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Coronary angiography. - As part of a cardiac catheterization, Angiography of the arteries supplying the heart muscle is performed. This reveals any narrowings or blockages. Contrast injections may also be made into the cardiac chambers to assess how the heart is contracting and to look for valve leakage. Catheterization and angiography are invasive procedures but they definite, specific information which guides the treatment you receive.

Coronary Angioplasty. - Once a narrowing or blockage in a coronary artery is detected by Angiography, this can be treated by Angioplasty. A special guiding catheter is stabilized in or near a coronary or bypass graft vessel, a thin flexible wire is passed beyond the narrowed area and a special cylindrical balloon is delivered over the wire to the narrowed area where it is briefly inflated. A tiny metal coil (stent) is then placed in the dilated area and left in place to keep the vessel open. In special circumstances, a directional cutter, a high-speed drill, a clot removal device, or intracoronary radiation may be used as part of an angioplasty procedure. Angioplasty may be added on to an elective or emergency diagnostic angiogram procedure. It is a safe and effective procedure. There is a small but definite chance of renarrowing of the dilated areas in the coronary vessels. New techniques are being introduced to minimize this possibility.

The risk of complications from a catheterization or an angioplasty is small but not zero. There can be bleeding, blood clots, injury to blood vessels, reaction to the x-ray dye- allergic or adverse kidney effects, and very rarely the complications of stroke, heart attack, the need for emergency surgery, or even death.. We recommend these procedures only when the benefits outweigh the risks. To see the hospital procedure consent forms please go to "Download Forms for Patient" .

Transesophageal Echocardiogram - This is an ultra high quality ultrasound study of the heart which is performed as an outpatient at Saint Raphael's. You are given sedation and a flexible probe is positioned in the esophagus (the food pipe between the mouth and the stomach) just in back of the heart. This approach is particularly useful in looking for blood clots in the heart, problems with the aorta, and fine details of the valves.

Tilt Table Testing - A tilt table test is a non-invasive test used to evaluate people with dizziness or fainting spells. Your heart rate and blood pressure are monitored while you stand still for 30-45 minutes

Pacemaker. - A cardiac pacemaker is a small electrical device implanted underneath the skin connected to wires placed in the heart chambers. Should your heart rate slow down too much the electronic pacemaker silently triggers your heart into action at the desired rate. Pacemaker insertion is a minor surgical procedure which is done under local anesthesia with infrequent complications. It requires one day of monitoring in the hospital after implantation. After initial adjustment we are able to follow your pacemaker conveniently by telephone monitoring as well as occasional office visits.

Biventricular Pacemaker - A newly available technique, biventricular pacing, involves placing several pacing wires into a weakened heart, enabling it to pump more efficiently and improving the patient's energy level. The insertion of the device is much like a standard pacemaker, involving a minor surgical procedure and overnight hospitalization.

Implantable Cardioverter - Defibrillator. (ICD) - An ICD is a type of pacemaker used to treat patients with potentially dangerous rapid heart rhythms (not all rapid heart rhythms are dangerous). ICD's may be life saving for certain people. Like pacemakers, they are implanted in a minor surgical procedure and require a one-night hospitalization.

NON-INVASIVE PROCEDURES

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