Now hundreds of thousands of coronary bypasses are done each year in the United States as well as a couple of thousand heart transplants — which could be more if there were more donors.
But surgery is the last resort. There are many tests, invasive and noninvasive, which can reveal your risk of a heart attack before it gets to the surgery stage.
“You can basically assess someone’s risk for having a heart attack over the next 10 years,” said Dr. Imran Arif, MD. Arif, an associate professor at the University of Cincinnati Medical School, is an interventional cardiologist and does procedures at the West Chester Medical Center.
“One of the methods that we currently use is called the Framingham Risk Score. By that method, the risk factors such as age, whether you are male or female, whether you have diabetes or high blood pressure, high cholesterol, if you smoke, and a family history. All of these are put into a certain calculation and then your risk comes out over the next 10 years as to what is your risk of having a heart attack,” Arif said.
Arif explained that the method separates patients into three categories: low, intermediate or high risk.
“If you have a low risk, that means you have less than a 10 percent chance of having an event in the next 10 years. Intermediate risk is 10 to 20 percent chance and high risk is more than 20 percent chance of having an event,” he said. “The higher the risk, generally more aggressive testing is recommended. If you have the typical symptoms of heart pain and your risk is more than 20 percent, some people proceed towards a more invasive treatment and evaluation.”
The American Heart Association Web site (www.heart.org) lists and explains the EKG, an Echocardiogram, a CT scan of the heart, and the exercise stress test as non-invasive procedures.
Low-risk patients often should not have the procedures done.
“If you are really, really low risk — you don’t have any risk factors, you are under 30 years old, then generally, you should not be doing some of these tests because you can be dealing with false positive results,” he explained.
Dr. Harvey Hahn, MD, is with Alliance Cardiology in Sidney and does procedures at Wilson Memorial Hospital.
He said that the echocardiogram and an exercise stress test — with or without nuclear medicine — are some of the most common procedures.
“If someone comes in with symptoms that are typically related to your heart such as shortness of breath, chest pain or a pressure or any other kind of chest discomfort, we would probably get a stress test,” he said. “What that does is it lets us monitor the electrical part of the heart at rest as well as during stress. During stress, if there is a blockage in an artery, your heart is not going to do as well as it should.
“(Echocardiograms) are good because there is no radiation with an echo and you can see what size the heart is and how well it works, how well the valves work and if you have slightly leaky valves,” he explained.
If a problem is indicated, the more aggressive treatment could be ordered and may consist of a heart catheter and possible angioplasty.
“If you have a blocked-up artery in your heart, we can run a wire up to your heart from a puncture in your leg,” Hahn said, describing both the catheter and the angioplasty. “We can go up there and put the wire into the blocked area and take a (collapsed) balloon up there and blow it up and crush all the cholesterol or plaque and the artery will get more blood flow, enabling you to do more and have less chest pain and shortness of breath.”
Hahn added that a stent is often used in the area to keep the artery open.
One major advance in heart catheters is in stereotaxis — a procedure involving magnets and a fluoroscope.
Kettering Medical Center’s Benjamin and Marian Schuster Heart Hospital has the only such machine in operation in the Miami Valley, although Miami Valley Hospital’s machine in its new Heart and Vascular Center should become operational in a few months.
Michael Brendel, RN, Director of Cardiac Services for KMC, explained that the stereotaxis has large magnets which are swung into place to help the electrophysiologist place the catheter more precisely.
“For a variety of reasons, the heart will develop an irregular heartbeat,” Brendel said. “So heartbeats can be regular until there is stress applied to it. That stress can be exercise, lack of oxygen or injury. Most often, we recognize it when there is an adrenaline rush.
“However, if you have malformed electrical pathways in the heart or if the heart sustains damage, there can be electrical irregularities or what we call arrhythmias,” he explained.
“We have an electrophysiologist who studies these pathways to the heart. These are cardiologists who have a subspecialty in the electrical conduction system of the heart,” Brendel said. “What stereotaxis does is, it allows us to take the (electrical) path areas of the heart and use specific wires to go to the desired location of the heart and ablate or change the tissues there with radio-frequency (waves.)
“The ablating makes an ineffective electrical pathway go away — basically it causes the circuit breaker to flip in that area of the heart. And we are talking about a very small area of the heart that we have to ablate. Stereotaxis uses magnetic navigation systems to pull these very fine catheters to the area of the heart that we can’t get to by pushing a wire. We bring a magnet from either side of the patient and we combine that magnet’s power with a computer and joystick so we can look inside the heart and pull those small wires where we need them and then perform the RFA.”
Brendel said the procedure has shown fewer complications and lowers the amount of time that the patient is exposed to the fluoroscopy.
Another new procedure that minimizes the amount of surgery on the heart was mentioned by Hahn — replacing a faulty aortic valve by use of a catheter rather than the standard major surgery.
“There are probably five or 10 places right now — it is still in clinical trials,” he said. “But in the next five years, it is going to be pretty wide open and a lot of people will do it. The valve is collapsed and you pull on it and it springs open like an umbrella.”
He added that the valve doesn’t have to be sewn to the heart.
“It self-expands and it goes up and attaches to the wall,” he said.
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