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Preventive interventions

Whether you have been diagnosed with a heart condition or are looking to prevent future heart or vein troubles, preventive interventions can help you maintain as good health as possible. The providers at Novant Health Cardiology work with patients and other physicians involved in their care to find ways to improve heart health. Sometimes, minor preventive procedures are performed to guard against the need for larger procedures later. Among the most common preventive procedures performed are:

Cardiac catheterization

Cardiac catheterization can be used to diagnose or treat cardiac concerns. In this procedure, your cardiologist inserts a very thin catheter (tube) into an artery in the arm or leg. The catheter is threaded back through the arteries to the heart. 

Cardiac catheterization is often used in patients who have a suspected or diagnosed plaque buildup in the arteries. As plaque builds up on the walls of the arteries, the arteries become narrow and stiff, causing a condition called atherosclerosis. Cardiac catheterization can detect the blockage and determine its extent.

Cardiac catheterization is also part of a procedure called angiography (also called arteriography). In this procedure, your doctor injects contrast dye through the catheter. X-rays show the dye within the arteries, creating an image illustrating how blood travels through the heart's blood vessels. These images will help your cardiologist identify problems and decide on a course of treatment.

You will need to fast for eight to 12 hours before cardiac catheterization. You might also be asked to increase fluid intake in the days before the procedure. You will likely be given a light sedative that will not affect how the heart functions. You will remain alert through the procedure to communicate with your doctor about any pain, however the test is generally painless. A small spot on your arm or leg will be cleaned and shaved for catheter placement, and the insertion point will be numbed to minimize pain. Since there are no nerves in the arteries, there is no pain and little sensation as the catheter moves through the body. The test can take anywhere from 45 minutes to three hours.

Angiography dye occasionally causes patients to be more aware of their heartbeats and a brief warm sensation.

After the procedure, the catheter and sheath used to access the artery are removed once the physician no longer needs access to the artery. Pressure is applied on the insertion site for 15 to 30 minutes to allow the area to close and prevent bleeding.

Complications from the procedure are rare. They can include allergic reaction to the dye, nausea, bleeding, and swelling, pain or numbness at the insertion site. Very rarely more serious complications occur. Most people can resume normal activities just days after cardiac catheterization.

Balloon Angioplasty/PTCA

Balloon angioplasty is a preventive intervention for patients suffering from coronary artery disease, a condition marked by restricted blood flow to the heart due to hardened arteries clogged with plaque. Balloon angioplasty pushes the plaque against the artery wall to make more room for blood flow. This reduces the risk of heart attack and sudden death without the need for more invasive bypass surgery.

Like cardiac catheterization, balloon angioplasty starts with numbing an area of the body so your cardiologist can insert a balloon-tipped catheter into an artery. The physician then guides the deflated balloon to the site of the blockage in the heart. The cardiologist then inflates the balloon against the walls of the artery. The balloon and catheter are then removed. In many cases, a wire mesh tube called a stent is permanently implanted to hold the artery open. The stent is placed using the balloon-tipped catheter.

Balloon angioplasty and stent placement are most often inpatient procedures. They take anywhere from one to two hours, and are done under general anesthesia. Most patients go home after 24 hours.

Compared to bypass surgery, balloon angioplasty is a lower-cost, lower-risk procedure. It also offers a faster recovery, allowing patients to return to normal activity within days in most cases.

One relatively rare but potentially serious complication of balloon angioplasty is abrupt vessel closure, when the artery treated becomes blocked. This could trigger the need for emergency bypass surgery. The risk of abrupt vessel closure is greatly reduced if a stent is placed at the time of balloon angioplasty.

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