Heart Treatments Heart Treatments
Learn more about the different ways to treat heart conditions, including procedures and devices.
Cardiac rehabilitation is a medically supervised program for people recovering from heart problems. Cardiac rehabilitation involves adopting heart-healthy lifestyle changes to lower your risk for more heart and blood vessel diseases. To help you adopt lifestyle changes, these programs include exercise training, education about heart-healthy living, and counseling to reduce stress and help you return to an active life.
Cardiac rehabilitation is usually provided in an outpatient clinic or in a hospital rehab center. Your team will design a program to meet your needs. During cardiac rehabilitation, you will learn to exercise safely and increase your physical activity. The length of time that you spend in cardiac rehabilitation depends on your condition. Medicare and most insurance plans cover a standard cardiac rehabilitation program that includes 36 supervised sessions over 12 weeks.
Cardiac rehabilitation can benefit you by:
- Improving your health and quality of life
- Reducing the need for medicines to treat heart or chest pain
- Decreasing the chance you will need to go back to a hospital or emergency room for a heart problem
- Preventing future heart problems
- Providing confidence that you can safely exercise
The heart-healthy lifestyle changes in cardiac rehab have few risks. Very rarely, physical activity during rehab can cause serious problems, such as injuries to your muscles and bones, or possible life-threatening heart rhythm problems.
Learn about the devices that help restore a normal rhythm and treat damaged or weakened hearts.
Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or too fast. Defibrillators can also restore a heartbeat if the heart suddenly stops pumping blood due to ventricular fibrillation.
Different types of defibrillators work in different ways. Automated external defibrillators (AEDs), which are in many public spaces, were developed to save the lives of people who experience cardiac arrest. Even untrained bystanders can use these devices in an emergency. Other defibrillators can prevent sudden death among people who have a high risk of a life-threatening arrhythmia. They include implantable cardioverter defibrillators (ICDs), which are surgically placed inside your body, and wearable cardioverter defibrillators (WCDs), which rest outside the body. The implantable cardioverter defibrillators typically consist of a small generator (like a long-lasting battery) that is placed under the skin, as well as leads or wires that go from the generator through the blood vessels and to the heart muscle chambers. It can take time and effort to get used to living with a defibrillator, and it is important to be aware of possible risks and complications.
A pacemaker is a small device that sends electrical pulses to help your heart beat at a normal rate and rhythm. Pacemakers can also be used to help your heart chambers beat together in sync so your heart can pump blood more efficiently to your body. You may need a temporary (short-term) or permanent (long-term) pacemaker. Permanent pacemakers consist of a small battery that is implanted under the skin and one or more leads or wires that go from the battery to the heart muscle chambers.
Ventricular assist device
A ventricular assist device (VAD) is a mechanical pump that helps the heart pump blood through the body when the heart can’t pump enough blood on its own. These devices can support the function of the left, right, or both heart ventricles. Ventricles are the lower chambers of your heart. A VAD includes tubes to carry blood out of your heart and to your blood vessels, a power source, and a control unit that monitors how well the device is working. This type of heart pump may be used to support your heart until it can get strong enough to pump completely on its own again, to support your heart while you are waiting for a heart transplant, or to help your heart work better if you are not eligible for a heart transplant.
Surgery is required to connect the VAD to your heart. You will go to the hospital for the surgery and will not be awake. For the surgery, you will be placed on a heart-lung machine (also known as cardiopulmonary bypass). Your surgeon will place the pump in the upper part of your belly wall and connect the pump to your heart with a tube. Another tube will connect the pump to one of your major arteries. Your surgeon will connect the VAD to the control unit and power source outside your body. When the heart-lung machine is switched off, the VAD will support blood flow and take over your heart’s pumping function.
After your surgery, you will recover in the intensive care unit (ICU) and may stay in the hospital for 2 to 8 weeks. Hospital staff will help you increase your activity gradually to gain strength. You may start a cardiac rehabilitation program.
Your healthcare provider will watch closely for signs of infection or blood clots. To prevent infection, it is important to practice good hygiene, obtain routine vaccines, and properly clean and care for your device and the hole in your abdomen. You will be given instructions on what to do if the device gives a warning that it is not working correctly. If you are on the waiting list for a heart transplant, you will stay in close contact with the transplant center.
Support from a VAD has serious risks, such as blood clots and bleeding from the surgery or from anticlotting medicines. There are other risks, including infection, device malfunction, and possible heart failure in the unsupported side of the heart. Some patients who require a VAD are also at high risk of developing an irregular heart rhythm. Because blood tends to clot more when coming in contact with the VAD, you likely will need to take anticlotting medicines for as long as you have the device. It is important to take your medicines exactly as your doctor prescribes to prevent clots.
Total artificial heart
A total artificial heart (TAH) is a pump that is surgically installed to provide circulation and replace heart ventricles that are diseased or damaged. The surgical procedure is complex and not available at all institutions. The ventricles pump blood out of the heart to the lungs and other parts of the body. Machines outside the body control the implanted pumps, helping blood flow to and from the heart. After the procedure, you may have to stay in the hospital to prevent or manage any complications. Sometimes, people with a TAH can leave the hospital to wait for a heart transplant.
Learn about the procedures and surgeries you may need to restore blood flow, a normal heart rhythm, or treat another heart condition.
Cardioversion is a procedure that uses external electric shocks to restore a normal heart rhythm.
Cardioversion is called defibrillation when it is done in an emergency to prevent death when irregular heartbeats in the lower chambers of your heart, called the ventricles, threaten to, or actually cause, cardiac arrest. Your doctor may also schedule cardioversion as a way to treat arrhythmias in the upper chambers of your heart. Scheduled cardioversion procedures may be done in a hospital or other healthcare facility by cardiologists, the doctors who specialize in the heart. While the procedure takes only a few minutes, it requires that you arrive a few hours before the procedure. To prepare, you will be given anesthesia through an intravenous (IV) line in your arm to make you fall asleep, and you will have electrodes placed on your chest and possibly your back. These electrodes will be attached to the cardioversion machine. The machine records your heart’s electrical activity and sends the needed electrical shocks to your heart. When ready, the doctor will send one or more brief, low-energy shocks to your heart to restore a normal rhythm. You will not feel any pain from the shocks.
You will need to stay for a few hours after your procedure. During this time, your healthcare team will monitor your heart rhythm and blood pressure closely and watch for complications. You will need a ride home because of the medicines or anesthesia you received. You may have some redness or soreness where the electrodes were placed. You also may have slight bruising where the IV line was inserted in your arm.
Although uncommon, cardioversion has some risks. It can rarely cause or worsen life-threatening arrhythmias that will need to be treated. This procedure can cause blood clots to break away and travel from the heart to other tissues or organs and cause a stroke or other problems. Taking anticlotting medicines before and after cardioversion can reduce this risk.
Percutaneous coronary intervention
Percutaneous coronary intervention (PCI), also called coronary angioplasty, is a nonsurgical but invasive procedure that improves blood flow to our heart. Doctors use PCI to open blood vessels to the heart that are narrowed or blocked by buildup. It is commonly used to open a blocked artery in patients suffering a heart attack due to a blocked coronary artery. PCI requires cardiac catheterization.
A cardiologist, the doctor who specializes in the heart, performs PCI in a hospital cardiac catheterization laboratory. Live X-rays help your doctor guide a catheter through your blood vessels into your heart, where special contrast dye is injected to highlight any blockage. To open a blocked artery, your doctor will insert another catheter over a guidewire and inflate a balloon at the tip of that catheter. Your doctor may also put a small mesh tube called a stent in your artery to help keep the artery open.
You may develop a bruise and soreness where the catheters were inserted. It also is common to have discomfort or bleeding where the catheters were inserted. You will recover in a special unit of the hospital for a few hours or overnight. You will get instructions on how much activity you can do and what medicines to take. You will need a ride home because of the medicines and anesthesia you received. Your doctor will check your progress during a follow-up visit. If a stent is implanted, you will have to take certain anticlotting medicines exactly as prescribed, usually for at least 3 to 12 months, but sometimes longer.
Serious complications during or after a PCI procedure or as you are recovering after one are rare, but they can happen. This might include:
- Blood vessel damage
- Treatable allergic reaction to the contrast dye
- Need for emergency coronary artery bypass grafting during the procedure
- Arrhythmias, or irregular heartbeats
- Kidney damage
- Heart attack
- Blood clots
Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart. Restenosis, when tissue regrows where the artery was treated, may occur in the months after PCI. This may cause the artery to become narrow or blocked again. The risk of complications from this procedure is higher if you are older, have chronic kidney disease, are experiencing heart failure at the time of the procedure, or have extensive heart disease and more than one blockage in your coronary arteries.
A stent is a small mesh tube that holds open passages in the body, such as weak or narrow arteries. Stenting is a minimally invasive procedure, meaning that it can be done via a small cut or incision using a cardiac catheter and coronary balloon angioplasty rather than open-heart surgery. The most common complication after a stenting procedure is a blockage or blood clot in the stent. You may need to take certain medicines, such as aspirin and other anti-clotting or anti-platelet medicines, for a year or longer after receiving a stent in an artery, to prevent serious complications such as blood clots.
Catheter ablation is a procedure to stop abnormal electrical signals from moving through your heart and causing an irregular heartbeat (also known as an “arrhythmia”).
Doctors perform catheter ablation in a hospital. Ablation is done through a procedure called cardiac catheterization that passes flexible tubes, or catheters, through your blood vessels until they reach your heart. Some catheters have wire electrodes that record and locate the source of your abnormal heartbeats. Other catheters can deliver treatments. Your doctor will aim the tip of a special catheter at the small area of heart tissue that is causing the heart rhythm problem. A machine will send either radiofrequency (RF) waves, extremely cold temperatures, or laser light through the catheter tip to create a scar on the heart. The scar prevents abnormal electrical signals from causing irregular heartbeats. Sometimes if you have to get heart surgery for another reason and also need an ablation, the ablation may be done during surgery.
Catheter ablation has some risks both during the procedure and during recovery, including:
- Blood vessel damage
- Heart damage
- Blood clots
There also may be a very slight risk of cancer from radiation used during catheter ablation. Talk to your doctor and the technicians performing the ablation about whether you are or could be pregnant.
Coronary artery bypass grafting (bypass surgery)
Coronary artery bypass grafting (CABG pronounced like “cabbage”), sometimes called coronary artery bypass surgery or just bypass surgery, is a procedure to improve poor blood flow to the heart muscle. The surgery creates new paths for blood to flow to the heart when the arteries that supply blood to the heart itself, called coronary arteries, are narrowed or blocked. The surgeon attaches a healthy piece of blood vessel from another part of the body on either side of a coronary artery blockage to bypass it. This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, which can cause chest pain or even heart failure. It may also be used in an emergency, such as a severe heart attack, to restore blood flow.
Transcatheter aortic valve replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a procedure to replace a faulty aortic valve with an artificial aortic valve. This is a procedure that can be done with a cardiac catheter that enters the body through a small incision and travels through the blood vessels. Your doctor may recommend TAVR if you have a medical condition that makes it too risky to replace the valve during open-heart surgery, which is far more invasive. The use of TAVR has also been extended to patients who are at less risk.
Heart surgery corrects problems with the heart and blood vessels around the heart if other treatments haven’t worked or can’t be used. Depending on your condition and your health, you may have traditional heart surgery, often called open-heart surgery. In this type of surgery, you are connected to a cardiopulmonary bypass machine, also called the heart-and-lung machine. The heart-and-lung machine pumps your blood through your body during surgery so that the surgeon can then stop your heart from beating to complete the procedure.
Some heart surgeries can now be performed while the heart is still beating. This is called off-pump or beating-heart surgery.
Any type of surgery involving the heart comes with some risks. However, your risk of complications is higher if the heart surgery is done in an emergency situation or if you have other diseases or conditions.
A heart transplant is surgery that removes a diseased heart and replaces it with a healthy heart from a deceased donor to improve your quality of life and increase your lifespan. Heart transplant surgery is a kind of open-heart surgery. It is done in a hospital under anesthesia.
After the surgery, you will recover in the hospital’s intensive care unit (ICU) and stay in the hospital for up to 3 weeks. During your recovery, you may start a cardiac rehabilitation program. Before leaving the hospital, you will learn how to keep track of your overall health; monitor your weight, blood pressure, pulse, and temperature; and learn the warning signs that your body may start rejecting your new heart. You will also learn to look out for early signs of an infection.
For the first 3 months after leaving the hospital, you will return often for tests to check for infection or rejection of your new heart, to see how well your heart is working, and to make sure that you are recovering well. You can help prevent complications after a heart transplant by practicing good hygiene, getting routine vaccines and dental care, and making healthy lifestyle choices.
Heart transplant has some serious risks.
- Primary graft dysfunction happens when the donor heart fails and cannot function. This is the most common cause of death in the first month after heart transplant.
- Your immune system may reject your new heart. Rejection is most likely to occur within 6 months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance for infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys.
- Cardiac allograft vasculopathy is a common and serious complication of heart transplant. This complication is an aggressive type of atherosclerosis, or buildup of plaque in the arteries, that over a few months or years can block the heart’s arteries and cause the donor heart to fail.
Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.
Despite these risks, heart transplant has a good success rate. Recent survival rates are about 85% at one year after surgery. Survival rates decrease by about 3% to 4% each extra year after surgery, mainly because of serious complications related to heart transplant.