2.17 Diagnosis of Cardiovascular Disorders

Modern research efforts have resulted in improved diagnosis of cardiovascular diseases (CVD), their treatment, and prevention. This topic covers the principles of angiography, coronary bypass, angioplasty, and open-heart surgery.

Definition

Angiography: Angiography is a technique in which a specially designed catheter is inserted into a vein or artery and advanced into the heart under radiographic fluoroscopic guidance. This allows the operator to obtain angiograms by injecting contrast media into an area of interest.

Coronary Bypass: A coronary bypass is a surgical procedure that relieves the effects of obstruction in the coronary arteries. The technique involves taking healthy segments of blood vessels from other parts of the patient's body to bypass obstructions in the coronary arteries.

Angioplasty: Angioplasty is a procedure in which a cardiologist threads a plastic tube into an artery of an arm or a leg and guides it through a major blood vessel toward the heart. When the tube reaches the region of plaque in a coronary artery, a balloon attached to the end of the tube is inflated, forcing the vessel open.

Open Heart Surgery: Open-heart surgery is a surgery in which the patient's chest is opened. The surgery is performed on the heart. The term "open" refers to the chest, not to the heart itself.

Main Idea

• Angiography — visualizing blood vessels using contrast media
• Coronary bypass — surgical procedure to bypass blocked arteries
• Angioplasty — balloon procedure to open blocked arteries
• Open-heart surgery — surgery to repair heart structures

These procedures help diagnose and treat cardiovascular disorders.

Core Concept

• Angiography = imaging blood vessels
• Cardiac catheterization = inserting catheter into heart
• Coronary bypass = bypassing blocked arteries
• Angioplasty = balloon to open arteries
• Stents = tubes to keep arteries open
• Open-heart surgery = chest opened; heart repaired
• Heart-lung bypass machine = adds oxygen; keeps blood moving

Detailed Explanation

Principles of Angiography

• A specially designed catheter is inserted into a vein or artery.
• Advanced into the heart under radiographic fluoroscopic guidance.
• Allows the operator to obtain angiograms by injecting contrast media into an area of interest.

• Evaluate disease of the mitral valve, aortic valve, and aorta.
• Determine the size and function of the left ventricle.
• Detect stenosis (narrowing of a tube).
• Guide revascularization procedures such as balloon angioplasty and stenting.

• Used to detect stenosis.
• Guides revascularization procedures.

Coronary Bypass

• A surgical procedure that relieves the effects of obstruction in the coronary arteries.
• Involves taking healthy segments of blood vessels from other parts of the patient's body.
• Usually a vein from the leg or an artery of the thorax.
• Used to bypass obstructions in the coronary arteries.

• Restores blood flow to the heart muscle.
• Relieves angina.
• Improves heart function.

Angioplasty

• A cardiologist threads a plastic tube into an artery of an arm or a leg.
• Guides it through a major blood vessel toward the heart.
• When the tube reaches the region of plaque in a coronary artery, a balloon attached to the end of the tube is inflated.
• This forces the vessel open.

• The artery may not remain open.
• Slotted tubes called stents are expanded inside the artery to keep it open.
• Stents are coated with heparin to prevent blood clotting.
• Stents are coated with chemicals to prevent arterial closing.

Open Heart Surgery

• The patient's chest is opened.
• The surgery is performed on the heart.
• The term "open" refers to the chest, not to the heart itself.
• The heart may or may not be opened depending on the type of surgery.
• Used to correct heart problems in children and adults.

• An incision is made through the breastbone (sternum).
• The patient is under general anesthesia.
• Tubes are used to re-route the blood through a special pump called a heart-lung bypass machine.
• The machine adds oxygen to the blood and keeps the blood warm and moving through the rest of the body.
• Using the machine allows the heart to be stopped.
• Stopping the heart makes it possible to repair the heart muscle, heart valves, or blood vessels outside the heart.
• After repair, the heart is started again.
• The machine is removed.
• The breastbone and skin incision are closed.

Intermediate Level

Comparison of Diagnostic and Treatment Procedures

Angiography

Coronary Bypass

Angioplasty

Open Heart Surgery

Formula / Mathematical Form

Not applicable to this topic.

Solved Example

Not applicable to this topic (descriptive topic).

Important Points

• 1. Angiography visualizes blood vessels.
• 2. Cardiac catheterization inserts a catheter into the heart.
• 3. Coronary bypass bypasses blocked arteries.
• 4. Angioplasty opens blocked arteries with a balloon.
• 5. Stents keep arteries open.
• 6. Stents are coated with heparin.
• 7. Open-heart surgery opens the chest.
• 8. Heart-lung bypass machine adds oxygen.
• 9. Heart is stopped during open-heart surgery.
• 10. Angiography detects stenosis.
• 11. Coronary bypass uses healthy blood vessels.
• 12. Angioplasty uses a balloon and stent.
• 13. Open-heart surgery repairs heart structures.
• 14. Angiography guides revascularization.
• 15. These procedures save lives.

Remember

• - Angiography = visualize blood vessels
• - Cardiac catheterization = catheter into heart
• - Coronary bypass = bypass blocked arteries
• - Angioplasty = balloon to open arteries
• - Stents = keep arteries open
• - Heparin = prevents clotting
• - Open-heart surgery = chest opened
• - Heart-lung bypass machine = adds oxygen
• - Angiography = detects stenosis
• - Coronary bypass = uses healthy blood vessels
• - Angioplasty = balloon and stent
• - Open-heart surgery = repairs heart structures

Common Mistakes

• 1. Confusing angiography and angioplasty — Angiography = diagnostic; angioplasty = treatment.
• 2. Thinking coronary bypass is non-surgical — Coronary bypass is surgical.
• 3. Forgetting the role of stents — Stents keep arteries open.
• 4. Mixing up the procedures — Angiography, coronary bypass, angioplasty, open-heart surgery.
• 5. Thinking open-heart surgery always opens the heart — The term "open" refers to the chest.
• 6. Forgetting the heart-lung bypass machine — It adds oxygen and keeps blood moving.
• 7. Confusing heparin and other coatings — Heparin prevents clotting.
• 8. Thinking angioplasty is always successful — The artery may not remain open.
• 9. Mixing up the uses of angiography — It evaluates valves, aorta, left ventricle.
• 10. Believing these procedures are risk-free — They have risks and complications.

Quick Revision

Diagnosis of cardiovascular disorders involves several procedures. Angiography visualizes blood vessels using contrast media and a catheter. Coronary bypass is a surgical procedure that uses healthy blood vessels from other parts of the body to bypass blocked coronary arteries. Angioplasty is a non-surgical procedure that uses a balloon to open blocked arteries; stents are placed to keep them open. Open-heart surgery involves opening the chest, stopping the heart, and using a heart-lung bypass machine to add oxygen and keep blood moving. These procedures help diagnose and treat cardiovascular disorders, saving lives and improving heart function.

60-Second Revision

• Angiography = visualize blood vessels
• Cardiac catheterization = catheter into heart
• Coronary bypass = bypass blocked arteries
• Angioplasty = balloon to open arteries
• Stents = keep arteries open
• Heparin = prevents clotting
• Open-heart surgery = chest opened
• Heart-lung bypass machine = adds oxygen
• Angiography = detects stenosis
• Coronary bypass = uses healthy blood vessels
• Angioplasty = balloon and stent
• Open-heart surgery = repairs heart structures

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