A Typical Patient's Journey: Coronary Artery Disease
| Diagnosis and Treatment of Coronary Artery Disease We treat coronary artery disease several ways at DHMC. Some treatments are non-surgical:
Other treatments are procedures:
CABG is the surgical bypassing of blocked heart blood vessels. CABG is performed by a cardiothoracic surgeon. A cardiothoracic surgeon is a doctor that has had special training in surgery on the heart, veins, arteries, and lungs. Angioplasty, or PCI, is the placing of an inflatable balloon and/or placement of a small mesh tube, or stent, into the heart artery to improve or restore blood flow. Interventional cardiologists perform PCI. An interventional cardiologist is a doctor who has had special training in doing procedures to the cardiovascular system (heart, veins, and arteries). Sometimes, PCI is also called PTCA, which stands for percutaneous transluminal coronary angioplasty. The diagram describes what happens for most patients who have CABG or PCI. Click on each box in the figure to find out more about that step in the journey.
Patient's coronary artery disease assessed with cardiac catheterization. Patients with coronary artery disease come to DHMC for evaluation and treatment in cardiology.
Cardiologists at DHMC review the patient's medical history and symptoms, as well as any diagnostic and lab tests. As needed, more tests are ordered such as an electrocardiogram (sometimes called an ECG or EKG), echocardiogram (sometimes called an echo), or a stress test. The cardiologist and patient talk about cardiac risk factors (such as smoking, cholesterol level, family history, etc). They talk about different ways the patient can reduce their risk of having cardiac problems in the future (such as quitting smoking). One key way that doctors can tell the extent of the patient's heart disease is by performing a cardiac catheterization (sometimes called a cath). Cardiac catheterization is a procedure where the cardiologist puts a small flexible tube (called a catheter) into a tiny cut in an artery, usually in the leg. They move the catheter through the artery to the heart and put in contrast dye. The dye lets the cardiologist to see the blood vessels with a series of x-rays. Numbing medication is used where the catheter is put in. The doctor or nurse gives the patient medication to help them relax, which may make the patient feel drowsy. At DHMC, cardiac catheterizations are done in the catheterization lab (sometimes called the cath lab). The cath lab is open 24 hours a day. The staff can take care of patients who come to DHMC at all times during the day and night. The doctors use the results of the cardiac catheterization to help determine the recommended treatment for coronary heart disease. Decide on treatment. The cardiologist, patient, and family talk about the different ways to treat the patient's heart problem. If the cardiac catheterization shows abnormal results, the patient may need treatment right away. Together the patient and cardiologist choose the treatment that is best for the patient. Each treatment choice has risks and benefits, some due to the patient's health status. Usually there are three choices to treat heart disease. At times a combination is chosen.
PCI (Percutaneous Coronary Intervention)
Patient has PCI The cardiologist and the cardiothoracic surgeon talk about the cardiac catheterization and recommend the best course of treatment. The health of the patient and extensiveness of the coronary artery disease decides how soon the patient has the PCI.
In most cases the PCI takes place in the DHMC catheterization lab (sometimes called the cath lab). The cath lab is open 24 hours a day so that the staff can take care of patients who come to DHMC at all times during the day and night. Post-procedure hospital stay & discharge. Many patients generally stay overnight in the hospital after they have their procedure especially if the patient has severe coronary artery disease. Some patients have medical conditions that make them good candidates for referral to cardiac rehabilitation services. This program includes exercise and education to prevent further heart problems. Routine care with primary care team. It is important for the patient to have routine care with their regular doctor. Their doctor checks medication and any heart symptoms. The cardiologist is also part of the patient's medical care after a PCI. After a patient has PCI, they should have a follow-up visit with a cardiologist, either at DHMC or in their local community.
Patient has CABG surgery. The cardiologist and the cardiothoracic surgeon talk about the cardiac catheterization and recommend the best course of treatment. The health of the patient and extensiveness of the coronary artery disease decides how soon the patient has the CABG surgery.
Patients who are recommended for CABG surgery speak with their family and the cardiothoracic surgeon to talk about the risks and benefits of surgery. Sometimes additional tests are needed before surgery. Any tests are scheduled during this visit. A tool that cardiothoracic surgeons have available to help talk with patients about the risks of surgery is a "risk calculator." The calculator helps the doctor know how likely it is that certain complications will occur from having CABG surgery, such as death, stroke, and heart failure. Each patient gets a score that is based on characteristics such as age, gender, how urgent the surgery is, and some additional health characteristics. Once the patient is ready for surgery, they are moved to the operating room and the anesthesiologist gives them anesthesia so that the patient will be asleep and pain free for the operation. The surgery team includes:
Post-surgery hospital stay & discharge. After surgery, the recovery (usually one day) starts in cardiovascular critical care (CVCC). Then the patient is moved to a cardiac unit, called the intermediate cardiac care unit (ICCU). On average, patients are discharged 7 days after their surgery. When patients are discharged, they go home and get help from the visiting nurse association (VNA), or go to stay for a short time at a rehabilitation center. Some patients have medical conditions that make them good candidates for referral to cardiac rehabilitation services. This program includes exercise and education to prevent further heart problems. Post-operative follow-up visit with cardiothoracic specialist. Patient comes to the cardiothoracic clinic about 4 weeks for a post-operative visit. The doctor may change the follow-up treatment plan, depending on how the patient is doing. Routine care with primary care team. It is important for the patient to have routine care with their regular doctor. Their doctor checks medication and any heart symptoms. The cardiologist and cardiothoracic surgeon is also part of the patient's medical care after CABG surgery. After a patient has surgery, they should have a follow-up visit with a cardiologist, either at DHMC or in their local community. The cardiologist or surgeon will make sure all information about the patient's heart condition is given to their regular doctor.
Patient is treated with medication. Some patients will be able to use medication and lifestyle changes to treat their coronary artery disease. Medications
Lifestyle
Routine care with primary care team. The patient will continue to manage and treat their heart disease with regular visits with their primary care team and occasionally, a cardiologist. | Make an Appointment
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