Glossary of Cardiology Related Terms

Common Diseases

Each link will contain a detailed explanation of causes, diagnoses, related symptoms, and treatment options for each disease. Where you see parentheses you will find a video in ASL.

Abdominal Aortic Aneurysm Hypertension Cardiomyopathy

Aneurysm (ASL Video) Infective Endocarditis

Angina (ASL Video) Ischemic cardiomyopathy (ASL Video)

Angioplasty Mitral Stenosis

Aortic Stenosis Mitral Valve Prolapse

Arrhythmia Open Heart Surgery

Atherectomy Pacemaker Implantation

Atherosclerosis / Arteriosclerosis Pericardial effusion

Atrial Fibrillation (ASL Video) Pericarditis

Atrial Septal Defect Peripheral arterial disease

Bypass Surgery PFO Closure

Cardiac Catheterization Phlebitis

Cardiac Resynchronization Pulmonary Artery Stenosis

Cardiomyopathy Pulmonary embolism

Carotid Artery Disease Renal artery disease

Carotid Artery Surgery Stenting

Chest Pain Stroke (ASL Video)

Congenital Heart / Valve Disease Sudden cardiac death

Congestive Heart Failure Syncope

Coronary Artery Disease (ASL Video) Thoracic aortic aneurysms

Deep Vein Thrombosis (ASL Video) Thoracic outlet syndrome

Defibrillator Implantation Valve Repair and Replacement

Ejection Fraction Varicose veins

Heart Attack (ASL video) Vascular disease

Heart Disease Venous insufficiency

Heart Murmur Ventricular septal defects

Heart Palpitations Visceral artery aneurysm

Hyperbaric Oxygen Therapy Visceral ischemic syndrome

Hypertension (ASL Video)

Retrieved from http://www.deafmd.org, http://www.asnc.org/content_275.cfm?navID=101, http://www.texashealth.org

Women and Heart Disease

You've seen it on television a hundred times; a man begins experiencing crushing chest pain. His family and friends rush him to medical care. The physician comes in, sees the man grasping his chest and determines he is indeed having a heart attack. Unfortunately, this image is so ingrained in our collective consciousness that we think all heart attack symptoms are the same. They are not.

For women, the signs of a heart attack are not predictable. National Institutes of Health research indicates that women often experience new or different physical symptoms as much as a month or more before having the heart attack. In fact, of the women participating in the research project and confirmed to have had a heart attack, fewer than 30 percent reported having chest pain or discomfort prior to their heart attacks, and 43 percent reported having no chest pain at all. With more women dying of heart disease each year than men, and with more women dying of heart disease each year than all cancers combined, it is important to know just how different a woman's heart attack symptoms might be (Texas Health Resources, 2012).

Significant symptoms prior to heart attack include:

Unusual fatigue Sleep disturbance Shortness of breath Indigestion Anxiety, feelings of impending doom or unusual nervousness

Significant symptoms during heart attack include:

Shortness of breath and/or inability to catch your breath when waking up Weakness Unusual fatigue Cold sweat, clammy sweat Dizziness Nausea, vomiting Chest pain, could also include back pain and/or deep aching and throbbing in one or both arms Fluttering or rapid heartbeats, palpitations Feeling of heaviness, such as pressure-like chest pain between the breasts that may radiate to

the left arm or shoulder

(Texas Health Resources, 2012)

A tip of prevention - The benefits of chocolate!

http://ajcn.nutrition.org/content/81/1/298S.full.pdf+html

Advanced Medicine in Diagnostics and Treatments

Flash CT

One the world’s fastest computed tomography (CAT or CT scan) machines, called Flash CT. The shutter speed of Flash CT’s camera is so quick that an entire chest scan can be done in half a second. This means that patients do not have to hold their breath or take medications to slow the heart rate. Three-dimensional color images of the heart help doctors evaluate coronary blood vessels. The detail of the images allows physicians to see some cardiac blockages that previously required cardiac catheterization procedures to diagnose. The high-speed scan also means that patients are exposed to significantly less radiation than the doses delivered by traditional CT scans.

3D Echocardiogram

A new type of echocardiogram that provides the first-ever live three-dimensional images of the beating heart moments before surgery. The technology helps surgeons better determine the course of open-heart surgery and how to better treat people with heart disease, one of the leading causes of death in the United States. Until now, doctors could see 3D images of heart valves only by looking directly at the valves during surgery – after the surgical site was “open” and the patient had been put on the bypass machine. At that point, the heart is not moving, so surgeons were not able to determine the functional integrity of a valve as it pumped blood. With live 3D pictures, surgeons can see the valves at work. In some cases, the images can help eliminate the need to replace heart valves that surgeons otherwise would not have known were

healthy. The 3D images also can be taken before surgeons close the surgical site, telling them whether any leaks exist or whether additional procedures are needed.

Remote EKGs

Speed is of the essence when treating a heart attack. In a matter of minutes, a heart attack can permanently damage the cardiac muscle, causing major health problems and even death. The more quickly patients receive treatment, the more likely they are to have a positive outcome. A new Web-based wireless technology that allows paramedics and other EMS personnel to instantly transmit an EKG (electrocardiogram) from the scene of an accident or medical emergency to computers at the hospital. The readout is automatically printed and wirelessly sent to the smart phones of doctors and nurses. The system is designed to quickly identify a type of heart attack known as a STEMI (ST elevation myocardial infarction). The American Heart Association estimates that nearly 400,000 people in the United States experience a STEMI every year. Studies have shown that “prehospital” EKGs can quicken treatment times by allowing clinicians to prepare for the patient while he or she is still en route to the hospital.

Minimally Invasive Heart Procedures

Cardiac Catheterization

Coronary angioplasty, commonly called a cardiac catheterization or “cath” procedure, is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery that has been narrowed by plaque buildup on the inner walls of the artery. A tiny balloon on the tip of a wire is inserted into an artery through the patient’s leg and guided through the maze of arteries to the location of the heart blockage. The balloon is then inflated to open the coronary artery and restore blood flow to the heart. A stent is typically placed in the artery to serve as a scaffolding to support the artery and prevent the blood vessel from closing again. More than a million people a year undergo angioplasty in the United States, according to the National Heart, Lung and Blood Institute.

Endovascular Repair of Heart Defects

An atrial septal defect is a hole in the wall between the two upper chambers of the heart. The defect is an incomplete closure of the atrial septum that everyone has before birth. Most seal shut naturally, but some do not. The hole can cause blood clots that travel to the brain or lodge in blood vessels of other organs. To treat the problem, surgeons on the medical staff at Texas Health are using minimally invasive catheter-based procedures to deploy devices that close the hole without major surgery. The device is guided to the hole in the heart wall through a tiny wire, called a catheter. Physicians insert the wire through a tiny incision in the patient’s leg. The closure device, which is at the tip of the wire; is opened once physicians find the exact location of the hole. The permanent implant is safe and restores proper blood flow within the heart.

Minimally Invasive Vascular Procedures

Endovascular treatments for peripheral artery disease and peripheral vascular disease Millions of Americans are threatened by peripheral artery disease (PAD). PAD (or PVD, peripheral vascular disease) is the leading cause of leg amputations in patients over 50 in the United States. Clearing blockages in leg arteries has always been a challenge because the blood vessels are small and have complex pathways.

Cryoblation

Atrial fibrillation (AF), one of the most common cardiac arrhythmias seen by physician in the US, is a condition that causes the upper chambers of the heart to start and stop erratically. Patients who struggle with AF often have high blood pressure and structural heart disease. If left untreated, AF can cause rapid and irregular heart palpitations as well as lead to both stroke and death. The first and only cryoballoon that is FDA approved to treat drug refractory recurrent symptomatic paroxysmal AF. Artic Front® Cryoablation is a minimally invasive procedure that uses a balloon catheter system to deliver a freezing coolant instead of heat to make circumferential lesions around the pulmonary vein. In contrast to traditional heat-based ablation, the freezing technology significantly reduces the risk of damage to critical structures adjacent to the heart. The procedure allows for trained surgeons to restore normal function to the heart in a safer and more efficient manner.

Crossing Chronic Total Occlusions

Angioplasty and stent placements are some of the best tools available to open clogged peripheral arteries, but chronic total occlusions (CTO), which are total blockages of the blood vessel for at least 30 days, pose a tougher challenge. To use stents and angioplasty, physicians first have to get through the blockage with a guide wire. Physicians on the medical staff at Texas Health are investigating the effectiveness of minimally invasive technologies to treat these once-impenetrable blockages of peripheral arteries, and are putting them into practice where appropriate. Crossing the CTO and restoring blood flow to the patient’s lower leg greatly reduce the risk of amputation. New technologies to cross the CTO include a minimally invasive catheter system that channels through the blockage like a corkscrew, allowing doctors to further treat the condition. Other technologies include a type of catheter that utilizes high-frequency mechanical vibration to help breach or cross dense blockages, allowing for balloon angioplasty and stent placement.

Minimally Invasive Stroke Procedures

Carotid Stenting

Carotid stenting is a procedure that involves inserting a wire mesh tube to prop open the arteries that supply blood to the brain. When the carotid arteries are obstructed, patients are at increased risk for stroke. It is a common treatment for carotid artery disease, a condition caused by buildup of fatty substances and plaque. It is a new device that allows them to cross blockages in carotid arteries while greatly reducing the risk of stroke. The procedure involves

using small balloons on the tip of a catheter that are inflated in the external carotid artery and the common carotid artery to suspend blood flow during the stenting process. The balloons act like surgical clamps, protecting the brain during the procedure. The percutaneous procedure requires no major surgery. It is a safe option to protect blood clots and other plaque debris from traveling to the brain during the treatment of carotid blockages.

Coiling

To get to the site of a brain aneurysm, surgeons have traditionally removed a section of the skull, a procedure called a craniotomy. They then used a metal clip to stop blood flow into the aneurysm, stabilizing the bulge and reducing risk of rupture. Called clipping, the procedure is still used today in some cases. A new technique, called coiling, treats patients more quickly and with fewer side effects and less pain. The endovascular treatment involves inserting a catheter into an artery in the patient's leg and navigating it through the vascular system, into the head and into the aneurysm. Real-time fluoroscopic imaging is used to map the catheter’s route though the vascular system. At the location of the aneurysm, coils made of platinum are threaded through the catheter and opened inside the aneurysm. This step blocks further blood flow into the aneurysm and prevents rupture. The coils are made of platinum, so they are visible on s-rays, allowing surgeons to see the treatment site. Platinum is also flexible, allowing the coils to conform to the size and shape of the aneurysm. The procedure can be done under light sedation, and most patients go home the day after surgery.

Minimally Invasive Treatments for Abdominal and Thoracic Aneurysms

Interventional cardiologists and vascular surgeons are pioneering new techniques to repair dangerous abdominal aortic aneurysms with minimally invasive techniques that allow patients to go home the day after surgery. Abdominal aortic aneurysms (AAA), sometimes called triple As are dangerous bulges in the aortic artery, the major pipeline that supplies blood to the lower half of the body. The walls of the artery are pushed out by blood pressure, making the artery bulge like a weak spot on a worn tire. Because of the large volume of blood that travels through the aorta, a rupture of the aneurysm can be deadly in just minutes. Traditionally, the way to repair these aneurysms has involved major abdominal surgery, with a long incision down the patient’s stomach. To access the aorta in one of these “open” surgeries, internal organs must be navigated and the patient’s intestines moved outside the body. Today surgeons are treating more and more people with minimally invasive procedures in the hospital’s cardiac catheterization laboratory. The percutaneous (through the skin) procedures involve inserting a tiny wire into the patient’s leg artery and guiding it into the abdomen to the site of the aneurysm. A stent graft is then deployed to give the artery new shape and strength. The aneurysm is stabilized, and there is no longer a threat of rupture. Some of these bulges in the artery dissipate and disappear over time and simply go away. The endovascular procedure, which is similar to the way stents are placed inside cardiac arteries to keep blood pumping to the heart muscle, is made even less invasive because of new suturing techniques. As surgeons are removing the wire and sheaths that guide the stent insertion during the procedure, they tie

the stitches outside the patient, then, slide the knot just below the skin surface where the leg artery was accessed. A minimally invasive percutaneous repair of an abdominal takes one to two hours, and patients go home as soon as the next day. Traditional open procedures usually require a four-to five-day hospital stay and weeks of recovery.

Endovascular Repair of Thoracic Aortic Aneurysms

Some physicians are now using minimally invasive techniques to repair deadly aneurysms of the thoracic aorta, the major pipeline leading out of the heart that is responsible for circulating blood throughout the body. Because the aorta carries such a high volume of blood, the rupture of an aneurysm, which is similar to a bulge in a bicycle tire, can be deadly in just minutes. Today surgeons can repair these aneurysms by deploying a graft through a tiny catheter, giving the aorta structure and stability and eliminating the possibility of a deadly rupture. Traditional open surgery to implant the synthetic graft is a high-risk procedure, but surgeons can now place the stent over the aneurysm using endovascular techniques. The procedure involves placing a tiny wire called a catheter into the patient’s leg artery and guiding it to the site of the aneurysm. Patients typically go home in one to two days and can resume full activities within several weeks.

Robotic Ablation Procedures for Cardiac Disorders

Electro physiologists are now using a new robotic system to treat heart rhythm disorders faster and more precisely. These ablation procedures are used to treat various cardiac disorders, including atrial fibrillation, the most common type of heart-rhythm problem. During the procedure, a tiny tube called a catheter is inserted into the body through a small incision in the patient’s leg. The wire is guided to the heart using a remote-control system that gives doctors a three-dimensional map to steer the wire. Physicians then pinpoint the source of the irregular heartbeat and use radiofrequency energy to correct the problem. The system means that patients are asleep for a shorter period of time and are exposed to less radiation than they would experience in a traditional ablation procedure.

(Texas Health Resources, 2012)

Post Procedure Care For Patients to Follow

Cardiac Catheterization After Care Checklist:

Do not drive for 48 hours after your procedure. Don’t lift anything more than 15 pounds for the next two weeks. Walk 10 to 15 minutes two times a day. Call your cardiologist if you have a fever of 101 degrees or higher. Call your cardiologist if you experience any bleeding or swelling at the site of your incision. Schedule a follow-up office visit in two to four weeks with your cardiologist. Another follow-up

office should be scheduled in three months. Call your doctor if you have any problems or questions.

Follow Up: Future Appointments

Once you get home, you’ll need to schedule follow-up appointments with your cardiologist and primary care physician within one month. The new medications you’ve been prescribed may be different from the ones you were taking before surgery. Your physicians can help you understand what your medications are for and adjust dosages as necessary.

As your doctor may have already told you, you’ll probably need to make some healthy lifestyle changes, and your cardiologist or surgeon will likely refer you to cardiac rehabilitation.

Life Style Changes

WebMd, LLC (2010) published an article review of The American Heart Association’s Seven Simple Steps for a healthier heart.

1. Never smoked or quit more than a year ago.2. A healthy body mass index (BMI), an estimate of body fat determined by a formula using weight

and height.

3. Physical activity, and the more the better. The new measure says at least 150 minutes per week of moderate-intensity exercise is necessary for ideal health, or 75 minutes weekly of vigorous physical activity.

4. Blood pressure below 120/80.5. Fasting blood glucose less than 100 milligrams/deciliter, a fasting measure of blood sugar level.6. Total cholesterol of less than 200 milligrams/deciliter.7. Eating a healthy diet. Four to five of the key components of a healthy diet are followed. For a

2,000-calorie diet, these include:

1. At least 4.5 cups of fruits and vegetables per day2. At least two 3.5 oz. servings of fish per week, preferably oily fish3. At least three 1-ounce servings of fiber-rich whole grains per day4. Limiting sodium to less than 1,500 milligrams a day5. Drinking no more than 36 ounces weekly of sugar-sweetened beverages

Video: http://www.youtube.com/watch?feature=player_embedded&v=Hi2MdTJgrE0 (Transcript is provided under the video in YouTube)

Retrieved from http://www.youtube.com/watch?feature=player_embedded&v=Hi2MdTJgrE0

Cardiac Rehab

The goal of cardiac rehabilitation is to restore and maintain optimal health while helping to reduce the risk of future heart problems. Led by a multidisciplinary team of physicians on the medical staff, cardiac rehabilitation involves others trained to deliver personalized exercise prescriptions, education and lifestyle-modification sessions.

Patients who have had any of the following procedures or conditions may benefit from cardiac rehabilitation:

Heart attack Atherosclerotic heart disease Angina pectoris Abnormal stress test Valvular heart disease Pacemaker or AICD Heart failure Angioplasty or atherectomy Coronary artery bypass surgery Heart transplant Cardiomyopathy

The Benefits of Cardiac Rehab:

Improvement of exercise tolerance Reduction of symptoms Reduction of cholesterol levels Reduction of cigarette smoking Improvement in psychosocial well-being and reduction of stress Lowering of blood pressure

Recovery and Depression

Unfortunately, over half of all patients that have suffered from a heart attack will more than likely suffer from some degree of depression. In this case, the patient’s situation can become even more serious and increase their risk of dying even sooner.

Outpatient Programs exist. They address symptoms such as insomnia, appetite changes, social withdrawal, fear of death or adverse cardiac incident, hopelessness, and recurrent thoughts of death or suicide. Studies have shown that 80 percent of patients with a co-occurrence of depression and heart disease improve if all their symptoms are treated with a combination of anti-depressants and individual and group cognitive behavioral therapy. Some programs involve a time commitment (days/week) and are designed to help participants balance their treatment requirements with work, education and home-life schedules. Patients may self-refer or be

referred to the center by a physician, therapist, or an Employee Assistance Program counselor. The American Hospital Association recommends that all cardiac patients should be screened for depression (Texas Health Resources, 2012).

References

1. American Society of Nuclear Cardiology. (2011). Glossary of terms. Retrieved fromhttp://www.asnc.org/content_275.cfm?navID=101

2. DeafMD.org: Health Education in American Sign Language. (2012). Diseases a-z, Retrieved fromhttp://www.deafmd.org/content/topics/index.cfm

3. Hendrick, B. (2010). 7 steps for a healthy heart. Retrieved from http://www.webmd.com/heartdisease/news/20100120/7-steps-for-a-healthy-heart

4. Keen, C. L., Holt , R.R, Oteiza, P. I., Fraga, C. G., & Schmitz, H.H. (2005). Cocoa antioxidants andcardiovascular health. The American Journal of Clinical Nutrition, 18. Retrieved fromhttp://ajcn.nutrition.org/content/81/1/298S.full.pdf+html

5. Texas Health Resources. (2012). Heart and vascular, Retrieved fromhttp://www.texashealth.org/heartV_template_home.cfm?id=3998

6. Texas Health Resources. (2011). Heart healthy tips from texas health resources, Retrieved fromhttp://www.youtube.com/watch?feature=player_embedded&v=Hi2MdTJgrE0