Heart disease is America’s leading health problem and the number one cause of death for men and women in this country. It’s estimated that heart disease claims a life every 40 seconds. The Memorial Health Heart and Vascular Institute is working to reduce that number through education, advanced technology and lifestyle-enhancing programs. Here are just a few of the specialized services we provide for our community.
Heart procedures in Savannah
Angiography and angioplasty
Angiography is used to find problems or blockages in the arteries. A catheter is inserted through a small incision in the groin area. A physician guides the catheter to the area where the blockage is suspected. Next, dye is injected into the arteries while X-ray images are taken. The dye highlights the arteries, allowing the physician to accurately pinpoint the blockage.
You will be asked to lie flat for six hours after your angiography procedure. If there is no bleeding or bruising at the catheter insertion site, you will be allowed to go home. You will probably be asked to return for angioplasty to repair the blockage. This is a process that involves surgically implanting a balloon or stent to re-open the blocked artery.
Types of procedures we perform include:
- Carotid angiography and angioplasty
- Cerebral angiography and angioplasty
- Peripheral angiography and angioplasty
- Balloon angioplasty
- Laser angioplasty
- Coronary artery stent
- Stent placement
Cardiac catheterization involves passing a thin flexible tube called a catheter through an artery or vein, to the heart and into a coronary artery. This procedure produces angiograms of the coronary arteries and the left ventricle, the heart's main pumping chamber. Catheterization can also be used to measure pressure in the pulmonary artery and to monitor heart function in critically ill patients.
In most cases, cardiac catheterization is recommended when a partial or complete blockage is suspected in an artery. It is used to obtain information about the blockage and to evaluate how well the heart is functioning.
Cardiac catheterization is performed in our cardiac catheterization lab. Usually, the procedure takes two to three hours to perform. Patients must remain immobile for four to six hours following the procedure.
Your physician may request cardiac catheterization for the following conditions:
- Angina (chest pain) that is not easily controlled with medication, disrupts your daily routine, occurs at rest or recurs after heart attack
- Heart failure with suspected coronary artery disease
- Heart valve disease with symptoms such as shortness of breath
- Markedly abnormal stress test results
- Recurring chest pain with no identified cause
Not everyone with angina needs cardiac catheterization. People who have very rare or easily controlled episodes of angina probably do not need to undergo the procedure. Many people who have suffered a heart attack can initially undergo a stress test rather than cardiac catheterization.
Mitral valve repair
Mitral valve repair is an open-heart surgical procedure to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is located on the left side of the heart and allows blood to flow into the heart's main pumping chamber. The mitral valve then closes to keep blood from leaking back into the lungs. When it is not working properly, it must be repaired by specially trained cardiothoracic surgeons. Our surgeons specialize in minimally invasive valve repair that is performed using small (less than 1-inch) incisions rather than one large incision. Tiny surgical instruments and a camera are inserted through the incisions.
By watching images, from the camera broadcast on a monitor, the surgeon does not open the entire breastbone and chest. This results in less risk, less pain and a faster healing time.
The MitraClip transcatheter mitral valve repair technique treats mitral regurgitation, a condition in which the heart’s valves do not close tightly. As a result, blood leaks into the chambers of the heart, forcing it to work even harder. During the MitraClip procedure, a catheter is inserted in the groin or chest and threaded through the artery to the leaking valve. A small clip is then dropped into the most severe part of the leak and attached to both mitral leaflets. The clip pulls the leaflets together, closing the leak.
Transcatheter aortic valve replacement (TAVR) repairs a heart valve without opening the chest and removing the damaged valve. During the TAVR procedure, doctors insert a catheter into an artery in the groin or chest. The catheter is carefully threaded through the artery to the damaged valve. A synthetic replacement valve is then fitted into the damaged valve. It works like a stent to open the valve and regulate blood flow.
An abnormal heart rhythm, also called an arrhythmia, can cause heart palpitations, dizziness, fainting, sweating, shortness of breath, heart failure or stroke.
It is important to have any arrhythmia investigated by a specialist. If your heart rate is too fast or too slow, your cardiac electrophysiologist may recommend one of the following treatments.
Medications and pharmacologic agents can often control an abnormal heart rhythm, but they must be taken consistently and under the supervision of a heart specialist. Some of the commonly used medications include anticoagulants, beta-blockers or calcium channel blockers.
Ablation is a highly effective non-surgical treatment for atrial fibrillation, atrial flutter, supraventricular tachycardia, premature ventricular contractions and ventricular tachycardia. A catheter is placed in a vein in the groin and threaded up to the portion of the heart that is creating an abnormal rhythm. Doctors deliver radiofrequency or cryotherapy energy through the catheter to scar the tissue in the damaged part of the heart, stopping the rapid impulses.
A two-stage ablation therapy for long-standing persistent atrial fibrillation and recurrences from prior ablations. This procedure combines minimally invasive surgery and catheter ablation together to create scar tissue inside and outside of the heart, restoring a normal rhythm.
Electrical cardioversion delivers a quick and controlled electrical shock to the heart to reset the heart’s rhythm. It can be delivered externally through pads placed on the chest, or internally through a catheter that is threaded through a vein and into the heart.
Cardiac insertion devices
An automatic implantable cardiac defibrillator (ICD) is an electronic device that includes a pulse generator and leads. The pulse generator is about the size and shape of a credit card and weighs less than two ounces. It is implanted into the chest just underneath the skin. The ICD is connected to one or more leads that are placed in and near the heart. The lead system sends electrical signals from the heart to the pulse generator, which continuously monitors the heart's rhythm. When the pulse generator receives signals from the lead system that the heart rhythm is shockable, it sends energy through the lead system to the heart to stop the abnormal rhythm. If the heart rhythm remains normal, the ICD monitors the rhythm and waits until a shock is needed. People who receive an ICD have generally had a prior heart attack, have a significantly damaged heart, show brief bursts of abnormal rhythm when on a heart monitor and have successfully undergone electrophysiology testing to rule out other dangerous rhythm abnormalities. Only about 10 percent of all heart attack patients end up needing an ICD.
When the heart’s electrical system malfunctions, it can result in an abnormally slow heart rate (bradycardia) or an abnormally rapid rhythm (tachycardia). Most pacemakers are designed to correct bradycardias. Left untreated, bradycardias can cause weakness, fatigue, lightheadedness, dizziness, loss of consciousness or even death. When used properly, pacemakers can correct the problem.
Pacemakers consist of a generator and leads. The generator is a tiny battery-operated computer that lasts for five to eight years. The lead is a flexible electrical wire. One end is attached to the generator and the other end is passed through a vein into the heart. Generally, one lead is placed in the right atrium and the other in the right ventricle. The pacemaker then helps to regulate the timing of the heartbeat.
Pacemakers can be implanted under the skin (right or left side). A small incision is made, and the leads are guided through a vein toward the heart. The generator is then placed in the incision site. The entire process generally takes less than 45 minutes. The newest leadless pacemaker devices are delivered through a catheter directly into your heart, through a small puncture in the groin, without the need for surgery.
After the pacemaker is implanted, a physician must program it. Every so often, it may need to be reprogrammed or changed to suit the individual user. It can be programmed with a handheld device that does not require any surgery.
Heart failure occurs when the heart does not pump properly. It can’t send enough oxygen and nutrient-rich blood through the body, meaning other organs cannot function properly either. As a result, you may experience fatigue and shortness of breath. Everyday activities such as walking, climbing stairs or carrying groceries become very difficult.
Although there is no cure for heart failure, many people with heart failure lead full, enjoyable lives by managing their condition with medication and lifestyle changes.
Congestive heart failure
When blood flow out of the heart slows down, blood returning to the heart backs up, causing congestion throughout the body. This often results in swelling in the legs and ankles. If fluid collects in the lungs, it causes shortness of breath, particularly when a person is lying down. This can lead to respiratory distress. Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water further increases swelling throughout the body.
Managing heart failure
Heart failure cannot be cured, but it can be managed with lifestyle changes and medication. Successful treatment depends upon your willingness to get involved and take control of your health. Caregivers and loved ones also play an important role in helping you manage heart failure.
Surgery may be needed if your heart failure is caused by a heart defect or a blocked artery. Your doctor may recommend:
Percutaneous coronary intervention (PCI)
This procedure re-opens blocked vessels. A small tube with a tiny deflated balloon on one end is inserted through an incision in the groin area and pushed through to the diseased artery. Then, the balloon is inflated to push open the artery. The balloon is removed and a stent may be inserted to keep the blood vessel open. This procedure is usually performed in the cardiac catheterization lab and does not require a hospital stay.
Coronary artery bypass
This procedure reroutes the blood supply around a blocked section of the artery. Surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. They surgically attach the vessels to the diseased artery so that blood can flow around the blocked section.
Warning signs of heart failure
When you have heart failure, it’s very important to keep track of symptoms and report any changes to your healthcare team. Watch for:
- Sudden weight gain: three or more pounds in one day, five or more pounds in one week
- Shortness of breath while at rest, not related to exercise or exertion
- Increased swelling of the abdomen, legs or ankles
- Trouble sleeping lying flat, including waking up short of breath
- Frequent dry, hacking cough at night
- Loss of appetite
- Increased fatigue or feeling tired all the time
- Increased heart rate or heart palpitations
Structural heart disease
A structural heart condition refers to a problem within the heart’s valves and chambers. Structural heart conditions can be the result of a birth defect or they can develop from rheumatic fever, illness, pregnancy or lifestyle wear and tear.
When the heart has a structural defect, blood is not pumped through the chambers correctly. As a result, it does not reach the rest of the body.
This can lead to:
- Chest or abdominal pain
- Heart palpitations
- Extreme fatigue
- Shortness of breath
- Irregular blood pressure
Heart care services
Cardiac rehabilitation may be prescribed for people who have had one of the following medical conditions or procedures:
- Myocardial infarction (heart attack)
- Coronary artery bypass graft (CABG) surgery
- Stable angina pectoris (chest pain)
- Heart failure
Memorial Health CT scanning
The Memorial Health Heart and Vascular Institute has a 64-slice computed tomography (CT) scanner. The SOMATOM™ Sensation Cardiac 64 can scan the body and give physicians clear, detailed images of the heart and its surrounding arteries without the need for any invasive procedures. If there is a blockage in the arteries, doctors can pinpoint where it is and immediately send the patient to surgery to repair it. If there is no blockage, they can investigate other diagnoses.
The 64-slice CT scanner is also used to screen for calcium build up in the coronary arteries. Calcium is a component of plaque, and calcium build up is an early warning of coronary artery disease, a leading cause of heart attacks. The CT scan can detect hardened calcium deposits without any needles, medication or hospitalization.
To schedule a test or for more information, call (912) 350-4327.
Specialized care units
Memorial Health is one of only a few centers in the nation that has implemented the comprehensive advanced life support (CALS) course to provide specialized training to manage complications that may occur after heart surgery.
Doctors prescribe anticoagulant drugs, or blood thinners, to treat or prevent blood clots. The anticoagulant warfarin requires a regular blood test called the international normalized ratio (INR). Your INR will tell us how long it takes for your blood to clot.
Because genetics, diet and other medications can affect how anticoagulants work in the body, you will be closely monitored to avoid serious complications, such as bleeding. Your doctor may refer you to our anticoagulation clinic. The clinic is staffed by pharmacists who are trained to manage anticoagulant therapy. They will closely monitor and adjust your therapy and teach you how to stay safe while taking your anticoagulant.
How often will I visit the clinic?
The frequency of your visits depends on your INR results. Patients who are new to anticoagulation therapy may initially be seen once or twice per week. After your INR level becomes stable, you may only need to be tested once a month. Because diet, illness and other medications can affect your body’s response to anticoagulants, there may be times when you are tested more frequently.
The anticoagulation clinic pharmacists work closely with your physician. Clinic services include:
- Blood sample (taken from your arm) for INR testing
- Anticoagulation medication adjustment
- Close supervision of treatment for effectiveness
- Monitoring for side effects
- Educational materials and instruction
- Screening and counseling about food and drug interactions