Coronary Artery Disease

Coronary artery disease, a narrowing of the arteries that supply blood and oxygen to the heart, is the leading cause of death in the United States for both men and women. While men in their 40s have a higher risk of coronary artery disease than women, as women get older (especially after they reach menopause), their risk increases to almost equal that of a man's risk.

At Methodist Hospitals, a number of techniques are used to diagnose and treat coronary artery disease.

Diagnosis

Many factors come into play in diagnosing diseases and conditions of the heart. Using top-of-the-line technologies, patients receive comprehensive examinations in order to confirm diagnoses and evaluate the progression of the disease.

Electrocardiogram

Commonly known as an EKG, this painless, brief test records the electrical activity of the heart. A wave pattern of electrical signals is measured and recorded on paper to show normal functioning or irregularities that can indicate an abnormal heart rhythm, strain or damage to the heart. Among the types of EKGs offered at Methodist are 24-hour Holter monitoring, where a portable heart monitor is worn through the day.

Stress Tests

Methodist Hospitals provides a full range of stress tests to help us observe, measure and record the heart's response to different kinds and levels of activity. Performed under the close supervision of a specially trained member of our Cardiology team, walking stress tests monitor how the heart reacts to increased activity.

Non-walking stress tests are performed on patients who are unable to walk on a treadmill in order to learn their heart's response to an increased workload. In these tests, medication is injected via an I.V. to simulate the effects of exercise on the heart. As with walking stress tests, ten electrodes are attached to the patient’s chest using small adhesive pads. Throughout the test, electrocardiogram (EKG) and blood pressure will be monitored.

Nuclear perfusion imaging uses a small dose of radioactive tracer and a gamma camera to visualize the movement of blood through the heart and are used in conjunction with walking and non-walking stress tests.

Echocardiography

Methodist Hospitals uses echocardiography to diagnose and manage numerous forms of heart disease, check heart valves, and track heart conditions.

Echocardiogram
In an echocardiogram, a transducer placed against the chest uses sound waves to create pictures of the heart. The pictures are displayed on a TV monitor and recorded on both CD and paper for a permanent record. Doppler studies use the same transducer to examine blood flow through the heart and obtain more valve function information.

Transesophogeal Echocardiogram (TEE)
Methodist Hospitals uses TEE studies to investigate heart valves or check for blood clots in the heart prior to interventional procedures or during surgery to monitor patients who have existing heart problems.

 
64-Slice Cardiac CT

64-Slice CT angiography allows physicians to view even the smallest of arteries in the brain, heart, and peripheral vascular system in a fraction of the time required in traditional angiography. This technology aids in the diagnosis of coronary artery disease, to distinguish among life-threatening possible causes of chest pain and the rapid assessment of stroke patients.
 

 Minimally Invasive Treatments 

Our highly skilled, compassionate doctors use the latest techniques and technologies with a goal of returning each patient to an active, full life. Methodist Hospitals’ experienced cardiac team works together to develop an individualized treatment plan that meet patients’ specific needs.

Cardiac Catheterization Laboratory

When a doctor suspects a condition such as blockages or valve leaks, the specialists in Methodist's state-of-the-art Cardiac Catheterization Labs can obtain important diagnostic information. Many minimally invasive procedures, including coronary angiography, angioplasty, stent insertion and atherectomy are also performed in our Cath Lab. With five labs between two campuses, our patients have access to top-of-the-line care when they need it the most.

At Methodist, our state of the art cath labs offer the following services:

Cardiac Catheterization/Coronary Angiography

A safe, radiographic dye is injected into the coronary arteries via a catheter, enabling the doctor to see the blood flow through the arteries. This diagnostic study observes the heart's pumping function to see if it is receiving adequate blood supply.

Angioplasty, Stents and Atherectomy

Methodist Hospitals uses these catheter-based techniques to open plaque-filled vessels in patients who have coronary artery disease. Our interventional cardiologists combine a high level of expertise with specialized tools and new medications to optimize results.

Trans Radial Angiogram
This technology allows cardiologists to perform an angiogram through the wrist's small, radial artery instead of the groin. With this treatment, post-procedure bleeding risks and reduced, and patients are up and around soon after the procedure, instead of required prolonged bed rest.

Balloon Angioplasty
In this procedure, the doctor inserts a catheter into a blocked or narrowed artery. A tiny balloon at the tip of the catheter is inflated to push plaque against the artery's walls, widening the path for blood flow.

Stents
Stents are small steel mesh tubes placed inside of arteries to keep them open and maintain blood flow. They are used during more than 70 percent of angioplasty procedures. Methodist also uses innovative, drug-eluting stents which are coated or medicated stents that can reduce scar tissue. Less scar tissue reduces the chance for restenosis, or renarrowing of the artery.

Atherectomy
Atherectomies remove plaque from inside of an artery. In rotational atherectomy, the tip of a catheter is fitted with a rotating blade shaves plaque into tiny pieces that can be carried away. With directional atherectomy, a small cutting device is used to cut plaque away from the artery. 

 

Optical Coherence Tomography 

Optical Coherence Tomography (OCT) is a new imaging technology platform that aids physicians in the diagnosis and treatment of cardiovascular disease. The system allows cardiologists to see inside human heart arteries using a high resolution camera and a light source. The system assists the cardiologist in stent selection and placement by providing precise measurements of lesion dimensions and coronary artery size and structure. The system also provides the cardiologist with information to potentially minimize the risk of coronary vessel renarrowing and to guide follow-up treatment.

Surgery

When surgery is indicated, Methodist Hospitals has the talented team and the full range of technology to provide excellent care. Our goal is always to return patients to healthy, productive lives using the least invasive procedures necessary. Our experienced, caring cardiac specialists consider a patient’s medical history, progression of their heart disease and other pertinent factors in determining the best treatment.

Valve Replacement & Repair (Open Heart Surgery)

Having one or more diseased heart valves can cause problems that are correctable by valve replacement or repair surgery. Stenotic or stiff valves make the heart muscle work harder. A leaky or insufficient valve causes blood to leak backwards, meaning less blood is pumped in the right direction. Traditionally, valve replacement or repair has been performed with open heart surgery.

When it best serves the patient, our cardiovascular team will use newer, less invasive techniques.

Coronary Artery Bypass Surgery

In patients with ischemic heart disease or coronary artery disease, the coronary arteries that supply the heart with the oxygen and nutrients from the blood have become partly or totally blocked. Sometimes medications and/or cardiac rehabilitation can successfully treat this condition. Depending upon the individual, bypass surgery may be the answer.

For bypass surgery, the chest is opened and a vein or artery is taken from another part of the body to create a detour around the blocked area. Generally, the patient is connected to a heart-lung bypass machine to do the work of the heart during the procedure. In some cases, called off-pump coronary artery bypass (OPCAB), the bypass is created while the heart continues its work.

Minimally Invasive Coronary Artery Bypass Surgery

Sometimes only one or two coronary arteries need a bypass. If they are located near the front of the heart, the surgeon may opt to perform a minimally invasive coronary artery bypass.

In this less invasive procedure, the doctor accesses the heart between the ribs by making a three- to five-inch incision in the left part of the chest. The surgeon locates and prepares an artery in the chest to attach to the blocked coronary artery.
 

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