Procedures

Holter monitoring
Holter monitoring is a painless way to record your heartbeat away from the doctor’s office. You can carry this small electrocardiogram (ECG) device with you to record your heartbeat for your doctor to later review. You can receive your heart monitor in a hospital, test center, or doctor’s office.

Your holter monitor
When you receive a Holter monitor, small, painless electrode pads are put on your chest. These connect to the lightweight unit, which attaches to a belt or shoulder strap. You need to keep the device on for at least 24 hours and complete a diary provided.

While wearing the monitor:

• Strengthen your heart after a cardiac event or surgery
• Relieve common cardiac symptoms, such as chest pain
• Build healthier habits and increase your energy

Stress test
Also called a stress electrocardiogram (ECG/EKG), an exercise stress test simply shows your heart’s response to exercise. The stress test records your heartbeat while you walk on a treadmill or ride a stationary bike. This test can be performed in a hospital, test center, or doctor’s office.

Before your test  

• Mention all medications you take, and ask whether it’s okay to take them before your test.
• Don’t eat, drink, smoke or have any caffeine for 3 hours before the test.
• Wear flat, comfortable walking shoes.
• Wear a shirt, blouse or sweater you can remove easily. You may be asked to remove your clothing from the waist up. Women will be given a gown.

During your test
Small electrode pads will be placed on your upper body and a blood pressure cuff is placed on your arm. These will monitor your heartbeat and blood pressure during and after the test. You will be shown how to use the treadmill or exercise bike, then asked to exercise for several minutes. Expect the exercise to be easy at first, and slowly get harder. Exercise for as long as you can, or until you’re asked to stop.

Tell your health care provider if you feel any of the following symptoms:

• Chest, arm, or jaw discomfort
• Severe shortness of breath
• Fatigue
• Dizziness
• Leg cramps or soreness

After the test
You can resume your normal activity. The results will be sent to your doctor. Be sure to keep your follow-up appointment.

Our Board-Certified Interventional Cardiologist Rafael Valencia M.D., F.A.C.C., has access to the world’s first FDA-approved dissolving heart stent. The Absorb Bioresorbable Vascular Scaffold is a major advancement in the treatment of coronary artery disease, which affects 15 million people in the United States. Despite decades of therapeutic advances, coronary artery disease remains a leading cause of death worldwide. We’re excited to offer this novel technology as a great addition to the treatment options we provide for our patients’ health and wellbeing.

If you have a blocked artery, your doctor may need to open the blockage and restore blood flow with a small mesh tube called a stent. The stent is placed in your artery during an angioplasty procedure. Angioplasty is called a procedure – not a surgery – since the doctor makes only very small cuts in the skin. Stents play a vital role in supporting the vessel during the first three months after a blocked artery has been opened. After that time, the artery can remain open on its own. Using the Absorb Bioresorbable Stent instead of the previously common metal stent allows the stent to simply dissolve when it is no longer needed – leaving nothing behind but a natural vessel.

To learn more about this procedure, please contact our office to schedule a consultation.

Known as the “silent killer,” Abdominal Aortic Aneurysms (AAA) affect an estimated 1.2 million people in the United States. This condition creates a bulge that weakens the aorta. Early detection is key in preventing rupture, or even death. New, advanced technologies have vastly improved patient care in this area.

NEVADA HEART AND VASCULAR CENTER CARDIOLOGISTS PARTICIPATE IN TRANSCATHETER HEART VALVE IMPACT

Our Board Certified Interventional Cardiologists Branavan Umakanthan D.O., F.A.C.C,. F.S.C.A.I., and Rafael Valencia M.D., F.A.C.C., participated in the first SAPIEN 3 Transcatheter Heart Valve (THV) implantation. It was the first percutaneous as well as the first Edwards SAPIEN 3 THV implanted in Southern Nevada. The surgery was performed at The Heart Center at Sunrise Hospital and Medical Center. (we should probably give this a date, example: “in July of 2024”)

The SAPIEN 3 THV is approved for patients who are inoperable or at high risk for death or complications during open-heart surgery. This is especially helpful for patients with a narrowing in the heart’s aortic value, called aortic valve stenosis. The SAPIEN 3 THV can assist in correcting the blood flow problem associated with aortic stenosis in patients who need open-heart surgery to replace the diseased valve, or those considered by their doctors to be at high risk.

The new valve design uses a smaller sheath, so the hole in the artery is smaller and no incision into the femoral artery is needed. This allows for much more infrequent leakage through and around the heart valve, as well as a greatly reduced procedure and recovery time.
Heart valve patients are normally hospitalized for about seven days. Using the SAPIEN 3, the patient was discharged the next day.

To learn more about this procedure, please contact our office to schedule a consultation.

Cardiac ablation procedures
An arrhythmia is a heart rhythm problem, causing your heart to beat too fast. The problem is often caused by cells in your heart that aren’t working as they should. This can cause bothersome symptoms, such as an irregular heartbeat, dizziness, and shortness of breath. The catheter ablation procedure destroys the cells that are causing the problem.

Before the procedure
You will meet with a specially trained heart doctor called an electrophysiologist, who will perform the procedure. Your doctor will give instructions on how to prepare. You will likely be told to stop taking all heart rhythm medications for a few days before the procedure. Be sure to follow all your doctor’s instructions. Also:

• Tell the doctor about all prescription and over-the-counter medications you take. This includes herbs, supplements, and vitamins. It also includes daily medications such as insulin or blood thinners.
• Tell the doctor any medications you are allergic to.
• Have any routine tests, such as blood tests, as recommended.
• Don’t eat or drink anything 12 hours before the procedure.

The procedure
Catheter ablation uses thin, flexible wires called electrode catheters to find and destroy (ablate) problem cells. Here’s how the procedure is performed:

• The heart’s signals are mapped. To find the problem, an electrophysiology study (EPS) is done. During this study, the doctor tries to induce (start) your arrhythmia. An electrical map of the heart is then created. This shows the type of arrhythmia you have and where the problem is. Using the map as a guide, the doctor knows where to ablate.
• Problem areas are destroyed. Once the EPS shows where the problem is, an electrode catheter is moved to that area. Energy is sent through the catheter to destroy the problem cells.
• The heart’s rhythm is tested again. After ablating the problem cells, the doctor tries to reinduce (restart) your arrhythmia. If a fast rhythm can’t be induced, the ablation is a success. If a fast rhythm does start again, further ablation may be needed.

Your experience during catheter ablation
In most cases, catheter ablation is done in an electrophysiology (EP) lab. It often takes 2-4 hours, sometimes longer. You’ll receive medication to prevent pain and help you relax or sleep during the procedure. If you feel uncomfortable during the procedure, be sure to tell the doctor or nurse.

• Getting started: First, the skin on your groin or neck is washed, and any hair in that area may be shaved. This is where the catheters will be inserted. An IV (intravenous) line is started in your arm. Medications and fluids are provided through this IV. To help keep the insertion site sterile (germ-free), your body is draped with sheets. Only the area where the catheters will be inserted is exposed.
• Inserting the catheters: The skin where the catheters will be inserted is numbed with a local anesthetic, so you won’t feel any pain. Then a small needle is used to make punctures in your vein or artery. Catheters are inserted through these punctures and guided to the heart with the help of X‑ray monitors.
• Finishing up: When the procedure is finished, the catheters are taken out of your body. Pressure is applied to the puncture sites to help them close. No stitches are needed. You’ll be taken to a recovery room to rest.

Risks and complications
The risks of catheter ablation are low, when compared with the benefits you receive. Discuss these risks with your doctor before the procedure.

Possible risks and complications include:

• Bleeding or bruising
• Blood clots
• A slow heart rhythm (requiring a permanent pacemaker)
• Perforation of the heart muscle, blood vessel, or lung (which may require an emergency procedure)
• Damage to a heart valve (rare)
• Stroke or heart attack (rare)
• Death (extremely rare)

Coronary angioplasty
Your doctor will talk with you about your heart problem and explain how angioplasty can help. Angioplasty relieves symptoms of coronary artery disease by improving the flow of blood to your heart.

During the procedure

• A guide wire is inserted through the guiding catheter (a thin, flexible tube) and moved to the narrow spot in your artery. Your doctor tracks its movement on a special kind of X‑ray called an angiogram.
• A balloon-tipped catheter is inserted through the guiding catheter and threaded over the guide wire. It is positioned at the narrow part of the artery.
• The balloon is inflated and deflated several times to compress the plaque against the artery wall. You may feel angina (chest pain) when the balloon is inflated. Tell your doctor if you do.
• The balloon is deflated, and the catheters and guide wire are removed. The artery is now open, and blood flow to the heart muscle increases.

After the procedure

• You’ll need to remain lying down for 6-12 hours.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check the insertion site and your blood pressure. Before going home, you may have a chest X‑ray and other tests.
• You will usually remain in the hospital for several hours or overnight.

Call your doctor right away if you have any of the following:

• Angina (chest pain)
• Pain, swelling, redness, bleeding, or drainage at the insertion site
• Severe pain, coldness, or a bluish color in the leg or arm that held the catheter
• Blood in your urine, black or tarry stools, or any other kind of bleeding
• Fever over 100F

Coronary stent placement
A stent is a small metal coil or mesh tube that is placed in a narrowed artery to hold it open, which helps improve the flow of blood to your heart. The stent also helps reduce the rate of restenosis (re-narrowing) of the artery. Some stents slowly release medication over time. This reduces the amount of scar tissue that forms inside the artery, helping to prevent restenosis.

During the procedure

• A stent, which comes mounted on a balloon-tipped catheter, is delivered to the blockage in your artery.
• The balloon is then inflated, causing the stent to expand.
• The expanded stent further compresses the plaque against the arterial wall, increasing the blood flow to the heart muscle.

After the procedure

• You may need to keep still, with your leg or arm straight, for 2-6 hours. How long depends partly on where the catheter was inserted and how the site was closed.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check your blood pressure and the insertion site.
• You may be asked to drink fluid to help flush the contrast liquid out of your system.
• When released, have someone drive you home from the hospital.
• It’s normal to find a small bruise or lump at the insertion site. This should disappear within a few weeks.

Call your doctor right away if you have any of the following:

• Angina (a feeling of pain, pressure, aching, tingling, or burning in the chest, back, neck, throat, jaw, arms, or shoulders)
• Increasing pain, swelling, redness, bleeding, or drainage at the insertion site
• Severe pain, coldness, or a bluish color in the leg or arm that held the catheter
• Shortness of breath
• Difficulty urinating or blood in your urine
• Fever over 100F

Defibrillator implantation

Implantable cardioverter defibrillator (ICD)
An ICD is a device that is placed permanently inside your body to monitor your heart rhythm, the speed and pattern of your heartbeat. If this rhythm becomes too fast or too slow, the ICD sends out electrical signals that help bring it back to normal. The ICD is put inside your body during a minor surgical procedure called implantation. In most cases, implantation takes 1 to 3 hours.ICD Implantation
The ICD is usually implanted on the left side of your chest. Implantation does not require open heart surgery, so your chest will not be opened. During implantation:

• An incision is made in the skin below the collarbone, creating a “pocket” to hold the ICD.
• A lead wire is threaded through the incision into a vein in the upper chest. With the help of X‑ray monitors, the lead is then guided into one of the heart’s chambers. Depending on how many leads your ICD has, this process may be repeated to guide leads into other chambers.
• The leads are attached to the heart muscle so they will stay in place.
• The generator (battery) is attached to the leads. Then the generator is placed in its pocket under the skin.
• A fast heart rhythm may be induced (started) to test the ICD.
• The incision is closed with sutures, medical glue, or staples.

Other implantation sites
In some cases, the ICD can be placed elsewhere in the body: in the abdomen, on the right side of the chest, or on the left side under the muscle. If one of these is an option for you, your doctor will explain more.

After the procedure
You’ll stay in the hospital at least overnight so your heart’s signals can be monitored to see how the ICD is working. You can go home when your condition is stable. Once you get home:

• Follow your discharge instructions to care for your incision.
• Watch for signs of infection (see below).
• Follow any special instructions to care for the side of your body where your ICD was implanted. Your doctor may tell you not to raise that arm above the shoulder for a certain amount of time.
• Bruising at the incision site is normal for about a month and will go away as the incision heals.
• You can most likely return to your normal routine soon after implantation. Ask your doctor when you can return to work.
• You may be instructed not to drive for a certain amount of time. Be sure to have someone available to drive you home after your procedure.
• See your doctor for follow-up visits as recommended.

Call your healthcare team if you have:

• Signs of an infection, such as: fever over 100F; drainage from the incision; redness, swelling, or warmth at the incision site
• Twitching chest muscles
• Pain around your ICD that gets worse, not better
• Bleeding from your incision
• Swelling in the arm on the side of the incision site
• Severe swelling of the incision site (bulging up like a golf ball)
• Chest pain or shortness of breath

Diagnostic cardiac catheterization
If you have had angina, dizziness, or other symptoms of heart trouble, your doctor may suggest having a cardiac catheterization to help diagnose your problem. This common procedure is also sometimes used to treat other heart problems.  

Before the procedure

• Tell your doctor what medicines you take and about any allergies you have.
• Don’t eat or drink anything after midnight the night before the procedure.
• You’ll likely be admitted to the hospital on the day of the procedure.  – Know that the skin where the catheter will be inserted may be shaved. You may be given medication to relax before the procedure.

During the procedure

• You will receive a local anesthetic to prevent pain at the insertion site.
• The doctor inserts an introducing sheath into a blood vessel in your groin or arm.
• Through the sheath, a long, thin tube called a catheter is placed inside the artery and guided toward your heart.
• To perform different tests or check other parts of the heart, the doctor inserts a new catheter or moves the catheter or X‑ray machine. – For some tests, a contrast dye is injected through the catheter.

Call your doctor right away if you have any of the following:

• Angina (chest pain)
• Pain, swelling, redness, bleeding, or drainage at the insertion site
• Severe pain, coldness, or a bluish color in the leg or arm that held the catheter
• Blood in your urine, black or tarry stools, or any other kind of bleeding
• Fever over 100F

After the procedure

• You need to remain lying down for 2-12 hours.
• If the insertion site was in your groin, you may need to lie down with your leg still for several hours.
• A nurse will check your blood pressure and the insertion site.
• You may be asked to drink fluid to help flush the contrast liquid out of your system.
• When released, have someone drive you home from the hospital.
• It’s normal to find a small bruise or lump at the insertion site. These common side effects should disappear within a few weeks.

Electrophysiology studies
An Electrophysiology Study (EPS) closely monitors your heart rhythm to determine exactly what your rhythm problem is, and what can be done to control it. A specially trained doctor called an Electrophysiologist performs the procedure in an EPS lab. The insertion site may be in the groin or arm.

Before the procedure

• Tell your doctor which medications you take and ask if you should stop taking them before the procedure.
• Have any routine tests that your doctor recommends.
• Don’t eat or drink anything after midnight the night before the procedure.

During the procedure

• The study takes about 1-4 hours.
• After the skin is numbed with a local anesthetic, an incision is made where the catheter will be inserted.
• One or more catheters are passed through the veins and positioned in the heart. The catheters record electrical activity of the heart. They find where and when signals begin and how often they are sent.
• Other procedures that may be performed during the study include defibrillation (electric shock to the heart to help adjust the heart rhythm) and catheter ablation (destruction of an abnormal electrical pathway or cells in the heart).

Call your doctor right away if you have any of the following:

• Insertion site pain, increased swelling, redness, bleeding, or drainage
• Shortness of breath or angina (chest pain)
• Severe pain, coldness, numbness, or a bluish color in the leg or arm that held the catheter
• Fever over 100F

After the procedure

• You’ll need to remain lying down for 6-12 hours.
• If the insertion site was in your groin, you may be asked not to move your leg for several hours.
• A nurse will check the insertion site and your blood pressure.
• After the study, you will most likely remain in the hospital for several hours or overnight.

Pacemaker implantation
A pacemaker is a small electronic device that helps your heart’s electrical system function properly by keeping your heart beating at the right pace. The insertion of the pacemaker into your body is called implantation. You will be awake during the procedure, and you may be asked some questions or asked to take some deep breaths.

During the procedure

• A local anesthetic is given by injection to numb the area where the pacemaker will be inserted, to keep you from feeling pain during the procedure.
• An incision is made where the generator is placed.
• The lead (which transmits to and from your heart) is guided through a vein into your heart’s chambers using X‑ray monitors.
• The pacemaker generator is attached to the lead or leads.
• The pacemaker’s settings are programmed to help your heart beat at a rate that’s right for you.

Call your doctor right away if you have any of the following:

• Any of the symptoms you had before the pacemaker was implanted (dizziness, lightheadedness, lack of energy or fainting spells)
• Twitchy chest muscles 
• Rapid or pounding heartbeat or shortness of breath
• Pain in the area around your pacemaker
• Fever over 100F, or other signs of infection (redness, swelling or warmth at the incision site)

After the procedure

• You will stay in the hospital a day or two.
• Your pacemaker settings will be rechecked.
• On the incision side, don’t raise your arm above your shoulder for at least a week. This gives the lead a chance to secure inside the vein in your heart.
• Take your temperature and check your incision for signs of infection every day for a week.
• Return for a follow-up visit as directed by our staff.

Peripheral angiography
Peripheral angiography is an outpatient procedure that makes a “map” of the vessels (arteries) in your lower body and legs, to show where blood flow may be blocked.

Talk to your doctor about the risks and complications of angiography.

Before the procedure

• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure.
• If your doctor says to take your normal medications, swallow them with only small sips of water.
• Arrange for a family member or friend to drive you home.

During the procedure

• You may receive medication through an IV (intravenous) line to relax you. You’ll be given an injection to numb the insertion site. Then, a tiny skin incision is made near an artery in your groin.
• Your doctor inserts a catheter (thin tube) through the incision and threads the catheter into an artery while viewing a video monitor.
• Contrast “dye” is injected into the catheter. You may feel warmth or pressure in your legs and back. You will need to lie still as X‑rays are taken. The catheter is then removed.

Call your doctor right away if you have any of the following:

• A lump or bleeding at the insertion site
• Pain at the insertion site
• Dizziness or lightheadedness
• Leg pain or numbness

After the procedure

You’ll be taken to a recovery area, where a doctor or nurse will apply pressure to the site for about 10 minutes. You will need to keep your leg still and straight for a few hours. Your doctor will discuss the results with you soon after the procedure.

Back at home
On the day you get home: don’t drive, don’t exercise, avoid walking and taking stairs, and avoid bending and lifting. Be sure to follow any other care instructions given by your doctor.

Peripheral angioplasty
Peripheral angioplasty is a procedure that helps open blockages in peripheral arteries, the vessels that carry blood to your lower body and legs.

Talk to your doctor about the risks and complications of angioplasty.

Before the procedure

• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure.
• Arrange for a family member or friend to drive you home.

During the procedure

• You may get medication through an IV (intravenous) line to relax you.
• After an injection numbs the site, a tiny skin incision is made near an artery in your groin.
• Your doctor inserts a catheter (thin tube) through the incision (insertion site), then threads it into an artery while viewing a video monitor.
• Contrast “dye” is injected into the catheter. X‑rays are taken (angiography).
• A tiny balloon is pushed through the catheter to the blockage and is inflated and deflated a few times to compress the plaque. A stent (small metal or mesh tube) may be placed to help keep your artery open. The balloon and catheter are then removed.

After the procedure
You’ll be taken to a recovery area, and pressure will be applied to the insertion site for about 15 minutes. You will need to keep your leg still and straight for a few hours. You may be released to go home the same day, or asked to spend the night in the facility. You will be instructed what to do when you go home.

Call your doctor right away if you have any of the following:

• A lump or bleeding at the site where the catheter was inserted
• Pain at the insertion site
• Dizziness or lightheadedness
• Leg pain or numbness