determine which medications you may need to stop.

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the test.

You will be admitted into the hospital so be prepared with an overnight bag.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

Bring a list of the names and dosages of all the medications you are on.

Let us know if you have had any previous allergic reactions to a contrast dye, iodine, or history of bleeding problems.

You will be asked to empty your bladder before the procedure.

During the procedure:

The procedure will be carried out at the hospital in the Cardiac Catheterization Laboratory (Cath Lab).

During the procedure you will lay awake on a table on your back.CathLab

Several electrodes will be attached to your arms, legs, and chest. These electrodes have leads that will connect to an electrocardiogram (EKG) machine that records the electrical activity of the heart throughout the test.

An I.V. will be inserted into your arm or hand. From this I.V. a sedative will be given to you to help you relax.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the catheter will be inserted. The catheter can be inserted either into the radial (wrist), brachial (inside your elbow), carotid (neck), or most commonly the femoral (groin) artery.

The radial approach may be better suited for you rather than the femoral approach for the transradialcathfollowing reasons:

  • Limited bed rest after the procedure, usually only 15 minutes. It is easy on patients with back problems or patients who can not lie down for a long period of time.
  • Does not require pressure on the groin.
  • Less bleeding risks.
  • Do not need to stop anticoagulants before the procedure.

A small incision is made in the skin, and a needle is used to enter the artery. A guide wire is threaded into the artery. A short plastic tube known as a sheath is slipped over the guide wire and into the artery. The guide wire is then removed. Once the sheath is in place, the catheter can be inserted.

A contrast dye will be given to view the arteries and seen under x-ray guidance. This allows Dr. Jamnadas to see the exact number, location, and size of the blockage.

Once the blockage is located, the catheter is advanced through the artery to the narrowed segment. A balloon is then inflated, compressing the plaque against the artery wall.

Since the restenosis (re-narrowing) rate is high in angioplasty, a stent is often placed to ensure and maintain blood flow.

There are two types of stents, bare metal stents and most of them today are drug coated called drug eluting stents.

  • Bare metal stents act as a scaffolding to keep an artery open, but suffer from a 30-40% restenosis rate. This is due to a process called intimal hyperplasia which is attributed to a keloid. A keloid is an overgrowth of the inner lining of the blood vessel that covers over the stent. However, this reparative process lasts no more than 6 minutes. After 6 minutes, if an artery has not re-narrowed at the site of the stent, it is unlikely to re-narrow.
  • Drug eluting stents have a less aggressive reparative process and therefore the narrowing rate within the stent is less than 5%. Drug eluting stents are one of the marvels of modern cardiology. Typically if a year has gone by with no evidence of re-narrowing, then that portion of the artery that has been stented will remain patent indefinitely in 99% of patients.

desvsbaremetal

If symptoms of angina reoccur after one year, it is usually due to NEW blockage in a DIFFERENT part of the artery, therefore risk factor modification is needed to prevent new blockages. ** Many people have the misguided understanding that patients who have received multiple stents over the course of years have had stent failures. In the vast majority of these cases, it is a stent in a New location that was needed.

Following stent placement in addition to atherosclerosis risk factor modification, patients need to be put on two antiplatlet therapies. Plavix or Effient + Aspirin are recommended for one uninterrupted year of antiplatlet therapy.

It is important to know that a Plavix sensitivity test is done for those who have a drug eluting stent to assess patients responsive to Plavix. Those who are sensitive and have the drug eluting stent will require Plavix therapy up to 1 year until the stent is covered by the natural lining of the blood vessel wall. This also helps in preventing blood clots from forming. For those with a bare metal stent applied, 1 month of Plavix therapy is required.

After the procedure:

Once the procedure is done, the puncture site in the artery will be closed.

You need to remain lying down for several hours.

If the insertion site was in the groin, the introducer sheath is usually removed within 6 hours of the procedure. You may need to lie down for 2-6 hours without bending or lifting your leg.

If the catheter was inserted into your wrist or arm, you will be permitted to get out of bed sooner.

After this you will be allowed to move about freely. This does not allow strenuous activity up to 1–2 days.

A nurse will monitor your heart rate, blood pressure, temperature, and the insertion site.

You will be asked to drink plenty of fluids after the procedure to flush out the contrast dye from your system.

It is normal to have a small bruise or lump at the insertion site. This should disappear in about 2 weeks.

What are the risks?

Stenting is a common interventional procedure, although with any medical procedure it carries risks.

Most of the complications, if they occur are minor and temporary.

These include:

  • Allergic reaction: may have an allergic reaction to the contrast dye.
  • Nausea and Vomiting
  • Bleeding, bruising, or swelling at the insertion site
  • Blood clot formation
  • Restenosis
  • Arrhythmia: irregular heart rhythm
  • Infection
  • Damage to the heart or blood vessels
  • Kidney damage: due to the contrast material which could possibly cause kidney failure.
  • Heart attack or stroke: on rare occasion, the catheter may dislodge a clot or debris from the inside wall of the artery

 What are the benefits?

  • Stenting can restore blood flow in the artery without requiring a major surgery.
  • Does not require an incision.
  • General anesthesia is not required.
  • Recovery time is short.
  • Can be done within an hour of an emergency situation such as heart attack to reverse damage.
  • You may feel better than you have felt in a long time.

 

feelgood

What is it?

Coronary artery bypass graft surgery (CABG) is a procedure which takes a blood vessel from a part of the body to restore blood flow to the heart muscle.

CABG is used for patients who have coronary artery disease (CAD). CAD is due to a disease process called atherosclerosis caused an accumulation of cholesterol, protein, calcium, etc. Collectively, these form what is called plaque within the coronary arteries. Plaque formulates within the arteries therefore, restricts the amount of blood flow to the heart and deprives the heart muscle from oxygen and nutrients causing ischemia. Ischemia can produce symptoms of chest pain (angina) or in more severe cases can produce heart attack (myocardial infarction), heart failure, arrhythmias, or cardiac death.

After CABG surgery, normal blood flow to the heart muscle is restored therefore, chest pain is relieved in the vast majority of patients. CABG can also prolong the survival rate in patients with severe coronary artery disease.bypass

 Who needs it?

CABG is recommended for the following:

  • Stable angina: this is when the frequency, severity, duration, and precipitating factors of chest pain remain unchanged. CABG is recommended in these patients if symptoms are persisting or remain intolerable despite medical therapy or interventional procedures. Those at high risk of heart attack or death are also recommended for CABG.
  • Extensive disease: this includes patients with narrowing of the left main coronary artery, multiple narrowed coronary arteries, or those with a low ejection fraction (poor pumping function of the left ventricle of the heart).
  • Future risk of a cardiac event: patients who have had testing done showing that they are at high risk for a future cardiac event, poor exercise capacity, low blood pressure during exercise, or severely restricted blood flow to multiple areas of the heart may require CABG.
  • Unstable angina: in patients whose chest pain increases in frequency, becomes more severe, long lasting, present at rest, or does not respond to medical management may require intervention or CABG.

What to expect:

During the procedure:

CABG usually takes anywhere from 3 to 6 hours or more depending on the severity. General anesthesia is required for the surgery.

A large incision will be made over the chest. Blood flow will be passed through a heart-lung machine called an on-pump coronary bypass surgery. After the chest is opened, the heart is temporarily stopped while blood flow is maintained from the heart-lung machine.

A section of a healthy blood vessel either from the internal mammary artery in the chest wall or the saphenous vein in the lower leg will be used as the graft. One end of the vessel will be attached above the blocked artery and the other end will be attached below the blocked artery to go around or bypass the diseased artery.bypasssaphenousmammary

After the procedure:

Once the surgery is over, the patient will remain in the hospital intensive care unit (ICU) for one to two days. While in ICU the patient’s heart rate and rhythm, blood pressure, temperature, and breathing will be continuously monitored.

  • The breathing tube that was placed in the airway before surgery will be removed a few hours after surgery, once the patient is awake and can breathe on their own.
  • A thin urinary catheter placed before surgery will be removed once the patient is able to walk and go to the restroom on their own.
  • An intravenous (IV) line will be fixed before surgery for the administration of medications, fluid, and blood. Once the patient is able to eat and drink on their own and IV medications are no longer required, the IV line is removed.
  • The incision over the chest usually causes the most discomfort in the initial 48 to 72 hours after surgery. Pain medication is usually given to help relieve any pain or discomfort.

After one to two days, the patient is encouraged to start walking. Early ambulation helps prevent the development of clots.

Most patients recover in the hospital for four to five days after surgery, although hospitalization may be longer.

Recovery period is about six to twelve weeks after the surgery. With the doctor’s approval, daily activities can be resumed.

What is minimally invasive bypass surgery?

This is a new technique being developed that may reduce the discomfort and risks associated with traditional bypass surgery.

This uses a small chest incision and the surgery is preformed while the heart is still beating. This technique is becoming increasingly popular, but is not suitable for all cases.

Long term results are comparable to traditional CABG, although a shorter hospital stay is included.

What are the risks?

CABG is an open heart surgery; complications may occur during or after surgery.

The major complications include:

  • Bleeding
  • Heart attack
  • Heart failure
  • Arrhythmia
  • Stroke
  • Changes in cognitive function
  • Pulmonary problems
  • Chest/wound infection
  • Renal failure
  • Death

Other complications include:

  • Pleural effusion
  • Phrenic nerve damage
  • Intercostal nerve damage
  • Aortic dissection
  • Thrombocytopenia

When to call your doctor?

Call your doctor if you have any of the following:

  • Fever higher than 100.4°F
  • Rapid heart rate
  • New onset or worsening pain at wound site
  • Redding, discharge, or bleeding from the chest wound
  • Shortness of breath
  • Fainting
  • Weight gain of more than 2 pounds in 24 hours or more than 5 pounds in one week
  • Swelling in your hands, feet, or ankles

What is the long term result?

In the long run after CABG surgery, most people feel better and may remain symptom free for as long as 10 to 15 years.

If proper care is not taken, arteries at other sites or even the new graft may become clogged. Symptoms will reoccur and further intervention or another bypass may be required.

The recurrence of angina is less frequently seen with an arterial graft used for bypass compared to a vein.

To prevent the recurrence of angina or the clogging of arteries, lifestyle modifications must be taken.

Lifestyle modifications include:

  • No smoking!!!no_smoking_sign_clip_art_23316
  • Reduce the amount of saturated fats and cholesterol you take. Saturated fats include cheese, butter, milk, and red meats.
  • Reduce your salt intake. Season foods with garlic or pepper.
  • Add more fruits and vegetables to your diet.
  • Try eating fish like cod, salmon, or tuna. These are low in fat and have healthy omega 3 fatty acids.
  • Increase fiber in your diet. This helps in lowering cholesterol levels. Eat more whole grain foods like brown rice and oatmeal.
  • Reduce your weight. Maintain a BMI below 25.
  • Exercise for 30 minutes at least 3-4 times a week and be more physically active.

Begin your recovery by enrolling in a cardiac rehabilitation program for proper cardiac exercise and education. This is a specially designed program for patients recovering from heart attack, from other forms of heart disease, or after surgery to treat heart disease.

Cardiac rehabilitation is usually initiated while in the hospital and is to be continued in an outpatient setting. Maintenance programs can be initiated within a home setting.

What is it?
Venous ablation is a minimally invasive technique using intense thermal energy to irreversibly destroy an incompetent or diseased vein.

 

Damaged valve causing venous insufficiency Damaged vein becomes tortuous (rope like) Pooling of blood due to damages valve

A catheter with heat is inserted into the targeted vein and closes off the vein. The vein is closed off, but not removed.

Who needs it?

Venous ablation is indicated in patients with symptoms of venous disease with reflux.

  • Dilated, engorged, or tortuous veins (varicose veins)
  • Skin discoloration
  • Burning or itching sensation in the legs or feet or around the veins
  • Swelling in the legs, ankles, or feet (edema)
  • Heavy feeling or weakness of the legs
  • Cramping or throbbing in the lower legs
  • Skin ulcers
  • Leg pain, especially after sitting or standing for a long period of time.
  • Spider veins

A venous Doppler ultrasound is used to confirm the presence of venous obstruction, reflux, valvular incompetence, or clot formation.
Who does not qualify as a candidate?
Patients who do not qualify for venous ablation include patients with:

  • Thrombus (blood clots) in the affected vein
  • Infection in the vein (phlebitis)
  • A combination of infection and clot known as thromboembolism.
  • Pregnancy
Clot Formation

Why do I need it?
The goal of venous ablation is to treat and reduce the symptoms and signs of venous disease.
Venous ablation is also useful in preventing the risk of complications from venous disease (blood clot formation).

How to prepare for the procedure: 

Before the procedure:
This procedure is done here in our clinic. Arrive at the clinic at the time of your appointment.
You may eat and drink before and after the procedure. This procedure is not effecting by eating.
This procedure does not require any alteration in medications, so take your morning medications as prescribed.
Arrange for someone to drive you home after the procedure. You may not be permitted to drive immediately after the procedure.
The procedure lasts about 1-2 hours.

During the procedure: 

The procedure will be carried out in our clinic in our procedure room.
During the procedure you will lay on a table positioned on your back.
Under ultrasound guidance, the exact location of the vein will be determined.
A guide wire is inserted through a small opening in the skin into the targeted vein.
Once the guide wire is in, an introducer sheath is passed over the guide wire. The guide wire can then be removed. Under ultrasound guidance, the catheter is passed through the sheath and is advanced up the vein until it reaches 2cms below a junction called the saphenofemoral junction.
Under sterile precautions, a local anesthetic along with sodium bicarbonate will be injected into the tissue along the length of the vein to ensure that you do not feel any heat from the catheter. This compress the vein from two sides and also separates the vein from other structures including nerves.
After the catheter is in place, the tip of this will send out a radiofrequency which is converted into heat that reaches 120oC. When the catheter is slowly withdrawn, the heat causes the vein to collapse and close off. Once the vein is closed off, blood is re-routed into other healthy veins.
After the procedure:
While you are on the table, an ultrasound will be done over the ablated vessel to confirm that the vessel is collapsed as well as an absence of blood flow in that vein.
Following the procedure, a bandage will be placed over the insertion site. A compression bandage will be wrapped around the entire length of the leg and should be worn for 2-3 days.

A compression bandage is important because it helps prevent bruising and tenderness as well as reduces the risk of blood clot formation and dislodgment. A compression stocking is required to be worn for up to 4 weeks.

You are encouraged to walk for at least 30 minutes a day after the procedure to prevent deep vein thrombosis.
Avoid heavy or strenuous exercise for a few days.
Avoid prolonged sitting or standing.
Wear compression stockings for up to 2 weeks.
An ultrasound follow up is required 3 days after the procedure to rule out any deep vein thrombosis (clot formation).
After 4 weeks of the procedure, an ultrasound follow up is required to ensure the complete closure of the vein and no reflux.

What are the possible risks and complications?

Venous ablation is generally a safe procedure, but with any surgical procedure it carries a risk.

If they occur are minor and temporary.

Complications include:

  • Bruising
  • Pain
  • Infection
  • Skin burn
  • Blood clot formation
  • Perforation of vessel
  • Nerve irritation or damage

What are the benefits?

The benefits of venous ablation include:

  • Relief of symptoms
  • Outpatient procedure
  • Well tolerated procedure
  • High success rate
  • Less invasive, less pain, tenderness, and few complications compared to surgical venous procedures
  • Does not require general anesthesia
  • Quick healing time
  • Can return to normal daily activities within 1-2 days.
  • Good cosmetic results
  • Greater efficacy compared to venous surgical procedures with a positive prognosis of 10 years.