CABG

The CABG is also called the heart bypass or the coronary artery bypass graft surgery.   When the arteries of the heart are too narrow to supply adequate blood to the heart, a bypass around the narrow areas is performed, sometimes using a graft of vein or artery tissue.  The average cost of this surgery is $40000.  There are about 400000 of these surgeries every year.

The most common reason a CABG is done is for clogging of the coronary arteries.  This may have been detected by a stress test, during a coronary catheter procedure (heart cath), or in the setting of chest pain or a heart attack.

 

Angioplasty and Arterial Stent

Angioplasty

Angioplasty is a procedure used to open up arteries that are affected by atherosclerosis or plaque.   This is done to restore the blood supply and treat and prevent problems like heart attacks.  There are 500000 coronary angioplasties every year.  Atherectomy, a related procedure, is done to remove plaque from the wall of an artery.  The procedure costs about $20000.

Angioplasty is often done at the same time as placement of an arterial stent, especially for treatment of the coronary arteries.

 

Arterial stent

In some cases, a stent is used to hold an artery open.  This is most often used in the coronary (heart) arteries, but it is sometimes used in the aorta, the renal (kidney) arteries, the iliac (leg) or the cerebral arteries.  About 500000 stent procedures are done every year, and the cost of a stent placement is about $18000.  The stent itself is also expensive, and the cost of this varies depending on its size and its function.

 

Premature atrial contraction

Premature atrial contraction, or PAC, is also called premature atrial beat.  This is a common cause of the feeling of a “skipped heart beat”.  They are frequent events for people with normal healthy heart function and people with heart disease.  They generally cause no symptoms, although a skipped heart beat or “fluttering” sensation is a common symptom.

The PAC is diagnosed when the p wave (atria contraction) occurs earlier than expected on an EKG recording.  The premature beat sensation occurs when the ventricles contract afterwards (the QRS complex).

The PAC is not related to other atrial rhythm abnormalities.  These others include atrial flutter, atrial fibrillation, atrial tachycardia, atrial escape beat, and ectopic atrial rhythm.

Atrial fibrillation

Atrial fibrillation (a fib or sometimes AF) is a condition when the atria of the heart beat quickly, irregularly and out of sync with the ventricles.  On the EKG, there is no definite p wave.  The contraction of the ventricles may also be irregular (irregular R-R interval).  Irregular contraction of the atria can promote blood pooling and small blood clots, which can be a cause of stroke.  It can also affect the heart rate or cardiac output, leading to lightheadedness or difficulty breathing.

Atrial fibrillation can be managed in different ways.  The maximum heart rate can be governed by medications.   This is called rate control, and medicines like a calcium channel or beta receptor blocker may be used.  The electrical circuits within the atria can be disrupted (catheter ablation). Electrical shock can be used to reset the electrical timing (cardioversion).  Medications can be used to prevent blood clots and stroke (anticoagulation, with warfarin, apixaban, dabigatran, bivalirudin, etc.)

Atrial fibrillation is caused by changes in the electrical conduction circuit within the atria.  This can be related to age, high blood pressure, or coronary artery disease.  Changes in the valves of the heart can also cause atrial fibrillation.  These include mitral valve stenosis or regurgitation.  Heart failure and thickening of the heart can be related to atrial fibrillation.   Changes in the blood chemistry, such as high alcohol or low magnesium, caffeine and a history of diabetes mellitus are also associated with atrial fibrillation. 

Wolf Parkinson White

Wolf Parkinson White or WPW syndrome causes changes in the heartbeat.

In this condition, a fast heart rate is caused by a redundant circuit connecting the parts of the heart.  This acts like a short cut, stimulating the heart to beat too early.

The symptoms of WPW can include light headedness, fainting, exercise intolerance, anxiety or chest pain.  Sometimes a person with WPW has no symptoms at all.

WPW is normally present at birth.  It can be diagnosed by a heart rhythm test called an EKG.  The EKG finding is a short PR interval or delta wave, which looks like an upsloping curve in the QRS complex.

When WPW needs to be cured, a procedure called catheter ablation can help.  In this procedure, the electrical short cut is disrupted by a tiny burn or scar.

Heart beat abnormalities

Heart beat abnormalities

There are several conditions that change the rate or rhythm of the heartbeat.  These can cause a feeling of fluttering, trouble breathing, exercise intolerance, lightheadedness or dizziness, fainting or a feeling of faintness, exercise intolerance, chest pain or anxiety.

 

These are some examples of heart beat abnormalities:

 

Atrial fibrillation

Atrial flutter

Wolf Parkinson White syndrome

PVC

PAC

Multi focal atrial tachycardia (MAT)

Heart block

Bundle branch block (right and left)