Heart (Cardiopulmonary) Services
As an academic medical center, University of Louisville Hospital offers heart care that never sleeps. Our staff is dedicated to providing the most advanced diagnostic and treatment services to our patients. We have physicians onsite 24 hours a day, seven days a week, along with operating rooms open day and night, should you need urgent or emergency cardiac care.
Cardiac Catheterization Lab
The Cardiac Catheterization Lab has an unsurpassed array of technology in an atmosphere specially created to meet the needs of both the patient and the cardiologist.
What is cardiac catheterization?
A cardiac catheterization is a procedure to examine blood flow to the heart and test how well the heart is pumping. A thin, plastic tube (catheter) is inserted into an artery or vein in the arm or leg. From there, it can be advanced into the chambers of the heart or into the coronary arteries.
This test can measure blood pressure within the heart and how much oxygen is in the blood. It is also used to get information about the pumping ability of the heart muscle. Catheters also are used to inject dye into the coronary arteries for a coronary angiography or coronary arteriography. Catheters with a balloon on the tip are used in coronary angioplasty (commonly referred to as percutaneous coronary intervention, or PCI).
The Chest Pain Center
The Chest Pain Center at UofL Hospital is designed to quickly provide the tests and diagnosis for patients that results in accurate, fast treatment. We also strive to educate patients on the risk factors associated with heart disease and the symptoms of a heart attack.
Patients who experience chest pain and have risk factors for heart disease, but whose ECG and labwork are inconclusive, are treated at the Chest Pain Center. This is a virtual observation unit, meaning patients stay in the same bed/area until undergoing a stress test to rule out a probable cardiac cause.
If the stress test comes back negative you will be allowed to go home to follow up with your physician.
Why do I need a cardiac stress test?
A stress test, sometimes called a treadmill test or exercise test, helps your doctor find out how well your heart handles work. As your body works harder during the test, it requires more fuel and your heart has to pump more blood. The test can show if there is a lack of blood supply through the arteries that go to the heart. Taking a stress test also helps your doctor know the kind and level of exercise that is right for you. The results of your stress test may help your doctor decide if you have heart disease, and if so, how severe it is.
What happens during the stress test?
- You are hooked up to equipment to monitor your heart
- You walk slowly in place on the treadmill
- It tilts so you feel like you are going up a small hill
- It changes speeds to make you walk faster
- You may be asked to breathe into a tube for a couple of minutes
- You can stop the test at any time if you need to
After slowing down for a few minutes, you will sit or lie down and your heart and blood pressure will be checked.
What is monitored during the cardiac stress test?
- Heart rate
- Blood pressure
- Electrocardiogram (ECG or EKG)
- How tired you feel
What equipment is used?
The electrocardiography machine will record your heartbeat and heart waves in an ECG. Wires, or electrodes, will be hooked up to your chest and arms or shoulders. The wires are connected to the ECG machine. Near the end, you might be asked to breathe into a mouthpiece that will measure how much air you breathe out.
Is there a risk?
There’s very little risk — no more than if you walked fast or jogged up a big hill. Medical professionals are on hand in case anything unusual happens during the test.
Patients who come to UofL Hospital for cardiac surgery are treated by a top group of cardiac surgeons. Recovery takes place in our Cardiac Services Unit, which is totally dedicated to cardiac care and staffed by a team of trained cardiac specialists. Our cardiac surgeons are experienced in performing a variety of open-heart procedures (described below).
Coronary Artery Bypass Graft (CABG)
Coronary Artery Bypass Graft (CABG) is a procedure in which one or more blocked coronary arteries are bypassed using a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins, located in the chest, leg or arm. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.
The goals of the procedure are to relieve symptoms of coronary artery disease (including angina, or pain) and enable the patient to resume a normal lifestyle and lower the risk of a heart attack or other heart problems.
Coronary artery bypass surgery is widely performed in the U.S. It is estimated that more than 800,000 coronary artery bypass graft surgeries are performed worldwide every year.
Ventricular Septal Defect
Ventricular septal defect, commonly known as a hole in the heart, is a hole in the wall or septum that separates the lower chambers or ventricles of the heart. This allows blood to flow from one ventricle to the other. Ventricular septal defect is a type of congenital heart disease, which means you are born with it.
Blood is pumped through your heart in only one direction. Heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like “doors” (called cusps or leaflets) at just the right time, then close tightly to prevent a backflow of blood.
There are four valves in the heart:
- Tricuspid valve
- Pulmonary valve
- Mitral valve
- Aortic valve
In the United States, surgeons perform about 99,000 heart valve operations each year. Nearly all of these operations are done to repair or replace the mitral or aortic valves. These valves are on the left side of the heart, which works harder than the right. They control the flow of oxygen-rich blood from the lungs to the rest of the body.
If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed.
What is valve replacement?
Severe valve damage means the valve will need to be replaced. Valve replacement is most often used to treat aortic valves and severely damaged mitral valves. It is also used to treat any valve disease that is life-threatening. Sometimes more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.
There are two kinds of valves used for valve replacement:
- Mechanical valves, which are usually made from materials such as plastic, carbon or metal. Mechanical valves are strong and last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines (called anticoagulants) for the rest of their lives.
- Biological valves, which are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes a patient’s own tissue can be used for valve replacement (called an autograft). Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.
You and your doctor will decide which type of valve is best for you.
What is valve repair?
Valve repair can usually be done on congenital valve defects (defects you are born with). Mitral valve defects are often successfully treated this way.
Some procedures surgeons may use to repair a valve:
- Commissurotomy, used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
- Valvuloplasty, which strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
- Reshaping, where the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
- Decalcification, which removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.
- Repair of structural support, which replaces or shortens the cords that give the valves support. (These cords are called the chordae tendineae and the papillary muscles.) When the cords are the right length, the valve can close properly.
- Patching, where the surgeon covers holes or tears in the leaflets with a tissue patch.
Interventional cardiology refers to various non-surgical procedures for treating cardiovascular disease. Interventional cardiologists use catheters – thin, flexible tubes – to get inside blood vessels for diagnostic tests or to repair damaged vessels or other heart structures, often avoiding the need for surgery.
What types of heart disease are treated with interventional cardiology?
Interventional cardiologists treat narrowed arteries and weakened heart valves – often caused by coronary artery disease, heart valve disease or peripheral vascular disease.
- Coronary artery disease is the narrowing of the coronary arteries, the tubes that supply the heart muscle with blood and oxygen. This narrowing of the arteries is caused byatherosclerosis, the buildup of fatty deposits, cholesterol, calcium and plaque on the arteries’ inner surfaces. Atherosclerosis restricts blood flow to the heart, which can lead to heart attack or other heart problems. Symptoms may include angina (intermittent chest pain), shortness of breath, sweating, nausea and/or weakness.
- Heart valve disease involves heart valves that are not working correctly to regulate the flow of blood through the heart chambers. This can be due to birth defects or damage by rheumatic fever, bacterial infection or heart attacks. Valves also can degenerate with the normal aging process. To compensate, your heart must pump harder and may be unable to supply adequate blood circulation to the rest of your body. Two common forms of heart valve disease are aortic valve stenosis and mitral valve regurgitation. Symptoms may include shortness of breath, chest pain, swelling of the ankles and legs, fatigue, dizziness and/or fainting.
- Peripheral vascular disease involves the other arteries that run throughout your body. Like the coronary arteries in your heart, these vessels can become clogged and hardened through atherosclerosis and increase your risk for high blood pressure, heart attack and stroke or limb loss. Symptoms may also include pain in the leg muscles (particularly calves and thighs) and/or severe aching pain in your toes or feet at night.
What types of procedures do interventional cardiologists perform?
Interventional cardiologists at UofL Hospital select one or a combination of procedures best-suited to each patient. Procedures include:
- Angioplasty and stenting: A long, slender tube is inserted through a blood vessel in the leg or wrist and guided to the heart or elsewhere in the body. A dye is injected through the arteries to guide the cardiologist during the stenting procedure. A balloon at the tip of the catheter is inflated to stretch open the artery and restore increased blood flow to the heart. In most cases, a small, metal mesh cylinder called a stent is then placed in the vessel to help keep it open.
- Atherectomy: Devices with tiny blades are sometimes used to cut away plaque deposits caused by atherosclerosis inside the blood vessel.
- Carotid stenting: Similarly, balloons and stents can be used to open the carotid arteries, the main blood vessels to the brain, and thereby lessen the risk of stroke.
- Embolic protection: In some cases, particularly when the treated area is in a bypass graft or the carotid arteries, filters and other specialized devices are used to help ensure pieces of the plaque do not break off and travel in the blood to cause damage.
- Percutaneous mitral valve repair: A catheter is introduced through a blood vessel in the leg and guided through a vein to the heart. Smaller catheters holding a special clip are guided into place and positioned near to, or actually attached to, the mitral valve to make it function properly. This is a very new treatment and we are one of just a few centers in the world participating in the clinical trials for this procedure.
Do you know how these controllable risk factors affect your risk of heart disease, stroke and metabolic syndrome?
- High blood pressure
- High cholesterol
- Being overweight or obese
- Physical inactivity
It is essential that you measure your risk of heart disease and plan how to prevent it in the future.
Symptoms and Warning Signs
If you think you are having a heart attack, call 9-1-1 immediately.
Some heart attacks are sudden and intense — the “movie heart attack,” where no one doubts what is happening. But most heart attacks start slowly with mild pain or discomfort. Often people affected are not sure what is wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
- Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
- Discomfort in other areas of the upper body: Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath: May occur with or without chest discomfort.
- Other signs: Breaking out in a cold sweat, nausea or lightheadedness
As with men, a woman’s most common heart attack symptom is chest pain or discomfort. But women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.
If you or someone you are with has chest discomfort, especially with one or more of the other signs, do not wait longer than a few minutes (no more than five) before calling for help. Get to a hospital right away.
We provide specialized, comprehensive treatments for vein, artery and circulation issues. Our expert team performs a full range of surgical and nonsurgical treatments, and their expertise can make the difference in your vascular care.
People with a vascular disease may or may not exhibit symptoms. For example, aneurysms rarely cause symptoms. However, there are other symptoms that should lead you to schedule an evaluation with our team. For instance, if you are experiencing pain, cramping or tiredness in your leg while exercising or walking stairs, you might have a peripheral artery disease.
Common Vascular Conditions
Our vascular specialists treat a wide range of conditions including:
- Aneurysms: Abnormal widening of a portion of an artery due to weakness in the blood vessel
- Peripheral artery disease (PAD): Narrowing or blockage of the vessels that supply blood to the legs
- Carotid artery disease (CAD): Narrowing or blockage of the vessels that supply blood to the brain
- Messenteric ischemia: Narrowing or blockage of the vessels that supply blood to the intestines
- Renovascular conditions: Narrowing or blockage of the vessels that supply blood to the kidneys
- Deep vein thrombosis (DVT): Blood clot that forms in a deep vein
Included in the vascular care provided at UofL Hospital are treatments for the aorta, the main artery in the human body that distributes oxygen-filled blood to all parts of the body and can require state-of-the-art treatment techniques.
If you are 50 or older with a history of smoking, high blood pressure or cholesterol, heart disease, stroke or diabetes - or a family history of cardiovascular disease - a vascular screening could be beneficial.