Interventional Cardiology

Interventional Cardiology

The cardiovascular system, comprising the heart and blood vessels, is a vital body organ system. Their primary role is distributing oxygen and nutrients to every body tissue. Deoxygenated blood is returned by way of the veins back to the heart. The heart itself has coronary arteries supplying blood to the heart muscle. If deposits of lipids, calcium, proteins, or tissues forming plaques within the artery wall narrow or block a coronary artery, the heart pumping function will be compromised.

A complete blockage of the coronary artery will lead to ischemic cardiomyopathy, acute myocardial infarction (heart attack), or even sudden death.  

According to the Thai Ministry of Public Health, cardiovascular diseases cause 70,000 deaths annually, averaging eight deaths per hour, with the number of deaths from cardiovascular diseases increasing every year.

If a patient displays signs and symptoms of atherosclerosis, like chest pain, fatigue, inability to lie flat, loss of consciousness, or heart attack, the specialists capable of timely intervention without open heart surgery are interventional cardiologists. In the parlance of the cardiology community, they are dubbed heart "plumbers" or "interior designers." The primary role of interventional cardiologists is to identify narrowed or obstructed areas in coronary arteries and use different tools to clear blockages and reestablish blood flow to the heart muscles.

In addition, one can also effectively deploy coronary artery intervention techniques for other heart or vascular conditions.

What is interventional cardiology?

Interventional cardiology treats acute and chronic cardiovascular conditions by threading thin catheters and specialized tools to clear the blockage and restore blood flow.

Interventional cardiology procedures are minimally invasive, typically involving a small 2mm incision in the wrist or groin area. These procedures usually last 1-2 hours and offer benefits such as effective treatment results, shorter hospital stays, minimal complications, and quicker recovery than traditional open surgeries.

Why should you consult an interventional cardiologist at MedPark Hospital?

• Interventional cardiologists at MedPark Hospital possess teaching-faculty proficiency skill levels and extensive experience treating cardiovascular diseases. They can perform diagnostic and interventional procedures for heart and coronary artery disease, including chronic total occlusion and distal coronary arterial disease. These intricate and complex conditions demand precise and meticulous intervention under restricted time.
• Our interventional cardiologists work closely with specialists in related fields, including cardiothoracic surgeons and radiology technicians, multidisciplinary medical professionals with vast experience in interventional cardiology. We believe collaboration among expert specialists can improve the effectiveness of procedures and assist patients with cardiovascular diseases in resuming their daily lives more quickly.
• MedPark Hospital is well-prepared to treat patients with cardiovascular diseases in any situation with a well-equipped catheterization laboratory and technology that enhances the precision of intervention cardiologists. When encountering more complex and challenging plaque lesions, a hybrid OR equipped with Bi-Plane imaging equipment allows clear visualization of blood vessels during a procedure. As a result, a cardiologist can perform an interventional cardiology procedure, while a cardiothoracic or vascular surgeon can perform another simultaneous surgical procedure. Additional benefits of a hybrid OR are increased accuracy for interventional cardiology procedures and reduced risk of adverse events during a surgical procedure.

Diseases and disorders treatable with interventional cardiology

• Congenital heart diseases
  
  • Hypertrophic cardiomyopathy
  • Coronary artery fistula
  • Ventricular septal defect (VSD)
• Valvular heart diseases, such as aortic valve stenosis
• Arrhythmia
• Heart attack
• Coronary artery disease (CAD)
• Carotid artery disease
• Peripheral artery diseases, such as renal artery stenosis and femoral artery occlusion
• Atherosclerosis
• Chronic venous disease
• Thromboembolic disease

Signs and symptoms that require immediate attention from an interventional cardiologist

• Chest tightness, especially during exertion or exercise
• Shortness of breath, fatigue causing reduced activity
• Difficulty breathing, inability to lie flat
• Palpitations, rapid heartbeat
• Syncope
• Nausea and vomiting
• Peripheral edema
• GERD-like or dyspepsia-like epigastric pain
• Jaw pain, pain in the left and right arms, or pain radiating to the back 

Who is at risk of developing cardiovascular diseases?

Cardiovascular disease now impacts younger individuals, expanding the at-risk demographic beyond men aged 35 and women aged 45. Unhealthy habits like consuming fatty foods, being overweight, lack of physical activity, smoking, or susceptibility to NCDs can elevate the likelihood of developing cardiovascular issues.

Therefore, if you develop signs and symptoms of cardiovascular disease, consult an interventional cardiologist for prompt and accurate diagnosis. If there is a family history of heart disease, an annual health checkup is essential to reduce the risk of cardiovascular diseases.

Diagnostic tests

Non-invasive cardiology includes diagnostic procedures that do not involve skin incisions or the insertion of medical devices into the body. Various non-invasive cardiology techniques are available, depending on the nature of the heart condition and the doctor's assessment. These techniques include:

• Exercise Stress Test
• Echocardiogram
• Nuclear Stress Test
• Cardiac MRI
• CT Scan
• CT Coronary Calcium Score
• Coronary Computed Tomographic Angiography (Coronary CTA)
• Tilt Table Test
• Holter Monitoring
• Other diagnostic tests, such as ambulatory blood pressure monitoring

Coronary Artery Angiography

Coronary artery angiography is a minimally invasive interventional procedure. It involves inserting a 2mm catheter into the wrist or the groin artery, coursing to a coronary artery before injecting contrast media to locate the blockage and assess its severity. Coronary artery angiography can help assess cardiac muscle and heart valve function for planning optimal treatment. It is utilized in the following scenarios:

• Balloon angioplasty and stenting
• Percutaneous transluminal mitral commissurotomy
• Transcatheter aortic valve implantation
• Procedures for congenital heart defects, such as transcatheter ASD and patent ductus arteriosus closure
• Peripheral artery angioplasty

Interventional cardiologists typically perform this procedure in a catheterization laboratory equipped with dedicated medical technology and devices for interventional cardiology procedures.

When there is an indication for multimodal treatments or a switch from interventional cardiology to surgery is likely, an intervention will occur in a hybrid operating room, which is better equipped and facilitates a seamless transition between techniques without moving the patient to another operating room.

Additionally, a hybrid operating room enables collaboration among specialists, including cardiothoracic and vascular surgeons, minimizing risks associated with patient transfers and ensuring continuous and timely interventions.

Medical tools and equipment for interventional cardiology procedures 

Medical tools and equipment used in interventional cardiology procedures vary, depending on the nature of diseases and treatment approaches. These tools include: 

• A catheter
• A balloon catheter
• Stents in various sizes
• A rotavator
• Intravascular ultrasound (IVUS)

Contraindications and limitations of interventional cardiology procedures

• An artery too small to accommodate a catheter
• Total occlusion of the wrist or groin artery requiring a catheterization to be made elsewhere, such as the elbow or the neck
• A heavily calcified artery too hard to penetrate
• A dementia patient who cannot hold still or follow a doctor's instruction during a procedure
• Patients with high creatinine or seafood allergies may preclude the injection of iodine-containing contrast agents.

Potential risks and complications from interventional cardiology procedures

Interventional cardiology procedures are highly safe, with only 2% complication risks and a 0.01% death rate. Potential complications of interventional cardiology procedures include:

• Adverse reactions to contrast media
• Pain or swelling at the site of the puncture
• Bleeding at the site of insertion
• Infected wound at the site of insertion
• Arrhythmia
• Coronary thrombosis 
• Cerebral thromboembolism

Frequently asked questions

• What is the mortality risk of the procedure?
  Although it is possible, the death rate from interventional cardiology procedures is only 0.01% 
• Are individuals too young for heart screening according to guidelines at risk of developing cardiovascular disease?
  Currently, cardiovascular issues are becoming more common among younger people. It's advisable to consult a cardiologist promptly upon experiencing any signs or symptoms.
• Can one self-monitor for the risk of cardiovascular diseases?
  Yes, individuals can monitor their risk for cardiovascular diseases by undergoing tests for their blood pressure, cholesterol, and blood sugar, as well as assessing their risk of CAD according to a doctor's advice.
• Is general anesthesia required for interventional cardiology procedures?
  No. Only local anesthesia is necessary at the skin puncture site. Nevertheless, general anesthesia may be applicable for patients who cannot communicate with a surgeon, such as a patient with dementia.