Managing heart disease

Treatment for heart disease can include lifestyle changes, medications, and procedures or surgeries. Depending on your specific type of heart disease, your doctor may recommend procedures and surgeries such as heart bypass, angioplasty, pacemaker or defibrillator implantation, heart valve surgery, or heart transplant.

Coronary artery bypass graft (CABG) is a surgical procedure performed under a general anesthetic that improves the blood supply to the heart. It is also referred to as "bypass surgery" and "cabbage" (a pronunciation of "CABG"). With CABG, a portion of blood vessel is taken from another part of your body (usually your leg) and is surgically attached to go around the part of a blocked blood vessel that supplies the heart.

Angioplasty and stent, now more commonly referred to as percutaneous coronary intervention (PCI), involves inserting a catheter (a thin flexible tube) with a balloon and stent on the end. The catheter is usually inserted into a blood vessel in your arm or leg and guided up to where a coronary artery is narrowed by plague. Once in place, the balloon inflates to open the artery, the stent (mesh tubing) is left in the artery to keep it open, and the catheter is removed. PCI helps to improve blood flow to the heart.

Ablation is a procedure used to treat abnormal heart rhythms or arrhythmias. During this procedure, abnormal heart tissue that is causing an arrhythmia is destroyed. Most ablations are performed by inserting a catheter into the heart. First, the exact cause of the abnormal heart rhythm will be located, and then another catheter will be inserted that will destroy the abnormal tissue with electrical energy. Scar tissue will form where the tissue was destroyed, stopping the abnormal tissue from causing the arrhythmia. In some situations, although less commonly, ablation is done surgically. With the Cox-Maze procedure, small incisions are made in the areas of the heart that are producing the abnormal heart rhythm. The incisions are stitched up and scar tissue forms where the incisions are made, stopping the abnormal heart rhythm. Newer methods of surgical ablation do not require incisions to be made.

Pacemakers are implanted when abnormal heart rhythms have not responded to medication. Pacemakers are computerized devices that generate electrical impulses and send them to the heart muscle through "leads" (wires). For most people, the leads are attached to the inside lining of the heart via a thin catheter and the pacemaker is inserted just under the skin of your chest or abdomen. Some people have the leads attached directly on the surface of the heart through a surgical incision.

Implantable cardioverter defibrillators (ICDs) are similar to pacemakers but are used to control dangerously slow or fast heart rates that can lead to sudden death or cardiac arrest. ICDs monitor how the heart is beating and deliver electrical impulses when needed to stop an abnormal heart rhythm. ICDs have leads and a computerized device and can be implanted through a vein or surgically.

Heart valve replacements or repairs are surgical procedures used to repair or replace a heart valve that isn't working like it should be. For a heart valve replacement, you may receive a mechanical valve (made of metals, ceramics, or plastics) or a biological valve (animal or human). Most surgery of this type is performed through a large incision in the chest. Sometimes, the surgery can be performed endoscopically (using long, flexible surgical instruments that are inserted through small incisions in skin). Some types of valve repair can be performed by inserting a catheter through a blood vessel and threading it to the heart valve. How your surgery is done will depend on the type of surgery you need.

Heart transplants are reserved for severe cases of heart failure. During a heart transplant, most of the diseased heart is removed and replaced with a donor heart.