Other Hospital Procedures

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  • AngioplastyAn angioplasty is a procedure used to open arteries that are partially or totally blocked by a buildup of fats and cholesterol (plaque) inside an artery. Usually, this procedure is performed during a left heart catheterization or a peripheral arteriogram procedure where a small tube (similar to an IV) is inserted into the artery of the arm or groin. A specialized catheter with a balloon on the tip is then inserted through the IV and is passed to the location of the blocked artery. The balloon is then inflated and opens up the artery re-establishing blood flow.
    • Why you are having this procedure: Your physician might schedule this procedure for symptoms such as shortness of breath, chest pain, or leg pain that is felt to be due to a partially blocked artery in your heart or legs.
    • Prep for the procedure: Do not to eat or drink for 8 to 12 hours prior to the procedure. You will need to make arrangements for someone to drive you home following the procedure.
    • What to expect: Prior to the procedure, you will be given a sedative which will cause drowsiness in order to relax you; however, we will be able to arouse you should it be necessary. The area where the catheter will be inserted is then numbed with a local anesthetic, the catheter is inserted, and the procedure performed.
    •  Risks: Complications from this procedure are rare, and the risk of death is very low. Possible risks include:

    (1) allergic reaction to the dye which can be treated with medicine;

    (2) damage to the kidneys from the dye;

    (3) irregular heart rhythms which can be treated with medicine;

    (4) bleeding can occur at the site where the catheter is inserted;

    (5) although uncommon, blood clots can form around the catheter or clumps of plaque can be knocked loose from the walls of the arteries during the procedure and can trigger a heart attack or a stroke.

    • Post procedure instructions/limitations: Refrain from heavy lifting, greater than 5 pounds, for approximately 1 week after the procedure due to possible bleeding from the site where the catheter was inserted. In order to avoid infection, do not take a tub bath until the site where the catheter was inserted is healed. You can usually return to your normal activities over approximately 1 week.
    • When to call your cardiologist: You should call your cardiologist immediately and/or return to the emergency department immediately if you experience acute onset of chest pain and/or shortness of breath or if you experience rapid swelling or bleeding at the site where the catheter was inserted.
    • Miscellaneous: Please follow all the instructions provided by your healthcare provider.
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Angioplasty and stent placement – heart

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries.

coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it that helps prevent the artery from closing in the long term.

Alternative Names :
PCI; Percutaneous coronary intervention; Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Description: 
Before the angioplasty procedure begins, you will receive some pain medicine. You may also be given medicine that relaxes you, and blood thinning medicines to prevent a blood clot from forming.

You will lie on a padded table. Your doctor will insert a flexible tube (catheter) through a surgical cut into an artery. Sometimes the catheter will be placed in your arm or wrist, or in your upper leg or groin area. You will be awake during the procedure.

The doctor will use live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctor see any blockages in the blood vessels that lead to your heart.

A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

A wire mesh tube (stent) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is left there to help keep the artery open.

The stent may be coated with a drug (called a drug-eluting stent). This type of stent may lower the chance of the artery closing back up in the future. Currently, drug-eluting stents are used only for certain patients.

Why the Procedure Is Performed: 
Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of artery walls. This condition is called atherosclerosis.

Angioplasty may be used to treat:

      •  Blockage in a coronary artery during or after a heart attack
      •  Blockage or narrowing of one or more coronary arteries that puts you at risk for a heart attack
      •  Narrowings that reduce blood flow and cause persistent chest pain (angina) that medicines do not control

Not every blockage can be treated with angioplasty. Some patients who have several blockages or blockages in certain locations may need coronary bypass surgery.

Risks: 
Angioplasty is generally safe, but ask your doctor about the possible complications. Risks of angioplasty and stent placement are:

      •  Allergic reaction to the drug used in a drug-eluting stent, the stent material, or the x-ray dye
      •  Bleeding or clotting in the area where the catheter was inserted
      •  Blood clot
      •  Clogging of the inside of the stent (in-stent restenosis)
      •  Damage to a heart valve or blood vessel
      •  Heart attack
      •  Kidney failure (higher risk in people who already have kidney problems)
      •  Irregular heartbeat (arrhythmias)
      •  Stroke (this is rare)

Before the Procedure: 
Angioplasty is often performed when you go to the hospital or emergency room for chest pain, or after a heart attack. If you are admitted to the hospital for angioplasty:

      •  Tell your doctor what drugs you are taking, even drugs or herbs you bought without a prescription.
      •  You will usually be asked not to drink or eat anything for 6 to 8 hours before the test.
      •  Take the drugs your doctor told you to take with a small sip of water.
      •  Tell your doctor if you are allergic to seafood, you have had a bad reaction to contrast material or iodine in the past, you are taking Viagra, or you are or might be pregnant.

After the Procedure:
The average hospital stay is 2 days or less. Some people may not even have to stay overnight in the hospital.

In general, people who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. You will be given information about how to care for yourself after angioplasty.

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Arteriograms

Arteriograms are x-ray pictures of the arteries. These are usually done during a left heart catheterization or a peripheral arteriogram procedure to look for partially blocked arteries in the heart or legs. During a left heart catheterization or a peripheral arteriogram procedure, a small tube (similar to an IV) is inserted into the artery of the arm or groin. Then a catheter is passed into arteries of the heart or legs; special dye is injected to produce the x-ray pictures.

  •  Why you are having this procedure: Your physician might schedule this procedure for symptoms such as shortness of breath, chest pain, or leg pain that is felt to be due to a partially blocked artery in your heart or legs.
  •  Prep for the procedure: Do not to eat or drink for 8 to 12 hours prior to the procedure. You will need to make arrangements for someone to drive you home following the procedure.
  •  What to expect: Prior to the procedure, you will be given a sedative which will cause drowsiness in order to relax you; however, we will be able to arouse you should it be necessary. The area where the catheter will be inserted is then numbed with a local anesthetic, the catheter is inserted, and the procedure performed.
  •  Risks: Complications from this procedure are rare, and the risk of death is very low. Possible risks include:

(1) allergic reaction to the dye which can be treated with medicine;

(2) damage to the kidneys from the dye;

(3) irregular heart rhythms which can be treated with medicine;

(4) bleeding can occur at the site where the catheter is inserted;

(5) although uncommon, blood clots can form around the catheter or clumps of plaque can be knocked loose from the walls of the arteries during the procedure and can trigger a heart attack or a stroke.

  •  Post procedure instructions/limitations: Refrain from heavy lifting, greater than 5 pounds, for approximately 1 week after the procedure due to possible bleeding from the site where the catheter was inserted. In order to avoid infection, do not take a tub bath until the site where the catheter was inserted is healed. You can usually return to your normal activities over approximately 1 week.
  •  When to call your cardiologist: You should call your cardiologist immediately and/or return to the emergency department immediately if you experience acute onset of chest pain and/or shortness of breath or if you experience rapid swelling or bleeding at the site where the catheter was inserted.

Miscellaneous: Please follow all the instructions provided by your healthcare provider.

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Atherectomy

An atherectomy is performed to remove buildup of fats and cholesterol (plaque) from an artery. This is done by using a shaver to cut the plaque away. Usually, the procedure is performed during a left heart catheterization or a peripheral arteriogram procedure to open up partially blocked arteries in the heart or legs.

  •  Why you are having this procedure: Your physician might schedule this procedure for symptoms such as shortness of breath, chest pain, or leg pain that is felt to be due to a partially blocked artery in your heart or legs.
  •  Prep for the procedure: Do not to eat or drink for 8 to 12 hours prior to the procedure. You will need to make arrangements for someone to drive you home following the procedure.
  •  What to expect: Prior to the procedure, you will be given a sedative which will cause drowsiness in order to relax you; however, we will be able to arouse you should it be necessary. The area where the catheter will be inserted is then numbed with a local anesthetic, the catheter is inserted, and the procedure performed.
  •  Risks: Complications from this procedure are rare, and the risk of death is very low. Possible risks include:

(1) allergic reaction to the dye which can be treated with medicine;

(2) damage to the kidneys from the dye;

(3) irregular heart rhythms which can be treated with medicine;

(4) bleeding can occur at the site where the catheter is inserted;

(5) although uncommon, blood clots can form around the catheter or clumps of plaque can be knocked loose from the walls of the arteries during the procedure and can trigger a heart attack or a stroke.

  •  Post procedure instructions/limitations: Refrain from heavy lifting, greater than 5 pounds, for approximately 1 week after the procedure due to possible bleeding from the site where the catheter was inserted. In order to avoid infection, do not take a tub bath until the site where the catheter was inserted is healed. You can usually return to your normal activities over approximately 1 week.
  •  When to call your cardiologist: You should call your cardiologist immediately and/or return to the emergency department immediately if you experience acute onset of chest pain and/or shortness of breath or if you experience rapid swelling or bleeding at the site where the catheter was inserted.
  •  Miscellaneous: Please follow all the instructions provided by your healthcare provider.
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CARDIOVERSION

Cardioversion is a method to return an abnormal heart rhythm back to normal.

Information: 
Cardioversion can be done using an electric shock or drugs.

ELECTRIC CARDIOVERSION:
Electric cardioversion may be done with a device that gives off a shock. The device can be placed inside (internal) or the shock can be delivered from the outside (external) the body.

External electric cardioversion uses a device called a defibrillator.

  •  Electrode patches are placed on the chest and back. The patches are connected to the defibrillator.
  •  The defibrillator is activated and an electric shock is delivered to your heart.
  •  This shock briefly stops all electrical activity of the heart. Then it allows the normal heart rhythm to return.
  •  Sometimes more than one shock, or a shock with higher energy is needed.

Emergency external electric cardioversion is used to treat abnormal heart rhythms (arrhythmia) that can cause death, such as ventricular tachycardia or ventricular fibrillation.

External electric cardioversion may also be used for non-emergency conditions. Heart rhythm problems, such as atrial fibrillation or paroxysmal supraventricular tachycardia (PSVT) that began recently or that cannot be controlled with medicines may be treated this way.

  •  You may need tests before having external cardioversion to make sure that there are no blood clots in the heart.
  •  Some people may need to take blood thinners.
  •  You may be given medicine to help you relax before the procedure.
  •  After the procedure, you may be given medicines to prevent blood clots and to help prevent the arrhythmia from coming back.

An implantable cardioverter-defibrillator (ICD) is a device that is placed inside your body. It is most often used in people who are at risk for sudden death from ventricular tachycardia or ventricular fibrillation, or who have had these heart rhythms before.

  •  The ICD is implanted underneath the skin of your upper chest or abdomen.
  •  Wires are attached that go into the heart.
  •  If the device detects a dangerous heartbeat, it sends an electrical shock to the heart to change the rhythm back to normal.

CARDIOVERSION USING DRUGS (PHARMACOLOGIC)
Cardioversion can be done using drugs that are taken by mouth or given through an intravenous line (IV). It can take from several minutes to days for this treatment to work. If you are given drugs for cardioversion in a hospital, your heart rate will be regularly checked.

Cardioversion using drugs can be done outside the hospital. This treatment is most often used for people with atrial fibrillation that comes and goes. However, you will need to be closely followed-up by a cardiologist.

As with electrical cardioversion, you may be given blood thinning medicines to prevent blood clots from forming and leaving the heart (which can cause a stroke).

COMPLICATIONS:
Complications of cardioversion are uncommon, but may include:

  •  Allergic reactions from medicines used
  •  Blood clots that can cause a stroke or other organ damage
  •  Bruising, burning, or pain where the electrodes were used
  •  Worsening of the arrhythmia

 Carotid Arteriogram

A carotid arteriogram is a procedure in which a thin flexible tube called a catheter is inserted through an artery, usually in the arm or groin, which allows the physician to take x-ray pictures of the arteries feeding the blood flow to the brain to evaluate for blockages.

Why are you having procedure (symptoms/indication)? There are several reasons a person might have a peripheral arteriogram, and these include:

  1. Patient with known carotid artery stenosis re-evaluation.
  2. Patient experiencing symptoms of dizziness or passing out episodes with the suspected cause being blockage in carotid artery.
  3. Patient has had an abnormal screening test such as a carotid ultrasound.

Prep for the procedure: Do not to eat or drink for 8 to 12 hours prior to the procedure. You will need to make arrangement for someone to drive you home following the procedure.

  • What to expect: Prior to the procedure, you will be given a sedative which will cause drowsiness in order to relax you; however, we will be able to arouse you should it be necessary. The area where the catheter will be inserted is then numbed with a local anesthetic, the catheter is inserted, and the procedure performed.
  • Risks: Complications from this procedure are rare, and the risk of death is very low. Possible risks include:

(1) allergic reaction to the dye which can be treated with medicine;

(2) damage to the kidneys from the dye;

(3) irregular heart rhythms which can be treated with medicine;

(4) bleeding can occur at the site where the catheter is inserted;

(5) although uncommon, blood clots can form around the catheter or clumps of plaque can be knocked loose from the walls of the arteries during the procedure and can trigger a heart attack or a stroke.

  • Post procedure instructions/limitations: Refrain from heavy lifting, greater than 5 pounds, for approximately 1 week after the procedure due to possible bleeding from the site where the catheter was inserted. In order to avoid infection, do not take a tub bath until the site where the catheter was inserted is healed. You can usually return to your normal activities over approximately 1 week.
  • When to call your cardiologist: You should call your cardiologist immediately and/or return to the emergency department immediately if you experience acute onset of chest pain and/or shortness of breath or if you experience rapid swelling or bleeding at the site where the catheter was inserted.
  • Miscellaneous: Please follow all the instructions provided by your healthcare provider.
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ICD (Implantable Cardioverter Defibrillator)

An implantable cardioverter-defibrillator (ICD) is a device that detects any life-threatening, rapid heartbeat. If such a heartbeat, called an arrhythmia, occurs, the ICD quickly sends an electrical shock to the heart to change the rhythm back to normal. This is called defibrillation.

Description: 
An ICD is made of these parts:

  •  The pulse generator is about the size of a large pocket watch. It contains a battery and the electrical circuits that read the electrical activity of your heart.
  •  The electrodes are wires (leads) that go through your veins to your heart. They connect your heart to the generator. Your ICD may have 1, 2, or 3 electrodes.
  •  All ICDs have a built-in pacemaker. Your heart may need pacing if it is beating too slowly or too fast, or if you have had a shock from the ICD.

A cardiologist or surgeon will usually insert your ICD while you are awake. The area of your chest wall below your collarbone will be numbed with anesthesia, so you will not feel pain. The surgeon will make an incision (cut) through your skin and create space under your skin and muscle for the ICD generator. Usually this space is made near your left collarbone.

Using special x-ray to see inside your chest, the surgeon will place the electrode into a vein, then into your heart. Then the surgeon will connect the electrodes to the pulse generator and pacemaker.

The procedure usually takes 2 to 3 hours.

Why the Procedure Is Performed:
An implantable cardiac defibrillator is placed in people who are at high risk of sudden cardiac death. Reasons you may be at high risk are:

  •  You have had life-threatening bouts of ventricular tachycardia (VT) or ventricular fibrillation (VF).
  •  Your heart is weakened, too large, and does not pump blood very well. This may be from earlier heart attacks, heart failure, or cardiomyopathy (diseased heart muscle).
  •  Certain congenital (present at birth) heart problems or genetic health conditions.

Risks:
Risks for any surgery are:

  •  Blood clots in the legs that may travel to the lungs
  •  Breathing problems
  •  Heart attack or stroke
  •  Allergic reactions to medicines (anesthesia) used during surgery
  •  Infection

Possible risks for this surgery are:

  •  Wound infection
  •  Injury to your heart or lungs
  •  Dangerous heart arrhythmias

An ICD sometimes delivers shocks to your heart when you do not need them. Even though a shock lasts a very short time, you can usually feel it.

This and other ICD problems can sometimes be prevented by changing how your ICD is programmed. It can also be set to sound an alert if there is a problem. Your cardiologist or electrophysiologist who manages your ICD care can program your device.

Before the Procedure:
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

The day before your surgery:

  •  Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you might have.
  •  Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap.
  •  You may also be asked to take an antibiotic, to guard against infection.

On the day of the surgery:

  •  You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  •  Take your drugs your doctor told you to take with just a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure:
Most people who have an ICD implanted are able to go home from the hospital in 1 day. Most quickly return to their normal activity level. Full recovery takes about 4 to 6 weeks.

When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your ICD and has contact information for emergencies. You should always carry this wallet card with you.

You will have scheduled appointments following the implant in order that your physician to monitor the healing of the incision and measurements of the electrodes. It is important that you keep all of your follow-up appointments.

You will need to make regular visits to the doctor so your ICD can be monitored. The doctor will check to see if the device is properly sensing your heartbeat, how many shocks have been delivered, and how much power is left in the batteries.

Outlook (Prognosis):
Your ICD will constantly monitor your heartbeats to make sure they are steady. It will deliver a shock to the heart when it senses a life-threatening rhythm. This device can also work as a pacemaker.

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LEFT HEART CATHETERIZATION

Left heart catheterization is the passage of a thin flexible tube (catheter) into the left side of the heart. It is done to diagnose or treat certain heart problems.

How the Test is Performed :
You may be given a mild medicine (sedative) before the procedure starts to help you relax. The health care provider will place an IV into your arm so that you can get medicine during the procedure.

You will lie on a padded table. Your doctor will make a small surgical cut on your body. A flexible tube (catheter) is inserted through the cut into an artery. It is most often inserted through the groin, but may be placed in your arm or wrist. You will be awake during the procedure.

Live x-ray pictures are used to help guide the catheters up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps show blockages in the blood vessels that lead to your heart.

The catheter is then moved through the aortic valve into the left side of your heart. The pressure is measured in the heart in this position. Other procedures, such as ventriculography to check the heart’s pumping function and coronary angiography to look at the coronary arteries can be done at this time. Sometimes procedures to correct blockages in the arteries are then performed, such as angioplasty with or without stenting.

The procedure may last from less than 1 hour to several hours.

How to Prepare for the Test: 
In most cases, you should not eat or drink for 8 hours before the test. (Your health care provider may give you different directions.)

The procedure will take place in the hospital. You may be admitted the night before the test, but it is common to come to the hospital the morning of the procedure.

Your health care provider will explain the procedure and its risks. You must sign a consent form.

How the Test will Feel:
You will be given medicine (a sedative) to help you relax before the procedure. However, you will be awake and able to follow instructions during the test.

You will be given local numbing medicine (anesthesia) before the catheter is inserted. You will feel some pressure as the catheter is inserted, but you should not feel any pain. You may have some discomfort from lying still for a long period of time.

Why the Test is Performed:
The procedure is done to look for:

  •  Cardiac valve disease
  •  Cardiac tumors
  •  Heart defects (such as ventricular septal defects)
  •  Problems with heart function

The procedure may also be done to repair certain types of heart defects, or to open a narrowed heart valve.

When this procedure is done with coronary angiography, it can open blocked arteries or bypass grafts.

The procedure can also be used to:

  •  Collect blood samples from the heart
  •  Determine pressure and blood flow in the heart’s chambers
  •  Examine the arteries of the heart (coronary angiography)
  •  Take x-ray pictures of the left side of the heart (ventriculography)

Normal Results: 
A normal result means the heart’s size, motion, thickness, pressure, and arteries appear to be normal.

What Abnormal Results Mean:
Abnormal results may be a sign of cardiac disease or heart defects, including:

  •  Aortic insufficiency
  •  Aortic stenosis
  •  Coronary artery disease
  •  Heart enlargement
  •  Heart valve disease
  •  Mitral regurgitation
  •  Mitral stenosis
  •  Ventricular aneurysms

Risks:
Complications may include:

  •  Cardiac arrhythmias
  •  Cardiac tamponade
  •  Embolism from blood clots at the tip of the catheter to the brain or other organs
  •  Heart attack
  •  Injury to the artery
  •  Infection
  •  Low blood pressure
  •  Reaction to the contrast material
  • Stroke
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Loop Recorder

Loop Recorder is a device implanted under the skin in your upper chest. This procedure is performed in the catheterization laboratory. You will be given a local anesthetic to your chest wall. The procedure usually lasts twenty minutes. Once the procedure is complete, a Medtronic representative will provide education regarding the loop recorder. You will then be discharged home with a scheduled follow-up appointment.

  •  Why you are having this procedure (symptoms/limitations): If you have experienced an unexpected abrupt loss of consciousness, you are possibly a candidate for this procedure. A loop recorder saves tracings of your heart rhythm if it pauses, beats too slowly, or beats too fast. The loop recorder also records when you signal a symptomatic event.
  • Prep: Nothing to eat or drink after midnight
    • Risks: Infection and bleeding
    • When to call your cardiologist: If you experience a loss of consciousness or feel your heart racing, or get dizzy to the point where you feel like you are going to pass out. These instructions will be reviewed with you in detail after your procedure.
    • After Implant: You will receive equipment which will enable you to mark your symptoms and transmit information from your home.
    • Miscellaneous: The battery can last up to three years.
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PACEMAKER

pacemaker is a small, battery-operated device that senses when your heart is beating irregularly or too slowly. It sends a signal to your heart that keeps your heart beating above a programmed rate.

Alternative Names: 
Cardiac pacemaker implantation; Artificial pacemaker; Permanent pacemaker; Internal pacemaker; Cardiac resynchronization therapy; CRT; Biventricular pacemaker

Description:
Newer pacemakers weigh as little as 1 ounce. A pacemaker usually has 2 parts:

  •  The generator contains the battery and the computer to control the heartbeat.
  •  The leads are wires that connect the heart to the generator and carry the electrical signals to the heart.

A pacemaker can usually sense if the heartbeat is above a certain rate. When it is above that rate, the pacemaker will stop sending signals to the heart. The pacemaker can also sense when the heartbeat slows down too much. It will automatically kick in and start pacing the heartbeat again.

A pacemaker must be implanted under the skin. This procedure usually takes about 1 hour. You will be given a sedative to help you relax. You will be awake during the procedure.

Following use of a local anesthesia, a small incision (cut) is made, usually on the left side of the chest below your collarbone. The pacemaker generator is then placed under the skin at this location.

Using live x-rays to see the area, the doctor puts the leads through the incision, into a vein, and then into the heart. The leads are connected to the generator. The skin is closed with stitches. Most patients go home within 1 day of the procedure.

Two other kinds of pacemakers — transcutaneous and transvenous pacemakers — are used only in medical emergencies. They are not permanent pacemakers.

Why the Procedure Is Performed: 
Pacemakers may be used for people who have heart problems that cause their heart to beat too slowly. A slow heartbeat is called bradycardia. Two common problems that cause a slow heartbeat are sinus node disease and heart block.

When your heart beats too slowly, your body and brain may not get enough oxygen. Symptoms may be lightheadedness, tiredness, fainting spells, and shortness of breath.

Some, pacemakers can be used to stop a heart rate that is too fast (tachycardia) or that is irregular.

Other types of pacemakers can be used in severe heart failure. These are called biventricular pacemakers. They match up the beating of both sides of the heart.

Most biventricular pacemakers implanted today can also work as implantable cardio-defibrillators (ICD), which restore a normal heartbeat.

Risks:
Possible complications of pacemaker surgery are:

  •  Abnormal heart rhythms
  •  Bleeding from the pacemaker site.
  •  Infection
  •  Punctured lung. This is rare.
  •  Puncture of the heart, which can lead to bleeding around the heart. This is rare.

Before the Procedure: 
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

The day before your surgery:

  •  Shower and shampoo well.
  •  You may be asked to wash your whole body below your neck with a special soap.

On the day of the surgery:

  • You may be asked not to drink or eat anything after midnight the night before your procedure. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  •  Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure:
You will probably be able to go home after 1 day. You should be able to return to your normal activity level quickly.

Talk with your doctor about how much you can use the arm on the side of your body where the pacemaker was placed. You may be advised not to lift anything heavier than 10 – 15 pounds and to avoid a lot of pushing, pulling, or twisting your arm for 2 – 3 weeks. You may also be told not to raise your arm above your shoulder for 6 weeks.

When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your pacemaker and has contact information for emergencies. You should always carry this wallet card with you.

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Renal Arteriogram

renal arteriogram is a procedure in which a thin flexible tube called a catheter is inserted through an artery, usually in the arm or groin, allowing the physician to take x-ray pictures of the arteries feeding the blood flow to the kidneys to evaluate for blockages.

  •  Why are you having procedure (symptoms/indication)? There are several reasons a person might have a peripheral arteriogram, and these include:

(1) a person has known renal artery stenosis that needs to be re-evaluated.

(2) a person is having extremely high blood pressures which are difficulty to treat and the suspected cause is a partially blocked renal artery.

(3) a person has had abnormal screening test such as an ultrasound of the renal arteries with suspected blockages.
• Prep for the procedure: Do not to eat or drink for 8 to 12 hours prior to the procedure. You will need to make arrangements to have someone drive you home following the procedure.

  •  What is patient expected to do during the procedure? Prior to the procedure, you will be given a sedative causing drowsiness in order to relax you; however, we will be able to arouse you should it be necessary. The area where the catheter will be inserted is numbed with a local anesthetic and the catheter is inserted.
  •  Risks: Complications from this procedure are rare, and the risk of death is very low. Possible risks include: (1) allergic reaction to the dye which can be treated with medicine; (2) damage to the kidneys from the dye; (3) irregular heart rhythms which can be treated with medicine; (4) bleeding can occur at the site where the catheter is inserted; (5) although uncommon, blood clots can form around the catheter or clumps of plaque can be knocked loose from the walls of the arteries during the procedure and can trigger a heart attack or a stroke
  •  Post procedure instructions/limitations: Refrain from heavy lifting, greater than 5 pounds, for approximately 1 week following the procedure due to possible bleeding from the site where the catheter was inserted. To avoid infection, do not take a tub bath until the site where the catheter was inserted is healed. You can usually return to your normal activities over approximately 1 week.
  •  When to call your cardiologist: You should call your cardiologist immediately and/or return to the emergency department immediately if you experience persistent numbness or coolness of the affected extremity; if you experience acute onset of chest pain and/or shortness of breath; or if you experience rapid swelling or bleeding at the site where the catheter was inserted.
  •  Miscellaneous: Please follow all the instructions that your healthcare provider gives you.
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Tilt Table

The Tilt table test is a test used to diagnose dysautonomia and other causes of syncope (or passing out). An IV will be started in your arm. A heart and blood pressure monitor will be placed on you. You will be placed flat on a special table, safety straps will be placed across legs, abdomen and chest, and tilted in a standing position at a 65-degree angle for possibly 60 minutes. A recording of your heart beat and blood pressure will be taken every two minutes during the test.

Why you are having this procedure (symptoms/indications): Near fainting, fainting or passing out spells

Prep for the procedure: Wear two-piece clothing. Nothing to eat or drink eight hours before test. If you are a diabetic on Insulin, take half of your usual dose of morning Insulin and bring a snack to eat after the test. Take your medications with small sips of water with the exception of the following medications:

Midodrine, Florinef, Beat Blockers (Atenolol, Tenormin, Inderal, Propranolol, Toprol, Metoprolol, Lopressor, Sectral Acebutolol, Pindolol, Visken, Sotalol, Betapace, Corgard, Nadolol, Coreg, Carvedilol, Normodyne, Labetalol, Trandate, Levatol, Penbutolol, Kerlone, Betaxolol, Zebeta, Ziac) and Calcium Channel Blockers (Dilacor, Cardizem, Tiazac, Diltiazem, Diltia, Cartia, Taztia, Verelan, Verapamil, Calan, Isoptin, Covera, Norvasc, Amlodipine, Procardia, Plendil, Felodipine, Dynacirc, Cardene, Nicardipine, Adalat, Procardia, Nifedipine, Sular, Nisoldipine)

Please HOLD them three days prior to your test. If you are on one of these medications for elevated blood pressure, let your primary care physician know in order for him/her to put you on a replacement blood pressure medication. If you are taking Zoloft or any other anti-depressant, please call your primary care physician and ask if you can hold it the day of the procedure. If you are unsure if your medications fall into these classifications, please call our office at (205)561-2370.

What to expect: You are expected to stand up to 60 minutes.

Risks: Fainting or passing out, abnormal rhythm

Post procedure instructions/limitations: Bring someone with you to drive for you if you pass out.

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TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)

Transesophageal Echocardiogram is a special type of echocardiogram test in which the back of your throat will be numbed and a flexible tube with an ultrasound transducer tip will be passed down your esophagus behind your heart. On the end of the scope is a device that sends out sound waves. Your physician will guide the scope down the esophagus. This method will allow your physician to get a clearer echocardiogram of your heart valves, chambers, blood vessels, and the heart muscle itself.

Why you are having this procedure:  There are several reasons why a patient would be scheduled for a transesophageal echocardiogram including:
1. Evaluate for infection of one of the heart valves (endocarditis)
2. Evaluate if a patient has a small blood clot in the heart
3. Evaluate to determine if the patient has a small hole that allows blood to pass between the two upper or the two lower chambers of the heart.
4. Evaluate if a patient has a split or tear between the layers of the walls of the aorta (aortic dissection)

Prep:  Do not eat or drink for 8 to 12 hours prior to the procedure. You will need someone to drive you home following the procedure as you will likely be drowsy following the procedure. You may return to your normal activities the next day.
What to expect:  Prior to beginning the procedure, you be given a sedative to relax you. The nurse will spray the back of your throat with an anesthetic solution to depress your gag reflex. The tube will then be passed down your esophagus and the procedure will be performed.
Risks:  Complications from this procedure are extremely rare. You may have a sore throat following the procedure. A small tear in the esophagus is also a risk which may heal by itself or require stitches. You should call your cardiologist immediately should you experience coughing or vomiting blood after the procedure.