Common heart tests, procedures and treatments

An angiogram lets your doctor see how well your heart pumps blood. Your doctor will be able to look at your heart muscle, valves and coronary arteries.

Over time, your heart’s arteries can become clogged from a build-up of cholesterol or plaque (a fatty build-up). This can reduce blood flow to your heart muscle.

This test uses contrast which is injected through a catheter (a small, thin tube). Your cardiologist (heart doctor) inserts the catheter through an artery in your arm or leg. He or she uses a special X-ray monitor to watch the contrast flowing through your heart vessels.

Your doctor will take X-ray pictures to see if your heart arteries are narrowed or blocked. He or she will work with you on a treatment plan.

Angioplasty — also called percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) — is the method used to open a blood vessel to improve blood flow by stretching a vessel from the inside and sometimes placing a stent to help keep it open.

• Percutaneous means that the procedure is done through the skin.
• Transluminal means that it is done inside the artery.
• Coronary means that it is an artery of the heart.

Angioplasty helps more blood flow through your coronary arteries. If you have this procedure, here is what to expect:

1. A cardiologist will use a catheter (a thin, flexible tube) with a tiny balloon at the tip. He or she will guide the catheter through a leg or arm artery.
2. The tube is guided through the arteries of your body to the blocked heart artery.
3. The balloon is slowly inflated many times.
4. The inflated balloon squeezes the build-up of plaque against your artery wall and slightly stretches the vessel to improve blood flow.
5. After the procedure, the balloon is removed from your body.

In some cases a cardiologist may use a medical laser to remove blockage. This procedure is called laser angioplasty.

During angioplasty, a cardiologist may insert a stent to help keep the coronary artery open.

What is a coronary stent?

A stent is a mesh tube made of stainless steel or metal alloy used to expand or open a narrowed section of your heart artery. It improves blood flow and relieves your symptoms.

A balloon catheter is used to position the stent. You have the same feelings during the stent placement as when the balloon catheter was expanded.

• The stent is placed on a balloon catheter (a tube-like device). The cardiologist (doctor specially trained in the study and treatment of heart and blood vessel disease) guides the catheter to the narrowed or closed artery.
• When the catheter is in place, the cardiologist inflates the balloon. When the balloon is inflated, the stent expands into place into the artery and is left there. You may need more than one stent.
• You will have X-ray images taken so the cardiologist can see the stent. He or she may need to make more inflations.
• The cardiologist deflates the balloon catheter and removes it.
• The stent stays in place to keep your artery open.

It is important to carry your stent identification card with you.

An electrophysiology study (EPS) is a detailed study of the heart's electrical system and is done to investigate an abnormal heart rhythm (arrhythmia).

The heart's electrical system

The heart has four chambers. Two upper chambers (atria) pump blood to the two lower chambers (ventricles). In order for the heart to pump, it requires an electrical impulse to start a heartbeat.

Each heartbeat originates from the sinoatrial (SA) node—the heart's natural pacemaker—which is located in the upper right atrium. This impulse travels through the atria, signaling them to contract. The impulse is received by the atrioventricle (AV) node.

The AV node acts as a relay center to delay the impulse before sending it from the atria to the ventricles. The impulse then spreads throughout the muscle of the ventricles, stimulating them to contract.

Normally, impulses are generated from the sinus node at a rate of 60 to 100 beats per minute (bpm). That is called a normal sinus rhythm.

Sometimes the heart will beat slower than 60 bpm (called bradycardia) or faster than 100 bpm (called tachycardia).

Tachycardias that start in the upper chambers of the heart are called supraventricular tachycardia. Heartbeats that are too slow or too fast may cause fainting, fatigue, palpitations (fluttering in the chest), shortness of breath, chest pain or pressure.

A transesophageal echocardiogram (TEE) records ultrasound images of your heart.

The transducer, about the size of a normal piece of food, is mounted on the end of a flexible tube, about the size of your index finger. The tube is placed in your mouth and guided down your esophagus (swallowing tube).

You will be given medicine to help numb the back of your throat. This will make swallowing the tube easier.

The TEE gives excellent pictures of your heart because the heart is next to your esophagus.