Conditions We Treat
Mount Sinai Heart's interventional cardiologists diagnose and treat various heart conditions causing stenotic (narrowed) coronary arteries and are highly skilled in performing the full range of minimally invasive procedures—from basic to highly complex–for coronary conditions that include:
Angina has the same root cause as a heart attack — atherosclerosis, which is narrowed or blocked coronary arteries due to cholesterol-related plaque. There is an important difference between the two, though. A heart attack occurs when the blood flow to a section of the heart is completely blocked and causes permanent damage to the heart muscle. Angina, on the other hand, doesn’t cause permanent damage.
There are two types of angina:
Stable Angina is caused by a fixed blockage in one or more coronary arteries. The pain is predictable, occurring during physical exertion.
Unstable Angina gives you unpredictable chest pain of increasing severity when you are at rest. This tells you that the angina is getting worse or that a heart attack is imminent.
If you have angina, you may experience chest pain that feels either dull and heavy, or tight – like pressure or squeezing. The pain can spread to your throat, neck, jaw, teeth, and left arm. You may also have other symptoms including sweating, feeling nauseated or dizzy, and difficulty breathing.
Treatment for Angina
Mount Sinai Heart cardiologists often begin angina treatment with medications called coronary vasodilators, which help your blood vessels relax. When relaxed the flow of blood, oxygen, and nutrients to your heart improves. We may also use medications including nitroglycerin, beta-blockers, or calcium antagonists, to treat angina.
If medications don’t sufficiently correct angina, we may perform an angioplasty to improve blood supply to the heart or coronary artery bypass surgery, using a vein from the patient’s leg to reroute blood around the blocked artery.
Aortic Stenosis is a condition that causes your aortic valve, which regulates blood flow from your heart to the rest of your body, to narrow. This narrowing reduces the blood supply to your body and increases strain on your heart. Affecting an estimated 300,000 people worldwide, aortic stenosis stems from a variety of causes including birth defects and progressive, age-related calcification of the valve.
Some people with aortic stenosis have no symptoms. Others can have reactions ranging from mild to severe, especially with exercise. Symptoms may include:
- Extreme fatigue with physical exertion
- Dizziness or fainting with physical exertion
- Pain, squeezing, pressure, or tightness in the chest, usually with physical exertion
- Rapid or irregular heartbeat (also called palpitations)
- Shortness of breath
To diagnose aortic stenosis, our doctors do a physical exam to listen for abnormal chest sounds (such as a heart murmur) and feel any vibrations (by holding a hand over your heart). We also do tests to confirm the diagnosis, which may include an electrocardiogram or an echocardiogram.
Treatment for Aortic Stenosis
Depending on the severity of your condition, treatment may include monitoring, lifestyle modifications, medication, a minimally invasive procedure, or surgery. Medical interventions for aortic stenosis can include diuretics (water pills), beta-blockers, and nitrates. If medication and lifestyle modifications are not enough your physician may suggest surgery.
Procedures offered at Mount Sinai Heart for the treatment of aortic stenosis include: balloon valvuloplasty, aortic valve replacement surgery, and transcatheter aortic valve replacement/implantation.
Peripheral arteries supply blood to the outer areas of the body. When those arteries become narrow or blocked, usually in the pelvis or legs, we call it peripheral artery disease (PAD) or peripheral vascular disease. Approximately 10 million Americans suffer from PAD, which is most usually caused by atherosclerosis, a build-up of fat and cholesterol deposits called plaque that hardens over time. This condition reduces the flow of oxygen-rich blood to your limbs.
Peripheral artery disease can be hereditary, with risk factors that include: aging, atherosclerosis, diabetes, high cholesterol, high blood pressure, obesity, physical inactivity, renal disease, and smoking.
While peripheral artery disease may develop without any obvious signs, patients suffering from the disease may experience the following symptoms:
- Claudication, which is pain, fatigue, tightness, or cramping in the leg after exercise
- Coldness or numbness in the arms, legs, fingers, or toes
- Erectile dysfunction
- Loss of sensation in the arms or legs
- Muscle spasms
- Non-healing wounds or skin ulcers / gangrene tissue
- Pain in the calves and feet
- Skin ulcers
- Thinning or loss of hair on the arms and legs
To diagnose peripheral artery disease, we usually do a physical exam, including checking the strength of the pulse in your legs. We also conduct tests including but not limited to ankle-brachial index (which compares blood pressure in the leg to blood pressure in the arm), angiography, arterial or venous duplex ultrasound, and echocardiogram.
Treatment for Peripheral Artery Disease
There is no cure for peripheral artery disease but we can reduce symptoms, improve function, and try to prevent future cardiovascular issues such as stroke or heart attack. When designing a treatment plan, our physicians consider your age, lifestyle, and the severity of your PAD.
Typically, our physicians recommend certain lifestyle changes, such as losing weight, increasing exercise, and quitting smoking. In addition, our doctors may prescribe antiplatelet or cholesterol-lowering agents, or other medications to help manage the disease.
At Mount Sinai Heart we also offer expertise in a full range of non-surgical and surgical procedures to treat PAD. Our physicians are highly-skilled in performing balloon angioplasty, stent implant, endarterectomy, cryoplasty, laser atherectomy, rotational atherectomy, and bypass surgery.
In severe cases or when minimally invasive options have failed, we may perform bypass surgery. This procedure redirects blood through a special grafted blood vessel–one that is surgically attached–so blood "bypasses" or avoids the constricted blood vessel and flows normally through the leg.
Chronic Total Occlusion (CTO) is a condition where your coronary artery, the blood vessel that brings oxygenated blood to the heart, has been completely or almost completely blocked for at least three months. CTO causes a range of problems, including ischemia, angina, and poor left ventricular function.
Treatment Options for Chronic Total Occlusion
While the American College of Cardiology recommends a procedure called a coronary artery bypass graft (CABG) for cases involving CTO in more than two vessels, this highly invasive surgery can pose a risk for elderly patients. As an alternative, we at Mount Sinai Heart offer a minimally invasive procedure called percutaneous coronary intervention (PCI). With this procedure, we thread a catheter fitted with a device (such as a stent, balloon, or grinding instrument) from a small incision in the groin or arm to the problem site in the heart, where it opens the blockage, restoring adequate blood flow. We currently use two types of PCI procedures:
Antegrade (front-end) approach, with which we have an 80 percent success rate at Mount Sinai Heart. We have developed technological advances, including ‘floppy’ and ‘stiff’ wires, which further increase our success rate.
Retrograde recanalization (back-end) approach, which involves insertingtwo guide wires that are carrying catheters, into the groin and femoral arteries. These wires use smaller blood vessels, called collateral vessels, which enlarge to serve as a detour around the blockage. When the wires breach this blockage, we thread a balloon and stent to the problematic site to clear a channel lengthwise and restore proper blood flow. This approach usually requires two procedures spaced six to eight weeks apart, and takes about twice as long to perform as the antegrade approach. We use retrograde recanalizationwhen the antegrade approach has proven ineffective.