Services and Specialties

Saint Louis University Hospitals cardiology and cardiac surgery services, in partnership with SLUCare physicians, make it one of the most advanced and comprehensive treatment centers in the country for heart conditions. Our diagnostic and treatment capabilities include preventive, medical, surgical and rehabilitative services ranging from management of high blood pressure to heart transplantation. We also have a broad range of experience with mechanical circulatory support and replacement devices, including one of the most experienced and largest ventricular assist device programs in the United States.

What are the different types of cardiovascular diseases and disorders?
Abnormal Heart Rhythms (Arrhythmias): Abnormal heart rhythms, or arrhythmias, are when the heart isnt properly reading the electrical signals that tell it when to beat. As a result, the heart beats in an abnormal rhythm.

Aneurysms (Aortic and Abdominal) : An aneurysm is an abnormal widening or enlargement of a blood vessel. This happens when the wall of the blood vessel weakens. Over time, an aneurysm can get big enough and the tension in the artery wall strong enough to cause the aneurysm to rupture. When this happens in the chest or abdomen, the outcome may be fatal.

Cardiomyopathy: Cardiomyopathy is a very serious form of heart disease where the muscle of the heart becomes weak, keeping the heart from working as it should.

Congenital Heart Disease: There are many different types of malformations of the heart that can occur during fetal development. These malformations are called inborn or congenital heart defects. One of the most common is a hole between the chambers of the heart.

Congestive Heart Failure: Congestive heart failure is a condition in which the heart cant pump enough blood to meet the metabolic needs of the bodys other organs. The failing heart keeps working, but not as efficiently as it should.

Coronary Artery Disease: Coronary artery disease is the build-up of plaque in the main arteries that supply the heart with oxygen-rich blood and other nutrients. In coronary artery disease, the arteries that carry blood to your heart build up with plaque and narrow. Over time, the blood may clot on the plaque, clogging the artery. Risk factors for coronary artery disease include: high blood pressure, diabetes, high cholosterol or other lipids, cigarette smoking, a family history of coronary artery disease, and perhaps lack of exercise and obesity.

Heart Valve Disease: When there is something wrong with the valves in your heart it affects the blood flow through your heart. Dysfunctional valves may be leaky, allowing the blood to go backwards, or narrowed, making it hard to get blood through the valve. Sometimes a valve is both leaky (insufficient) and narrowed (stenotic). These abnormal valves can put excess stress on the heart muscle, resulting in congestive heart failure. Heart valve disease is common in the elderly and those with previous rheumatic fever.

What are the symptoms of cardiovascular disease?
There are many different symptoms you can experience if you have cardiovascular disease. For people who may be suffering from heart disease, common symptoms are:

• Angina (A burning, squeezing, ache in the center of your chest or left arm that feels like your heart might collapse because of the pressure. These attacks can last anywhere from 30 seconds to 5 minutes.)
• Rapid heart beat (palpitations)
• Shortness of breath
• Nausea
• Heavy sweating

TESTING AND TREATMENT FOR CARDIOVASCULAR DISEASES & DISORDERS
SLUCare and Saint Louis University Hospital diagnostic and treatment options (in alphabetic order) include:

Adult Congenital Heart Disease Specialty Clinic (Click here for more information)

Cardiac Catheterization Service: A catheter is a thin tube that is inserted into an artery in the arm or leg through a needle.

Alcohol Septal Ablation: Alcohol ablation is a non-surgical way of treating an enlarged portion of the hearts muscle mass which is preventing blood from properly flowing through the heart. By injecting alcohol through a catheter in one of the coronary arteries, the affected area in the heart is rendered inactive without the need for surgery.

Angioplasty (Percutaneous Transluminal Coronary Angioplasty) and Laser Angioplasty: If an area of the heart is blocked or partially blocked because of plaque buildup, a catheter is inserted in the blood vessel and guided to the area of blockage by a fiber optic camera. Then a tiny deflated balloon is passed through the catheter. The balloon is inflated at the blockage area and the plaque is pushed against the walls of the artery, restoring blood flow through the vessel. Doctors are also performing the same type of procedure using lasers instead of a balloon to clear away plaque.

Atherectomy or Rotablator Therapy: Atherectomy is a way to restore blood flow in a blocked or narrowed artery near the heart without having to perform open-heart surgery. By using a catheter with a rotating shaver (called a burr) at its tip, plaque build-up is shaved from the artery.

Atrial Septal Closure Devices: A hole in the membrane between the two small upper chambers of the heart can be closed with a catheter-based technique to plug the hole without open-heart surgery.

Angiography and Arteriography: A coronary angiography is performed by inserting thin tubes (catheters) into the arteries found in the arm or leg. Doctors can determine if and where a blockage is by guiding the catheters into the coronary arteries and injecting a harmless dye to get a clearer picture on the X-ray. While the catheter is in the heart and the surrounding areas, it also takes pressure readings to properly analyze the hearts performance. An arteriogram determines which arteries outside the heart and brain are damaged. Similar to an angiogram, a harmless dye is injected into the arteries to get a clearer picture on the X-ray.

Coronary Stent Placement: In order to keep the blood vessel open, a coronary stent (an expandable metal mesh tube) is placed in the coronary artery where the blockage is. The stent keeps the blood vessel open, hopefully avoiding the need for future surgery.

Thrombolytic Therapy: Thrombolytic therapy is the use of clot-dissolving drugs to open blood vessels throughout the body, including the heart and brain.

Transradial Catheterization: In this procedure, cardiologists access the heart through a catheter in the arm instead of the groin, promoting a faster recovery from cardiac catheterization.

Valvuloplasty (aortic and mitral) : This procedure is used to improve blood flow through the heart when there are problems with the heart valves. A special catheter (a tube introduced into a blood vessel and threaded to the heart) containing a deflated balloon is inserted into the opening of a narrowed heart valve. When the balloon is inflated, the valve is stretched open; then the balloon is removed.

Cardiac Rehabilitation
This program is designed to restore patients with heart disease to the best level of physical and mental function possible. Services offered include assessment, exercise prescription and formal exercise sessions, smoking cessation and patient education.

Cardiac Stress Testing & Nuclear Cardiology Service
A variety of procedures using exercise and injectable blood flow tracers as a way of testing for cardiovascular disease are available through this service. A nucelar tomography scan and a radionuclide angiogram require the injection of a small radioactive isotope into one of the veins in the arm. While exercising, a special camera scans the body and looks for and records several pictures of the isotopes location. Any dark areas on the picture indicate to the doctor the area of the heart or vascular system where the blood isnt flowing as it should. Positron Emission Tomography, otherwise known as P.E.T., is an accurate way of detecting plaque buildup in the coronary artery and ventricular dysfunction.

Cardiac Surgery
Coronary Artery Bypass (CABG) : A coronary artery bypass graft operation is a type of heart surgery. It is sometimes referred to as CABG or cabbage. The surgery is done to reroute, or bypass, blood around clogged arteries and improve the supply of blood and oxygen to the heart. These arteries are often clogged by the build-up over time of fat, cholesterol and other substances. The narrowing of these arteries is called atherosclerosis. It slows or stops the flow of blood through the hearts blood vessels and can lead to a heart attack. During bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked part of the coronary artery. An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area, or a long vein from the leg may be removed and one end sewn into the large artery leaving the heart (aorta). The other end of the vein is attached of grafted to the coronary artery below the blocked area. Either way, blood can then use this new path to once again flow freely to the heart muscle. Cardiopulmonary bypass with a heart-lung machine is used for most coronary bypass graft operations, but at Saint Louis University Hospital some bypasses can be performed without the heart-lung machine.

Off-Pump Coronary Artery Bypass (OPCAB) : This procedure is a coronary artery bypass graft done without the aid of a heart-lung machine. This technique cannot be done for all patients (and does not apply to those with valve disease), but it may reduce some of the complications associated with coronary artery bypass graft and the heart-lung machine.

Minimally Invasive Coronary Artery Bypass (MIDCAB) : Like CABG, the surgery is done to re-route or bypass blood around the clogged arteries. MIDCAB is used when only one or two arteries need to be bypassed. To perform the procedure, the surgeon makes a combination of small incisions in your chest. The cardiac surgeon usually detaches an artery from inside the chest wall and reattaches it to the clogged coronary artery.

Mitral Valve Repair and Replacement: When the heart valve between the left atrium and the left ventricle (mitral valve) malfunctions, it may be necessary to repair or replace it. With replacement, the surgeon replaces the damaged or dysfunctional valve with a mechanical valve or one from a pigs heart. The malfunctioning valve doesnt have to be replaced in all cases and often can be repaired with either a surgical reconstruction or a balloon catheter (called balloon valvuloplasty). Surgical reconstruction is mostly used for leaky, or insufficient, mitral valves, and the balloon valvuloplasty is used for mitral stenosis, or narrowing.

Transmyocardial Revascularization (TMR) : This innovative treatment involves the use of a laser and is mainly for those who suffer from severe angina but who have an area of their heart which cannot be bypassed because an artery is diffusely diseased. When severe blockage has occurred in the artery, the laser is applied and creates 10 to 50 channels. The newly created channels may fill with oxygen-rich blood, relieving the chronic chest pain associated with angina. Or, the channels may stimulate new blood supply.

Valve Replacement for Aortic Valve Stenosis: The aortic valve in the heart regulates the direction and pressure of the blood flowing from the left ventricle to the aorta and the rest of the body. Aortic stenosis means that the aortic valve has narrowed, forcing the ventricle to work harder to get enough blood to where its needed. The only way to treat aortic valve stenosis is with surgical replacement of the aortic valve.

Congestive Heart Failure Program
New drugs and other medical treatments are now providing options for longer, more productive lives to people with heart failure. The goals of SLUCares Heart Failure Program are to use medical options to successfully manage heart failure and to monitor patients closely to see if surgery is required. SLUCare cardiologists who specialize in treating patients with heart failure work closely with SLUCare cardiac surgeons when surgery such as implantation of a ventricular assist device or heart transplantation is needed.

Echocardiography
Ultrasound waves are used to determine if the heart has been damaged. By recording sound waves sent into the chest to rebound from the hearts walls and valves, the shape, texture and movement of the heart valves and walls are recorded on a VCR tape attached to an echocardiogram. They also reveal the size of the heart chambers and how well theyre working. This is a painless procedure that poses no risk. We offer several types of echocardiograms:

• Stress Echo
• Transesophageal Echocardiography
• M-Mode Studies and Two-Dimensional Studies
• Doppler Studies of the Heart

Electrocardiographic Monitoring Service
Ambulatory electrocardiography, also called Holter monitoring, ambulatory E.C.G. or E.K.G., makes a graphic record over a 24-hour period of the electric currents generated by the heart. Its done while the patient is walking or moving around with a small recorder called a Holter monitor. The main goal of ambulatory electrocariography is to document and describe occurrences of heart rhythm disturbances. These can be random, spontaneous, sleep-related, or emotion- or stress-induced. Other recorders are used for intermittent recording over a longer period of time weeks to months. These recorders are event recorders activated by the patient at times when palpitations or other symptoms may occur.

Electrophysiology and Pacing Services
This service offers up-to-date diagnostic and treatment techniques to manage arrhythmias and other electrical abnormalities in the heart. The experts who work in this service use technology to record electricity in the heart, to identify the site of arrhythmias, and to implant pacemakers and defibrillators. A non-surgical procedure called radiofrequency alblation is available to treat some types of rapid heart beating. For this procedure, a physician guides a catheter with an electrode at its tip to the area of heart muscle where the arrhythmia is originating. Then a mild, painless burst of energy (similar to microwave heat) is transmitted to keep that area from conducting the extra impulses that cause the rapid heartbeats.

Heart Transplantation ProgramClick here to go to Organ Transplantation Web page

Preventive Cardiology
The SLUCare Cardiovascular Risk-Reduction Program includes comprehensive screening followed by an in-depth explanation of the risk factors for coronary artery disease. A blood test may be taken to measure cholesterol levels, to rule out or confirm diabetes, and to analyze the thyroid hormone.