Conditions and Diagnoses

Interventional cardiology refers to minimally invasive procedures that use catheters (thin, flexible tubes) and imaging technology to treat arterial and vascular conditions without the use of open surgery, including:

Coronary Artery Disease

Coronary arteries supply oxygen-rich blood to the heart muscle. Coronary artery disease results from atherosclerosis, a buildup of fatty deposits and plaque in the lining of a coronary artery, which narrows the artery and causes a decrease in blood flow to the heart muscle.

When a coronary artery suddenly becomes blocked and blood flow to an area of heart muscle stops, it is called a heart attack. A heart attack can permanently damage heart muscle and cause the affected area of the heart not to pump properly.

Common symptoms of coronary artery disease include shortness of breath and angina (pain or a feeling of increased pressure in the chest). Less common symptoms include nausea, sweating, fatigue, dizziness and decreased exercise tolerance.

In addition to diet, exercise, medication therapy and coronary artery bypass graft (CABG) surgery there are a number of minimally invasive procedures that can restore blood flow through a blocked coronary artery.

Learn about minimally invasive procedures to treat Coronary Artery Disease

Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), is a life- and limb-threatening condition that develops as a result of atherosclerosis, a buildup of fatty deposits and plaque in the lining of blood vessels. When plaque builds up in the blood vessels that carry blood from the heart to the rest of the body, they harden, narrow and clog, causing poor circulation. This diminished blood flow can result in a number of serious conditions, including leg ulcers or sores, infections and gangrene (death of soft tissue).

The most common symptom of PAD is leg pain that occurs when walking or exercising and improves with rest. Other symptoms include numbness and tingling in the lower legs and feet, cold lower extremities and decreased hair growth.

Because atherosclerosis is a systemic disease, it is common for people with PAD to have blocked arteries in other areas of the body. People who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also associated with diabetes and hypertension, among other conditions.

Learn about a minimally invasive procedure to treat Peripheral Arterial Disease.

Carotid Artery Disease

Much like the blockages that occur in the arteries of the heart and lower extremities, atherosclerosis can occur in the arteries that supply blood to the brain, also called the carotid arteries. These arteries originate from the aorta and travel up the neck and into the skull.

Blockages in the carotid arteries usually do not cause symptoms until a piece of atherosclerotic debris breaks off and makes its way into the brain, resulting in a stroke. Symptoms of a stroke include numbness, tingling, weakness and the inability to walk, talk or see clearly.

Learn about a Minimally Invasive Procedure to Treat Carotid Artery Disease.

Heart Valve Disease

Valves control the flow of blood into, through and out of the heart. In valve disease, the valve may narrow (stenosis), which can reduce blood flow, or leak (regurgitation), which can allow blood to flow backward though the valve. Common causes of valve disease include congenital heart conditions (present from birth), rheumatic fever (often associated with untreated strep throat or scarlet fever), the formation of calcium deposits around the valve, atherosclerosis (narrowing of the arteries) and endocarditis (inflammation of the heart valves and inner lining).

Symptoms vary depending on which valve is affected, but common symptoms include:

• Weakness or chest pain (often increasing with activity)
• Palpitations (rapid, noticeable heart beats)
• Shortness of breath
• Fatigue
• Swelling of the feet or ankles
• Fainting

Learn about a Minimally Invasive Procedure to Repair a Damaged Heart Valve.

Learn about a Minimally Invasive Procedure to Replace a Damaged or Diseased Aortic Valve.

Hypertension (High Blood Pressure)

Hypertension or high blood pressure occurs when the blood flows with too much force through the arteries, stretching the arteries beyond a healthy limit and causing microscopic tears. Though the body naturally repairs these tears with scar tissue that tissue also traps plaque and white blood cells, which can turn into blockages, blood clots, and hardened, weakened arteries. These effects in turn prevent blood flow and cause heart tissue to die, causing further severe conditions such as stroke, heart attack, kidney failure, and heart failure.

Blood pressure measures the force pushing against your arterial walls. A blood pressure reading consists of two numbers, systolic and diastolic. The systolic blood pressure is usually the higher number on the top that shows the pressure on the arteries when the heart is beating or contracting. This usually increases as you get older, but is given more attention as it can be major risk factor for heart disease for those 50 years and over. Diastolic blood pressure is the lower number at the bottom that measures the pressure on the arteries between heart beats or when the heart is resting.

A normal level of blood pressure is less than 120 mm Hg systolic AND less than 80 mm Hg diastolic, so less than 120/80 mm Hg, for ages 20 and over.

Congenital Heart Disease (Septal Defects and Patent Foramen Ovales)

Septal Defects
The left and right side of the heart are separated by a wall called the septum. Some people are born with a hole in either the upper septum (atrial septal defect) or the lower septum (ventricular septal defect). When these defects are present, oxygen-rich blood from the lungs may mix with oxygen-poor blood returning from the body. Common symptoms of a ventricular defect may include shortness of breath, hard or fast breathing and frequent respiratory infections. Common symptoms of an atrial defect may include difficulty breathing, shortness of breath with activity, heart palpitations (rapid, noticeable heart beats) and frequent respiratory infections.

Patent Foramen Ovales
Foramen ovales are holes in the heart needed before birth to transfer oxygenated blood from the umbilical cord to the unborn child, bypassing the lungs, which are not used by the fetus. Soon after birth, this hole generally closes, but in about 20% of people, it does not close completely. This remaining opening is called a patent foramen ovale (PFO). Many PFOs are relatively small and do not cause significant problems, but in some people, the opening is larger and can provide a pathway for blood clots to more easily reach the brain and cause a stroke. In these cases, treatment may be necessary to correct the defect.

Coronary Microvascular Disease (MVD)

What is Coronary Microvascular Disease?
MVD, also known as small vessel disease or microangiopathy, is a type of coronary heart disease that is affects the very small arteries, the arterioles and capillaries. The walls of the heart’s smallest arteries are damaged and/or diseased.

Symptoms
Women are more likely to be diagnosed with coronary MVD than men and it appears to be linked to a drop in estrogen levels during menopause alongside traditional cardiovascular risk factors such as diabetes. Patients who have chest pain and other symptoms of heart disease without coronary obstructions many times have MVD. Because of the atypical presentation of the disease, it is often hard to diagnose and therefore many patients who have MVD are undiagnosed and are not seeking treatment for the disease.

Diagnosing MVD
A stress test is the first diagnostic test used to detect MVD. If the test shows an abnormality, patients may undergo a cardiac catheterization. If there is no coronary obstruction, physicians will perform a flow study to see if the blood flow that feeds into the tiny heart vessels are narrowed or not dilating enough to provide adequate blood flow to the heart.

Treatments
Research is being done to study this disease and learn more about how heart disease is affected by hormonal changes. In addition, researchers are searching for the most effective ways of treating patients with this disease. Currently, medical management is the best way to treat MVD because surgery and angioplasty are not effective.  Physicians also work with the patient to develop healthy habits that will help reduce the underlying conditions that contribute to MVD. Maintaining a heart healthy diet, exercise, stopping smoking, maintaining a healthy cholesterol level, eating a low sodium diet and reducing stress in your life are all ways to reduce the risk factors for the disease.

Physician Team
A skilled team of physicians and staff at the Emory Heart & Vascular Center are leaders in the treatment of MVD.

Watch Joan Jahnke’s story of living with MVD.