Heart disease

Midwest Heart and Vascular Specialists are your Kansas City community cardiologists and cardiovascular and thoracic surgeons, providing comprehensive cardiovascular care as well as vascular and thoracic surgical services in greater KC and the surrounding areas.

Heart disease is a term that encompasses a variety of different heart conditions, which can include:

• Coronary artery disease—blockage in the arteries to the heart
• Heart arrhythmias—abnormal heart rhythms
• Heart valve disease—problem with one of the heart valves
• Atherosclerosis—hardening of the arteries
• Cardiomyopathy—causes the heart's muscles to harden or grow weak
• Congenital heart abnormalities—structural problems with the heart present since birth
• Heart failure—when the heart isn't pumping blood sufficiently to the rest of the body

Untreated heart disease can result in additional medical problems, like heart attack or stroke.

CAD occurs when the coronary arteries begin to narrow, due to atherosclerosis—buildup of fatty plaque that hardens over time. The coronary arteries supply oxygen-rich blood to the heart. When a blockage occurs, blood flow to the heart becomes blocked resulting in damage to the heart muscle.

When CAD becomes very severe, chronic total occlusion (CTO) may occur. CTOs are diagnosed when arteries become completely blocked for three months or more. Because these arteries are 100 percent blocked, they can be difficult to open for restored blood flow.

CAD can contribute to additional cardiovascular conditions, like heart attack, heart arrhythmia and heart failure. Common symptoms associated with CAD include:

• Chest pain (angina)
• Fatigue
• Heart attack
• Pain that spreads to the arms or jaw
• Shortness of breath

CAD is the most common type of heart disease in the U.S. It develops over long periods of time, normally many years, so patients may not notice a problem or experience any symptoms until a significant blockage occurs. It is important to regularly visit your primary care provider and to be honest about your lifestyle choices, so your doctor knows to look for the risk factors and symptoms associated with CAD.

If your doctor suspects you have CAD, they may recommend a heart scan commonly referred to as coronary calcium scoring. This is a non-invasive test that shows how much plaque is built up in the coronary arteries. If you are concerned about your risk for CAD, you can take HCA Midwest's free, online heart disease risk assessment.

If your doctor or cardiologist suspects you may have CAD, they may order diagnostic tests to confirm the diagnosis. Our heart screening technologies help us understand the extent and severity of heart disease and may include:

• Cardiac imaging
• Cardiac stress tests
• Coronary angiogram (diagnostic cardiac catheterization)

If your CAD is still causing lifestyle-limiting symptoms while taking medications for heart disease or you simply cannot tolerate treatment through medications, your doctor may recommend coronary revascularization. There are many types of coronary revascularization, all of which focus on restoring blood flow to the heart that has been inhibited by diseased coronary arteries.

The HCA Midwest Health Heart and Vascular Institute offers the latest technology and treatments for CAD. Our interventional cardiologists and cardiac surgeons work together to determine the best treatment approach for every patient.

Percutaneous coronary interventions for CAD

Percutaneous coronary interventions (PCIs) are minimally-invasive, catheter-based heart procedures that open clogged arteries and restore blood flow to the heart. We offer the latest PCI procedures using advanced technologies to treat even the most complex cases of CAD.

PCIs are commonly performed by our interventional cardiologists, who will make a small incision in the wrist or groin and use that access point to guide catheters up to the heart. Our doctors use angiograms (specialized X-ray technology) with a contrast dye for increased visualization during these procedures.

New PCI procedures have opened a range of new options for patients with complex CAD, who have blockages that are very hard to clear. Complex CAD may occur in patients with advanced age, severe or complete blocked arteries and those in frail physical condition.

We perform several types of PCIs. Our cardiologists will choose the procedure that best fits each patient's needs.

Percutaneous transluminal coronary angioplasty (PTCA), also called percutaneous balloon angioplasty, is a minimally invasive PCI procedure to open up narrowed and/or blocked arteries. During the procedure, a catheter is used to reach the targeted area. Once at the proper location, a tiny balloon is inflated, pushing plaque against the artery walls to open up the artery. After the artery is cleared, the balloon is deflated and removed via the catheter.

Angioplasty with a cardiac stent

This type of PCI includes the entirety of the balloon angioplasty procedure with the addition of a stent. A stent is an expandable tube, typically made of a mesh metal wire. The stent is navigated to the same site the balloon was inflated and is used to hold the artery open. There are several types of stents used in cardiac care, including stents that release medications to prevent reblockages.

Stents are typically recommended for patients with moderate to severe coronary atherosclerosis. The procedure takes about one to two hours to complete and usually requires an overnight hospital stay for monitoring. Patients will follow up with their cardiologist within two weeks of the procedure.

Most patients recover from this procedure very quickly, with many being able to walk the day after the procedure. Patients normally can return to normal activity levels within a week.

Robot-assisted coronary angioplasty

Patients at Overland Park Regional Medical Center may benefit from robot-assisted angioplasty. When using this advanced technology in a PCI procedure, the interventional cardiologist is in complete control of specialized angioplasty tools that allow for increased surgical precision.

This technology allows us to measure each patient's anatomy to help choose the best stent for them. We can move the stent a millimeter at a time to ensure it is placed exactly where it needs to be. This robot-assisted technology also offers better visualization for our doctors and leads to a shorter procedure time with less radiation exposure for patients.

Chronic total occlusion percutaneous coronary intervention (CTO PCI)

Until recently, the only method of treating CTOs was through coronary artery bypass grafting (CABG), a type of open-heart surgery. We are excited to offer our patients a new minimally invasive alternative PCI option to the CABG procedure.

During a CTO PCI, an interventional cardiologist will use imaging technology and specialized coronary tools to navigate around and through the blockage. We use new surgical techniques that allows us to approach the blockage from multiple sides, which is beneficial when treating such severe blockages.

CTO PCI takes about one to three hours to complete, with most patients returning home the following day. Patients will follow up with their cardiologist within two weeks of the procedure.

Protected percutaneous coronary intervention (protected PCI)

Protected PCI is when a normal PCI is performed to open a blockage, but it is supported by a heart pump. By using a heart pump, the patient's heart can rest while the pump ensures the heart continues to function. This may be beneficial for patients who are at risk for interruptions in blood flow during a PCI. The pump helps support the heart by facilitating blood flow while allowing the cardiologist to complete the procedure.

If a patient's heart requires extra support following a PCI, they may be left on a heart pump during recovery until they reach a stable condition. Candidates for protected PCI may include:

• Patients who are not candidates for open-heart surgery
• Patients who are too high-risk for an angioplasty and/or stent procedure
• Patients with additional health concerns, such as diabetes, kidney disease or obesity
• Patients with severe CAD

Our cardiologists also specialize in a two heart pump approach, where one pump supports the left ventricle and the other supports the right ventricle. This helps certain patients undergo a higher-risk procedure with added safety measures to support the heart.

Protected PCI procedures may last anywhere from two to five hours. Each patient's hospital stay will depend upon when they are stable enough for the pump to be removed. Patients will attend a follow-up appointment with their cardiologist within two weeks of discharge.

Coronary bypass heart surgery for CAD

If a less invasive PCI approach is not an option, due to certain risk factors or the severity of a patient's CAD, heart surgery may be needed. Our surgeons can take one of two approaches to this surgery:

• Coronary artery bypass grafting (CABG) – This is an open-heart surgery used to restore blood flow to the heart. During the surgery, an artery or vein from another part of your body is used to make a new path for blood to flow around the blockage. With traditional CABG, the surgeon accesses the heart through the breastbone and a heart-lung machine is used to maintain blood and oxygen flow through the body while the heart is repaired.
• Minimally invasive coronary artery bypass grafting –With this type of CABG, a small incision is made in the chest to perform the bypass instead of a large incision through the breastbone. The heart continues beating throughout the procedure and the heart-lung machine is not needed.

Structural heart disease refers to abnormalities or disorders in the heart's structure, such as its walls, valves and muscles. HCA Midwest specialists can identify these conditions and correct them through several treatment options, including:

• Mitral valve regurgitation treatment — We offer a non-surgical, minimally invasive approach to repair and replace mitral valves.
• Aortic valve replacement — Our surgeons remove the damaged valve and replace it with an artificial valve. This is typically done through open-heart surgery.
• Patent foramen ovale (PFO) & atrial septal defect (ASD) closure — These abnormalities are treated by threading a catheter through a surgical incision, through the veins and into the heart. Once in the septum, the surgeon opens an umbrella-like device to close the hole.
• Transcatheter aortic valve replacement (TAVR) — Our doctors use TAVR to treat aortic stenosis. It's a nonsurgical, minimally invasive approach.

There are several risk factors associated with heart disease. These include both controllable an uncontrollable factors, such as:

Women don’t often think about their risk of heart disease. Many falsely feel it predominantly affects males. However, cardiovascular disease is the leading cause of death in women. More women die of heart disease each year than all types of cancer plus other diseases combined.

At HCA Midwest, many of our cardiologists specialize in diagnosing and treating women with heart disease. Women often put their health on the back burner, choosing to prioritize caring for others. They also have smaller arteries and often present with symptoms later in life. These factors can cause women not to get the treatment they need early enough.

Pregnancy related complications such as gestational diabetes and preeclampsia can be predictors to help identify women who are at a higher risk of heart disease. Our team can identify these precursors and help our patients take preventive measures earlier in life, rather than waiting until the disease develops.