Coronary Angiography or Coronary Arteriography is a real-time X-Ray visualization of the arterial vessels of the heart, it’s recorded into a CD and can be reviewed in any computer for further analysis. A 2 mm diameter catheter is inserted into a major blood vessel usually in the groin using just a small amount of local anesthetic.

The tip of that catheter is advanced and placed in the origin of the coronary arteries, which supplies blood and oxygen to the heart. Then, a contrast medium or dye is injected to visualize the lumen of the artery and shows if there is a narrowing segment that may need to be unblocked by Angioplasty. Patients usually don’t experience any discomfort due to the procedure itself, there is no pain after the anesthetic is injected, there may be a hot flush sensation during injection of contrast to the heart chambers but it is just a minor discomfort and it fades away in seconds.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

Angioplasty (AN-je-o-plast-tee), Coronary Angioplasty or Percutaneous Coronary Intervention (PCI) is a procedure to open narrowed or blocked blood vessels of the heart (coronary arteries), involves temporarily inserting and expanding a tiny balloon at the site of the blockage to help widen a narrowed artery.

Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery and decrease the chance of it narrowing again (elastic recoil or restenosis). Angioplasty can reopen clogged heart arteries during a heart attack or when plaque buildup is causing chest pain, shortness of breath or other symptoms.

Angioplasty is not a surgery, it is a minimally invasive procedure. Angioplsty is usually performed right after the narrowing or blockage is identified during the coronary angiography, under local anesthetic and sometimes, mild sedation to diminish patient anxiety. The procedure is generally safe. Coronary angioplasty has become a common non surgical-procedure with more than 1 million done in the United States every year.

Benefits of angioplasty

As with most medical procedures, angioplasty has both benefits and risks. Among the benefits are:

• It doesn't require a major incision.
• It doesn’t require general anesthesia.
• Major complications are uncommon.
• It can relieve your symptoms, such as chest pain and shortness of breath.
• It can improve your physical capacity.
• Under certain circumstances, it is well demonstrated that angioplasty reduces mortality from cardiovascular causes.

Risks of angioplasty
Restenosis. Angioplasty isn't without some risks. A major drawback of coronary angioplasty is the potential for your artery to re-narrow (restenosis) within months of the procedure. With angioplasty alone — without stent placement — restenosis happens in as many as 30 percent to 40 percent of cases. Stents were developed to reduce restenosis. The original bare-metal stents reduce the chance of restenosis to less than 20 percent, and the use of drug-eluting stents has reduced the risk to less than 10 percent.

Acute myocardial infarction: as an interventional procedure, there is a very small but real chance of having a myocardial infarction because the angioplasty itself may remove from the artery cellular debris or calcified cholesterol fragments to the distal circulation, other periprocedural mechanisms of myocardial infarction includes coronary dissection and acute closure of the coronary lumen. Technology and advancement in antiplaquetary drugs allow us to have a decrease in periprocedural major complications to as low as 1%.

About The recovery period
You'll probably remain hospitalized a day — in rare cases two or more days — while your heart is monitored and your vital signs and other organ functions are checked frequently. Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your coronary arteries and protect against coronary spasms. When you return home, drink plenty of water to help rid your body of the contrast dye and therefore decrease renal complications. Avoid strenuous exercise and lifting heavy objects for several days afterward

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

There are several conditions that affect the pulmonary circulation and leads to Pulmonary Arterial Hypertension (PAH). Less frequently, there is PAH due to hereditary factors and of unknown origin. The prognosis of PAH depends on several factors, it is a progressive and severe disease; symptoms include shortness of breath, precordial pain, fainting (syncope) and even sudden death.
In order to determine which treatment is the best for you, the interventional cardiologist must complete a protocol with a vasorreactivity test, that is, to place a catheter in the vascular pulmonary bed and measure whether the pulmonary arterial pressure decreases with the infusion of a vascular relaxing drug, if the test gives positive, you might be a good candidate for certain drugs to control PAH.
The procedure is well described and is an indication to be performed to patients with PAH.
It is a safe procedure; it takes an average of 1 hour to be completed and is done under local anesthetic.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

A vena cava filter is a small, metal device, shaped like the spokes of an umbrella or like a rhomboid cage. The filter is placed in the vena cava through a minimally invasive procedure. If there are blood clots in the veins of the legs or pelvis, these could pass up the vena cava and into the lungs, causing an Acute Pulmonary Embolism, which may be a fatal condition. The filter’s function is to trap these blood clots so they don’t pass to the lungs, actually, these filters are retrievable so they can be removed if indicated.

There are several conditions that predispose to form blood clots in the deep veins of the legs or pelvis. Usually, clots are first detected by ultrasound Doppler or other diagnostic tool. If clots are small or the patient is not at high risk, some anticoagulant drugs might be prescribed as the only treatment , if not, it is considered to place a vena cava filter to prevent those clots to cause more damage or even death due to pulmonary embolism.

The insertion takes place, as in most interventional procedures, in a special X ray room (angiography room), under local anesthetic. It is a very safe and quick procedure, it is necessary to use a small amount of dye, so if you are allergic to iodine you must tell the doctor before performing the insertion. After the insertion is done, there are some routine indications to do in order to have a successful implantation. If the implantation is a pre-planned intervention, you must return home on the same day. If the procedure was done under special circumstances while you were in hospital for other reason, then your doctor will be talking to you about the outcomes.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

A pacemaker is an artificial implantable device that stimulates the heartbeat to a frequency that allows adequate amount of blood pumped through the body. A pacemaker has two components.

1) The generator, that is a battery and electrical circuits, it has round shape and it looks more like a big coin.

2) The electrode(s) lead(s), that has the function to conduct the electrical stimulus directly to the heart to a frequency previously determined by the cardiologist according to the patient’s needs.

There are single chamber pacemakers and dual chamber pacemaker, the later, is a more physiological device that emulates more efficiently the normal electrical stimuli of the heart Nowadays, pacemaker are intelligent device that stimulate faster in response to the patient’s physical activity in order to provide enough blood to the whole body, and decreases the frequency of pulse during sleep hours to save battery. The pacemaker is used to stimulate and regulate the beating of the heart when the native stimuli or conduit system is affected by a spectrum of diseases. The insertion of the pacemaker is through a small infraclavicular incision under local anesthetic and mild sedation and is performed under X-ray visualization to ensure that the components are well located. The patient may need 1 or 2 day post-procedure stay in hospital.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

Treadmill test is an exercise testing that helps the doctor to find out whether you have occlusive coronary disease as a cause of angina, chest pain or shortness of breath with a reasonable percent of accuracy. It is performed under Electrocardiography continuous monitoring and repetitive blood pressure measurement.

Its more like walking up a hill, if the patient can’t walk or jog further the test can be stopped, but there is a goal to achieve in heartbeat frequency determined in every patient according to age and gender. The test not only provides information about coronary occlusive disease, but also gives very important information about arterial blood pressure response, physical capacity, cardiovascular rehabilitation after suffering a myocardial infarction, after Bypass surgery or after coronary angioplasty.

There is even a tool that calculates the percent of having a cardiac attack in the future based upon the results of the treadmill test.
It is a very safe non-invasive procedure and in Cardiología Integral, the cardiologist will perform the test personally to you.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

A tilt table test may be prescribed for individuals that have a history of passing out (fainting, syncope). This condition may be caused by an imbalance in the nerves that normally control heart rate and blood pressure. The tilt table test involves monitoring an individual while they lie on a table that is slowly rotated to a vertical (standing) position in order to help diagnose an abnormality of blood pressure regulation. Based on the results, your doctor may be able to determine the cause of your symptoms and recommend treatment.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

also known as an "echo". A non-invasive test that uses high-frequency sound waves to produce a study of the motion of the heart's chamber and valves. During this procedure, a sound transducer is placed on the chest and images of the heart are recorded for further analysis. This is used to test resting cardiac function, and given the non-invasive nature of this test, it is usually use as one of the first diagnostic tests for heart function.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com

A Holter monitor provides a continuous EKG recording, usually for 24-48 hours, while you go about your normal daily activities. It is used to detect abnormalities that may not occur during a resting EKG. Wires are attached to your chest and connected to a small recording device that you carry with you.

If you experience any symptoms, you push a button so that your heart rhythm at the time of your symptoms can be determined. An doctor will later analyze the recordings of your heart to determine what your heart rhythm was while you were experiencing your symptoms and also whether any abnormal heart rhythms occurred while you were wearing the Holter monitor.

If you want to know more about this procedure e-mail us at drlugocardiologist@cardiologia-integral.com