The test to detect the presence of coronary artery disease is called “coronary angiography.” It is most commonly referred to as a cardiac catheterisation.
The two terms are used interchangeably.
The procedure is performed under local anaesthetic and involves inserting a short plastic
tube with a one way valve called a sheath into an artery in the groin, wrist or elbow. Your doctor will select the site usually the right groin.
Through the sheath, thin flexible hollow tubes called catheters are threaded over a guide wire and positioned under X-ray in the heart and/or coronary arteries.
A liquid contrast (X-ray dye) is injected through the catheter and X-ray video pictures are taken. The test reveals if any of the coronary arteries are narrowed or blocked by plaque (fatty) deposits. At the same time the pumping chamber and valves on the left side of the heart are examined for any abnormalities.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

PTCA involves opening a narrowed or blocked segment of coronary artery by insertion of a small balloon catheter via the femoral artery in the groin (or occasionally the brachial artery located in the arm). This is performed under sedation and local anaesthetic.
A fine guidewire is introduced through a guide into the coronary artery. A balloon catheter is then inserted over the wire and positioned across the narrowed / blocked segment. The balloon is then inflated. This procedure opens the narrowed artery by compressing the fatty material (plaque) against the wall of the artery and restores blood flow to the area of the heart previously deprived by the narrowed or occluded artery.
It is not uncommon to experience some angina during inflation of the balloon as the coronary artery is temporarily occluded and the heart muscle is deprived of oxygen.
This only lasts for a very brief period of time and resolves as soon as the balloon is deflated.
At the same time a stent may be placed in the coronary artery. A stent is a small stainless steel mesh tube that supports the coronaryartery and maintains patency.

Understanding How the Heart Works:

The heart consists of 4 chambers. The upper two chambers (atria) fill the lower chambers ventricles) which pump blood to the lungs and body. The heart’s natural ‘beat’, the sino-atrial (SA) node, is located in the right atria. In order for the heart to beat, this node sends regular impulses to the atria and stimulates the atria to contract and empty blood into the ventricles. The impulse then continues down a pathway to the atrio-ventricular (AV) node where the impulses spread down the ventricles causing the ventricles to contract and pump blood to the lungs and body.

What is a Permanent Pacemaker:

A permanent pacemaker is required when there is a disturbance in the heart’s ability to transmit electrical impulses. This may result in the heart beating too slow and / or too fast or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fatigue, fainting spells or shortness of breath.
A permanent pacemaker delivers electrical impulses to the heart via one or two flexible insulated wires to restore normal function and rhythm.
In brief, the Doctor will inject local anaesthetic into the chest wall. A small pocket will be made under the skin and the electrodes (wires) are introduced into the right side of the heart via a vein. The electrodes are positioned under x-ray and tested. The pacemaker is then attached and the skin is sealed with dissolvable stitches.

The Heart's Electrical System

In order for the heart to beat and pump blood to the lungs and the body, the heart is dependent on precise electrical signals that originate from specific areas in the heart. These electrical signals originate from the Sino-Atrial (SA) node ( the heart’s ‘pacemaker’ ) and stimulate the atria to contract and empty blood into the ventricles. The impulse then travels along a pathway to the Atrio-Ventricular node where the impulses then spread down specialised conduction fibres in the ventricles. These electrical impulses cause the ventricles to contract thus pumping blood to the lungs and body.

The purpose of an Electrophysiology Study is to examine the electrical system of the heart, to produce and analyze the mechanism of abnormal heart rhythms and to evaluate the effect of drug therapy.
In brief, the Doctor will inject local anaesthetic into the skin in the groin area (and occasionally in the arm). Once the skin has been anaesthetised small tubes are placed in the vein. Electrode catheters will be inserted with minimal discomfort and positioned at specific locations in the heart. The electrical system of the right heart is stimulated (paced), recorded and the information is then analyzed. This information will enable your Cardiologist to diagnose the abnormality and choose the appropriate treatment.

Conduction Abnormalities

When there is a disturbance in the heart’s ability to transmit electrical impulses or these impulses are blocked, this may result in the heart beating too slowly, too fast or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fainting spells or palpitations.

Your Cardiologist has recommended you have an ICD inserted, your ICD acts as a pacemaker but also has the ability to deliver shock to your heart to terminate life threatening heart rhythms with a brief period of rapid pacing or a shock.
An ICD is required when there is a disturbance in the hearts ability to transmit electrical impulses. This results in the heart beating too slow or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fatigue or generally feeling unwell.
Tour ICD acts as a pacemaker but also has the ability to deliver a shock to your heart to terminate life threatening heart rhythms.
The Anaesthetist will give you a general anaesthetic for the entire procedure so any shocks delivered during testing of the device will not be felt.

Your Doctor has recommended that you have your pacemaker and or previously inserted pacing leads removed. There are a number of reasons why you may have to undergo this procedure but the most common indication is due to an infection. Your Doctor will discuss with you the specific reasons for undergoing this procedure.
This procedure requires a general anaesthetic.
The Cardiologist will re-open the site where your pacemaker was originally placed & remove the generator. Depending on how long your pacemaker has been in, it may take some time.
If the leads are being extracted due to infection then it may be necessary to insert temporary pacing wires until the infection has cleared.
When you wake you may have a bulky dressing in place, this will say on for 24hours to prevent bleeding and swelling. The thin dressing beneath this will be removed when specified by the cardiologist.
You should not move your arm above your shoulder for 2 weeks (or as advised by your Cardiologist)

PFO or ASD is an abnormal communication (hole) between the two top chambers (atria) of the heart.
This can cause an abnormal rhythm and shortness of breath and may cause a clot to form in the eye.
The Cardiologist will inject local anaesthetic into the groin. A fine guide wire is introduced, via the groin, into the hole between the two top chambers of the heart.
A device called the Patent Foramen Ovale /Atrial Septial Defect is then inserted over the wire and placed between the two chambers to occlude the hole. The guide wire is then removed through the groin. An Echo-cardiogram is then performed to check the position of the PFA/ASD device.

Cardiac Valves

Cardiac valves allow blood to flow in one direction through the heart from the atria to the ventricles and from the ventricles to the major blood vessels and organs. When these valves become narrowed (stenotic) it causes an obstruction to blood flow.
As a result, one can experience symptoms such as fatigue, shortness of breath, cough, dizziness and fainting and angina. These symptoms may be alleviated with restoration of valve function following a balloon valvuloplasty.

Balloon Valvuloplasty

A balloon valvuloplasty is performed when a valve in the heart (mitral, aortic, pulmonary or tricuspid) becomes rigid and narrowed preventing normal function of the valve. This requires insertion of a balloon across the valve to split the valve open thus re-establishing function. In brief, you will be given sedation prior to the procedure and the Doctor will inject local anaesthetic into the skin in the groin area. Once the skin has been anaesthetised small tubes are placed in the artery and vein. A balloon is inserted over a guidewire across a narrowed valve When this balloon is inflated it splits the valve leaflets. Measurements are taken before and after the procedure in order to calculate the degree of narrowing across the valve and to gauge the success of the procedure.

PTRA is a procedure that is performed under sedation and local anaesthetic. A small catheter is inserted via the femoral artery in the groin ( or occasionally the brachial artery in the arm) and guided to the renal artery. Dye is injected and the x-ray pictures taken that show whether there is any narrowing of the artery.
For renal angioplasty a fine guidewire is introduced into the renal artery. A balloon is then inserted over the wire and positioned across the narrow area. The balloon is the inflated. This procedure opens the narrowed artery by compressing the fatty material (plaque) against the wall of the artery and restarts blood flow to the area of the kidney, previously deprived by the narrow or occluded artery. At the same time, a stent may be placed in the artery. A stent is a small stainless steel mesh tube that supports the renal artery and maintains patency.

Radiofrequency ablation is a treatment that uses electrical energy to destroy tissues in the heart that are causing rhythm disturbances.
This procedure may be performed under a local or general anaesthetic. Your Doctor will advise you which one best suits your needs.
A small incision is made in the groin. A special RFA catheter is inserted into the vein and guided up to the heart using x-ray screening.
With catheters in place, recordings of the heart’s electrical activity can be made from inside the heart and the tissues that are responsible for the rhythm disturbance can be located.
Once the Doctor finds the specific origin of the abnormal heart beat, the RFA catheter will ablate (or burn) that area. This means a scar forms in that area and stops the abnormal heart rhythm occurring.