There are various techniques and procedures used in cardiology to correct, prevent, diagnose, and treat conditions associated with the heart muscle. Some are relatively simple – you can do them at home with a portable digital blood pressure monitor. Other procedures require the expertise of a cardiologist and his/her team to perform in a sterile surgical setting. The following are examples of procedures for each of the three categories.
Briefly, a non-invasive procedure is one in which there is no cutting or access to the body below the skin. The only invasive operation is the insertion of a needle for some tests.
One of the routine tests done in a doctor’s or even a dentist’s office is your blood pressure. Today, there are wrist monitors for a quick reading that requires no training. A dental technician may use this type in a dentist’s office, which for some reason – the hygienist needs to know your blood pressure (BP). At a physician’s office, the nurse or assistant wraps a cuff around the bicep, presses a button, and instantly has your systolic (higher figure) and diastolic numbers. Taking your BP is one non-invasive procedure.
The procedure, better known as ECG or EKG, measures the electrical activity of the heart. Each beat of the heart produces an electrical impulse or wave, which the machine captures as squiggly lines on a strip of graph-like paper. First, the nurse or technician applies 12 to 15 sticky electrodes to the patient’s chest, arms, and legs. The electrodes’ application takes longer than the readout, which is almost instantaneous with the push of a button on the ECG machine.
The EKG produces a wealth of information for the cardiologist, such as heart rate, the proper function of the heart’s valves, defects (enlarged heart, lack of blood flow, and congenital anomalies), prior heart attacks, arrhythmias, and more. A painless, non-invasive process could save one’s life!
As the name suggests, the procedure involves stressing the heart in a controlled environment. The test begins with a technician applying the same electrodes as the EKG, attaching a BP cuff, and possibly by inserting a breathing tube into the mouth to monitor respiration. Next, you start walking on a treadmill, which the technician may adjust the incline remotely to elevate heart rate, breathing, and BP.
This non-invasive test may elicit additional information for the cardiologist that the EKG alone did not show. Walking on the treadmill varies between 45 to 60 minutes, depending on the age and physical condition of the patient.
In this category, the tests become more intricate. As the name implies, some of the procedures require access below the skin or subcutaneous, in medical terminology.
The name refers to a group of invasive diagnostic procedures to determine the function and/or condition of the heart. The test begins with the insertion of an IV line into an arm vein. Electrodes and a BP monitor your vital signs throughout the process. The cardiologist makes a small incision in your groin through which he/she threads the catheter to your heart. Upon arriving there, the doctor injects a dye whose purpose is to show blockages or constricted vessels on the monitor.
Similar to the procedure above, the specialist threads a catheter from the thigh to the coronary vessels to correct a blocked or constricted vessel. Once the catheter reaches the affected location, a balloon on the end of the catheter inflates to widen the blood vessel.
This type falls under the classification of minimally invasive. This option is available for cardiologists in the treatment of atrial fibrillation that affects about 15 million Americans each year. A-fib occurs when the heart has an erratic, rapid rate in the upper chambers (atria). One of the more severe types is permanent A-fib, which means there is a consistent abnormal heart rhythm. In many cases, the cardiologist uses non-invasive techniques, including robotic surgery—robot-assisted cardiac surgery results in small incisions or ports through the ribs. Consequently, hospital stays are dramatically reduced, as well as recovery time.
Robotic Heart Surgery has many applications; examples are:
- Coronary artery bypass Grafting
- Mitral Valve Repair
- Atrial Septal Defect Surgery
- Heart tumor removal
- Congenital heart conditions
This group of procedures is a sub-category of invasive surgeries and a subspecialty of cardiology that the cardiologist performs in a hospital or outpatient surgical facility. An example is a balloon valvuloplasty that is a similar procedure as the balloon angioplasty. The difference being the valvuloplasty opens narrow valves versus blood vessels.
Many of the interventional operations involve access through the femoral artery (groin area), at which point the cardiologist passes a catheter through vessels to the heart. This method can repair mitral valve malfunctions, such as mitral regurgitation and mitral stenosis. The former refers to cases when the left between the left atrium and left ventricle does not close completely. Stenosis is the medical condition when the same valve doesn’t open properly.
Stents are another interventional minimally invasive procedure that the physicians may do at the time of angioplasty. A stent is a wire mesh or fabric material device placed in one of your coronary arteries to maintain normal blood flow.
Interventional cardiology is highly specialized – it requires three years to complete a fellowship in this branch of cardiology. This completion follows a four-year undergraduate program, four years of medical school, a two to three-year internal medicine residency, and a prior fellowship in cardiology.