Info About Your Heart... Your "Actual" Heart!  

LilBlondeNZ 40F
1259 posts
5/9/2006 1:02 pm
Info About Your Heart... Your "Actual" Heart!

I'm in heaven...

I'm FINALLY doing my **favorite** clinical rotation - cardiac catheterization. I'm working in a cath lab in a major hospital in Long Island. So I figured I'd tell you guys a little about the cool stuff I'm involved with at work. My director asked me to write an article for one of the local publications... so I'm sharing a rough draft with you.

There are three most common procedures they do in my lab: angiograms, PTCA, and arthrectomy. All three procedures involve a small puncture in the crease of a patient's groin to insert a tiny wire and catheter in the femoral artery (or vein), and from there the catheter goes up the aorta (or vena cava) and into the heart.

If a doctor wants to check out the right side of your heart, he will go through the femoral vein, up the inferior vena cava, then the superior vena cava and into the heart, right atrium first then through the tricuspid valve and in the right ventricle. Since the blood returns to the heart through your veins, the catheter goes with the flow. The doctor also might go even further up into the main pulmonary artery (which arises from the right ventricle and is pretty big) and measure what the blood pressures are in there.

Right heart catheterizations are usually done for purely for diagnostic purposes; to measure pressures and check out how the tricuspid valve is working on that side. A tricuspid valve that is leaky will allow backflow (called "regurgitation" ) which causes the heart to work a lot harder and/or faster to pump the same amount of blood through the body. A tricuspid valve that has a narrowing (called "stenosis" ) or hardening (called "calcification" means the blood isn't getting through the heart as fast as the body wants to pump it through, and it causes the blood to back up into the right atrium and the venous system. Measuring the different pressures and looking for backflow are main reasons a right heart catheterization is done. Right heart catheterizations are also helpful for diagnosing many pulmonary- related cardiac problems.

If a doctor wants to check out the left side of your heart, he'll go through the femoral artery. Since the blood is being pumped away from the heart through the arteries, the catheter has to go against the flow of the blood circulation on the way up. Once the doctor is in the femoral artery he'll thread the catheter up through your aorta, and then into heart-left atrium first, through the mitral valve, and down into the left ventricle. Then all roads lead to the small capillaries in the lungs, so that's pretty much as far as you can go on that side.

The coronary arteries branch off right between the where the left atrium ends and the aorta begins. These important vessels are the first stop for oxygenated blood as it leaves the heart chambers. The coronary arteries supply the muscle that pumps your heart. It's only possible to get to the coronary arteries through the aorta, so if your doctor wants to perform an angiogram on your coronary arteries, he will be doing a left heart catheterization.

An angiogram is a diagnostic test where the cardiologist will thread a catheter up to your heart and shoot dye into your cardiac arteries to diagnose blockages. The contrast dye shows up on a "moving Xray" called flouroscopy and it's recorded for playback at many angles so the vasculature can be visualized fully while your heart is beating, and blockages can be assessed.

Left heart catheterizations and angiograms are helpful for diagnosing acute myocardial infarctions (a complete blockage of a coronary artery which causes a "heart attack" ), partial blockages (which temporarily cut off blood flow and oxygenation causing "angina", chest pain), and assessing how the heart muscle as a whole is contracting. Your left ventricle is the biggest and most powerful chamber of the heart because it's responsible for pumping blood from the heart through the aorta to the rest of the body, at very high pressures. To generate the pressure necessary to do that job, the heart muscle (myocardium) in your left ventricle has to be very strong, and has to be fed nicely by several sets of arteries.

If a complete blockage, or "heart attack", occurs, the myocardium doesn't get the amount of oxygenation and blood flow it needs, and it can get damaged or die. If a *major* cardiac artery is blocked off, and a corresponding major part of the heart (especially the left ventricle) gets damaged or destroyed, a patient can die, or at the least the heart will not beat as efficiently anymore. The myocardium generally cannot regenerate enough to heal and reverse this damage. Depending on what part of the heart is oxygen deprived, it may cause serious life threatening arrhythmias such as ventricular tachycardia "V-Tach" and ventricular fibrillation "V-Fib"; which is why you hear those two terms always on medical shows when someone is dying and they are trying to revive then with shocks (defibrillation) and drugs. Even a series of small heart attacks can eventually lead to heart failure, and then a heart transplant would be needed.

PTCA (percutaneous transcatheter cardiac angioplasty) and arthrectomy are therapeutic procedures that fix whatever blockages are diagnosed with the angiogram. PTCA is a very common procedure where the cardiologist will thread a deflated balloon up into your heart and into the cardiac artery that's blocked. Blockages are caused by plaques that are made of hardened deposits and cholesterol. The doctor positions the balloon where the blockage is, then inflates the balloon to open up the artery. If your blockage is hard or "calcified" they can also use a little rotoblator drill-ish end on the catheter to bust up some of the hard calcified plaque and open the artery up again. This drilling of plaque is called arthrectomy.

Angiograms, PTCA and arthrectomy can all can be done independently, together, but are also sometimes followed by the insertion of "stents". Stents are tiny little wire mesh tunnels that are threaded over the top of a balloon catheter and expanded when the balloon is pumped up at the right spot. Stents give support to the artery wall and smoosh the plaque back against the wall of the artery to open up a better flow of blood through the blockage. Stents can stay in place forever, and depending on risk factors, are often a good alternative to coronary bypass and graft surgery (CABG).

The downside to stenting is that, depending on the location and size of the stents, the vessel can block up again ("restenosis" ) as the inside of the artery tries to grow back through the mesh or more plaque builds up. However, newer stents have been invented that are covered with a time-released drug that inhibits the regrowth of tissue. These are called "drug eluding stents". They can lower restenosis rates pretty significantly in some instances. Most doctors use drug eluding stents almost exclusively in their patients, although bare metal stents are still used in some circumstances. drug-eluding stents are very expensive; a single stent can cost thousands of dollars,

Everyone probably has some degree of blockage in some vessels by the time age 55 approaches. For mild blockages that don't cause serious symptoms, medication and a cholesterol-lowering plan may be the answer. If the blockages are severe enough for your doctor to suggest intervention, PCTA and arthrectomy are usually the most common treatment. Both procedures are pretty easy to recover from in themselves, but if they were done as a heart attack intervention, your total recovery may be longer. Sometimes if blockages are too severe, affect major arteries, or if there are too many sites in one artery that need to be opened up, coronary bypass and graft (CABG) is the only alternative at that point. Patients are transferred out of our lab at that point and booked for bypass at our hospital or transferred to another hospital.

After seeing some the angiograms I've seen this week so far, I think I will be getting some exercise and cutting out junk food! Some of the patients had awful cholesterol junking up all of their arteries and it was just gross. Ewww! I don't want that thick, gooey sludge gunking up my beautiful arteries. They have to last me a lifetime. I'm just happy I don't smoke because those people had the *worst* arteries of the week so far, and their hearts were all screwed up and their lungs too. It's actaully pretty sad because most of the people were pretty regretful about having smoked all the years that they did. It's so hard to quit though; my dad smoked for 45 years and he just was successful quitting after his 12th try. (Nothing like a bad stress test score to scare the crap outta a guy).

Well, do whatever you want, it's a free country. But if you saw all the stuff I saw the past few days, you might want to think more about your heart health. All the trite and overused phrases are true; eat well, cut down on fatty food and red meat, don't smoke and exercise. The advice is so overpreached that I don't think anyone really listens anymore. But if you saw the gross sludgy goo that was in these people's hearts... you'd be totally grossed out, I swear. So I thought I'd just share. Most of the patients were pretty freaked out when they saw the damage they had done. And it was all types of people, white, black, fat, skinny, old and young... one guy was 37 and a bodybuilder!

Well, take care of your heart and I hope I don't see you in the lab... I think I have to go for a run now!

A


hansum_strangrr 47M
384 posts
5/9/2006 2:25 pm

Wow... forget Grey's Anatomy. You are wrong you do smoke. You are smokin' hot.

Everybody Dies, Not Everyone Really Lives.


LIBlonde97 40F
1028 posts
5/9/2006 2:57 pm

Hahaha....

Wow, I didn't know my boring medical knowledge was such a turn on.

That's pretty funny. I'll have to ask bulging_boy if that's what did it for him! I'll have to tell you where all the hospital girls hangs out here by me so you can go get yourself your own smart little cardiac chick.

Thank you for the compliment.

A


bulging_boy 49M

5/9/2006 3:02 pm

uhhhhhhh.... thanks babe.


digdug41 49M

5/9/2006 9:21 pm

Hey blonde thats really cool stuff there,I have honestly been trying to quit the cigs so I am rolling them now and that sucks to high hell so I've been chewing alot of gum LOL What you said about the stuff that comes out of peoples hearts reminded me of that commercial they run here in new york late at night showing the yellow goo coming out of the heart. I'm glad you are on top of your game, what you wrote was easy enough for the lamen to understand cya

roaming the cyber streets of blogland


Peche85 31F

5/9/2006 10:35 pm

I could never be a nurse or doctor, that stuff just freaks me out! Even just hearing/reading the word catheter freaks me outbecause I had one after a kidney operation and to me the feeling of them pulling it out is the grossest feeling in the world!


chasingfun27 38M
1108 posts
5/9/2006 11:00 pm

All I do is drink piss and gorge on red meat so I'm in top physical condition.
What's the record for blood donation? I'm at 3m55s but no one else seems to consider it a competitive sport, so I say I'm NZ Champ - go ME!


curious082385 31F
4925 posts
5/10/2006 2:46 am

My mom had to have an angiogram done a few monthes ago when she was in the ICU. Gave us some good information and helped nail down the cause of her heart problems.


bardicman 50M

5/10/2006 10:19 am

My heart has been broke so many times. I dont know if it is still pumping or not.

I went to see the OB/GYN because I was have problems with my Angina.



I am not dead yet


rm_noah27 40M
3 posts
5/15/2006 4:11 pm

i always knew these blogs were educational.


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