CHI Health Nebraska Heart

A new noninvasive way to view coronary artery disease

In the past, the recognized “gold standard” for detecting atherosclerotic plaque was the use of invasive coronary angiography (cardiac catheterization). Now, advances in computed tomography (CT) scan technology allow us to use this noninvasive tool in the detection of coronary artery disease.

As leaders in the detection and treatment of cardiovascular diseases, the CHI Health Clinic Heart Institute has opened a dedicated center for cardiovascular CT imaging, located on the campus of the Heart Institute.

Technology

The CHI Health Clinic Heart Institute is one of the first centers in the region with this technology, enhancing patient care by offering the state-of-the-art 64-slice CT scanner. We now are able to noninvasively image the coronary arteries and other vessels. The 64-slice CT technology represents an innovation of great magnitude that allows for information to be obtained faster and more accurately than ever before. This allows us to view the coronary arteries without having to utilize a catheter and to obtain a three-dimensional image of the heart. With this new 64-slice technology, the entire heart can be imaged with a breath hold of 8 to 10 seconds when previously it required 25 or more seconds.

What happens during the examination?

The patient will be lying on a table, which will move the patient slowly through the opening of the CT unit. A contrast medium administered through a small IV line will be used to highlight the blood vessels. The technologist will periodically ask the patient to briefly hold their breath. During this process, the CT scanner will take extremely detailed cross-sectional images which are used to generate the pictures from which the physicians make their diagnosis. Patients can expect the scanning process to take 10 to 15 minutes.

Who should receive CT Coronary Angiography?

CT coronary angiography may be recommended for many patients including those with a family history of heart disease and those who suffer from high blood pressure, high cholesterol, obesity or diabetes. Additional indications are:

• Evaluation of chest pain
  
• Evaluation of progression of coronary artery disease
• Assessment of coronary artery bypass grafts
• Follow-up to a stress test

The decision whether a patient undergoes CT coronary angiography will be made in consultation with the patient’s primary care physician and a Heart Institute cardiologist.

Results

During the exam, hundreds of images are taken to create a picture to aid in diagnosis. These images will be interpreted by a board certified cardiologist specifically trained in cardiovascular CT. Within twenty-four hours, the cardiologist will share the results with the patient’s primary care physician for follow-up care.

Anticoagulation Clinic Goals:

• Determine care needs
• Manage anticoagulation dosing
• Provide systematic monitoring & patient evaluation
• Provide ongoing education
• Communicate with other providers involved in the patient’s care

What is the Anticoagulation Clinic?

The Clinic is a service established to monitor and manage the medications that you take to prevent blood clots. Nurses and Advanced Practice Clinicians, in conjunction with your physician, will work together to ensure these medications are used safely. For patients taking Warfarin (Coumadin), we will routinely check blood work and adjust your dose of Warfarin (Coumadin) as well as other medicines that may be needed.

Why do I need to take an Anticoagulant?

Anticoagulants may be administered to patients after mechanical valve replacement surgery, diagnosis of clotting disorder, stroke, deep vein thrombosis, pulmonary embolism, and atrial fibrillation. For patients taking Coumadin, a regular blood test, called an INR (International Normalized Ratio), is done to determine whether you’re getting the right amount of Coumadin. For alternative anticoagulants such as Eliquis, Pradaxa, Savaysa or Xarelto, INR testing is not necessary.

Why is a special clinic needed to manage my medicine?

Medications used to thin the blood can be dangerous if not closely monitored. Specifically with Coumadin, your blood clotting time or INR must be checked. When Coumadin therapy is initiated your labs will need to be checked on a weekly basis while we work to get your levels in the proper range. Once your levels are stabilized, we will likely check blood work every 4-5 weeks. However, you may be checked more often when changes are made to other medications or if INR results are not within the designated therapeutic range. For alternative anticoagulants such as Eliquis, Pradaxa, Savaysa or Xarelto, labs are checked every six months.

What is the procedure for follow-up in the Anticoagulation Clinic?

Patients generally begin treatment after surgery or diagnosis. After your physician sends in the referral form, you will be contacted by the Anticoagulation Clinic to discuss your therapy and to arrange your first appointment. At your initial visit you will be given thorough education about your medication. For patients starting Coumadin therapy, a nurse will check your INR by using a finger stick blood test (the result will be available immediately). You will be asked some questions about your health and medications, determine if your warfarin dose should be adjusted, and schedule your next appointment. Patients are assessed by the nurses in the Anticoagulation clinic at least once a month after the initiation of Coumadin therapy. Future frequency of visits is determined by stability of the INR. All patients on any anticoagulant therapy will be evaluated in the office every six months.

The Anticoagulation Clinic will provide patient education which includes the purpose of the patients therapy, duration of therapy, dosing and administration of prescription(s), what to do if you miss a dose, compliance, monitoring, signs and symptoms to watch for (bleeding and clotting), drug interactions, preferred nutritional diet as well as alcohol intake, informing the patients other healthcare providers, follow-up appointment information, medical alert bracelet or card.

Despite advances in medicine, heart disease remains the leading cause of death in the United States. The CHI Health Clinic Heart Institute Cardiovascular Health and Lipid Clinic is committed to working to prevent the development and progression of coronary and vascular disease using a holistic approach including risk assessment, lifestyle changes and medical treatment. A team of physicians, advanced practice clinicians and nurses works to provide personalized risk assessment and a customized plan to decrease your risk of developing cardiovascular disease.

Whether you have a family history of heart disease, have been diagnosed with a risk factor for heart disease or have experienced difficulty in tolerating cholesterol lowering medications, our team can partner with you to lessen your risk and improve your quality of life.

Patients who may benefit from a cardiovascular risk assessment include those with any of the following conditions

• Abnormal cholesterol levels.
• Prior intolerance to cholesterol lowering medication.
• Elevated blood pressure.
• Diabetes or metabolic syndrome.
• Tobacco Use.
• Family History of Heart attack, stroke or vascular disease.
• Any patient concerned about their risk of developing cardiovascular disease.

Program Components

• A comprehensive evaluation by a cardiologist and nurse practitioner.
• Advanced lipid testing to assess biomarkers of cardiovascular disease.
• Diagnostic testing such as stress testing, coronary calcium scoring or vascular screening; if indicated.
• Referral to additional support services such as tobacco cessation counseling and exercise programs.\

Call with any questions or to schedule an appointment: (402) 328-3998

Surgeons with the CHI Health Clinic Heart Institute perform a variety of procedures to treat cardiac, vascular, and thoracic diseases. Please scroll down the page to read each procedure’s description.

• Coronary Artery Bypass
• TAVR
• Transmyocardial Revascularization (TMR)
• Valvular Procedures 
• Transplantation
• Vascular Disease 
• Peripheral Angiography
• Vein Clinic

Coronary Bypass

Coronary artery bypass operations have become the gold standard to restore health and vigor to people suffering from coronary artery disease. The surgeons of the CHI Health Clinic Heart Institute perform single-vessel as well as multi-vessel bypass procedures to channel blood flow to coronary arteries.

During traditional heart bypass surgery, a heart-lung machine is used to provide circulatory function. Since 1997, in addition to this traditional method, the surgeons of the Heart Institute I have been performing the procedure off-pump. By utilizing specialized stabilizing devices, surgeons can work on specific areas of the heart while the rest of the heart continues to beat and provide support to the patient. Benefits of this procedure include faster recovery time and less chance of infection, neurological disorders, and blood clots.

Transmyocardial revascularization (TMR)

Transmyocardial revascularization (TMR) is another procedure surgeons may utilize to restore blood flow to the heart and relieve chest pain. The procedure, which involves a laser to create new channels, may be used in place of or in addition to traditional bypass.

Vascular Disease

In addition to cardiac abnormalities, surgeons at the Heart Institute treat peripheral vascular diseases. Atherosclerosis occurs in the peripheral arteries as well as the coronary arteries. To aid surgeons in identifying the amount and location of blockages, Doppler ultrasound testing is performed. Arms, legs, and carotid arteries are evaluated to determine the speed and direction of blood flow.

Valvular Procedures

If initial treatment with medications does not correct problems with the heart’s valves, then surgical treatment is used to prevent possible or further damage to the heart muscle. Possible causes of valvular disease include birth defects, bacterial endocarditis, Scarlet Fever, and Rheumatic Fever.

Treatments performed at CHI Health Clinic Heart Institute include:

• Valvuloplasty
• Valvular Repair
• Valve Replacement

There are two types of valves that the Heart Institute surgeons use: mechanical and biological. The choice as to which valve to be used is based on the patient’s age, physical condition, and lifestyle.

Peripheral Angiography

Another diagnostic test that may be performed is peripheral angiography. Similar to a heart catheterization, the procedure uses dye contrast to identify narrowing or blockages.

Surgeons use the following treatment methods to improve blood flow to peripheral vascular areas:

• Thrombectomy
• Stents
• Atherectomy
• Angioplasty
• Bypass Surgery
• Aneurysm Grafting

Whether it’s cardiac, vascular or thoracic disease, the surgeons of the Heart Institute work closely with an entire team of referring physicians, nurses and rehab specialists in diagnosing and treating patients, so they can return to an active and healthy life.

MiniMaze

A stand-alone minimally invasive surgical procedure for atrial fibrillation (AF) is now an option for a wider range of patients. AF is a progressive, debilitating heart arrhythmia and is associated with a five-fold risk of stroke. Recent advances in devices are expected to increase the effectiveness of this procedure in chronic AF sufferers, making it a viable treatment option for a broader group of patients.

Cardiac Abnormalities

In the area of open-heart surgery, CHI Health Clinic Heart Institute physicians utilize the latest procedures and instruments to treat heart disease; more than 1,500 open-heart procedures annually. Procedures include treatment for blockages in the heart’s blood vessels; repair or replacement of heart valves; and repair of heart muscle due to birth defects, aneurysms, or disease.

What is Transmyocardial Revascularization (TMR)?

When performing TMR with a low powered Holmium:YAG laser, a qualified cardiac surgeon delivers precise laser energy directly to the target area(s) of the heart muscle. When performed as a sole therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia. TMR can also be performed as a complement to bypass surgery in patients that have diseased areas of the heart that cannot be bypassed. The precise laser energy is delivered to create small channels into the heart chamber. During a typical procedure, approximately 20 – 45 channels are made in the heart muscle.

The channels in the heart muscle seal over immediately with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately. According to research and clinical studies, these channels promote growth microvascularization, or angiogenesis, over time. That, in turn, may provide damaged heart tissue with a better supply of blood and oxygen. Angina symptoms, including chest pain, usually subsides over time in the majority of patients treated with TMR.

What to expect following the procedure.

The follow-up requirements for recovery after a TMR procedure are similar to those following other heart surgeries, including regular check-ups by your physician. Your physician will advise you when you may expect to return to more normal activities.

How TMR works

At this time it is not fully understood how TMR relieves angina, although there are several theories that are under investigation for the way in which TMR works including:

• Directly increasing the blood flow to the heart muscle
• Stimulating the growth of new small blood vessels within the heart muscle
• Reducing angina or chest pain by impairing the nerves and/or placebo effect

TMR May Benefit You

• TMR may benefit you if there is an area of your heart that is not receiving enough oxygen and your disease cannot be treated by balloon angioplasty or bypass surgery.
• TMR has been proven to reduce angina or chest pain and improve the quality of life in patients with coronary artery disease.
• Treatment with TMR may help you return to a more active lifestyle.
• Treatment with TMR may also reduce the need for some of the medications you are currently taking to manage your angina symptoms, including, chest pain.

How to determine if TMR is an option for you.

Patients who are candidates for TMR usually have severe chest pain, often even at rest. They may or may not have had a previous heart surgery.