There are few things in which I take more pleasure than seeing immediate relief and renewal in patients whose chest pain affected their lives to the point of being unable to work, enjoy their family, and pursue their hobbies.

That’s what happens when a patient gets “PCI” — the acronym for a procedure involving a balloon angioplasty that opens up clogged arteries and a small wire mesh stent that keeps the artery from closing up again.

Upon receiving PCI, my patients tell me they are able to once again play with a grandchild, take a walk around the park, or even bring a load of laundry up from the basement. For them, to be able to resume a normal life free from pain, discomfort, and fear is a miracle of modern medicine.

So when I read this week’s headlines that proclaim “Drugs as good as stents,” citing a new study out of the COURAGE trial that looked at ‘quality of life’ for these patients when they took medicine alone versus having PCI, I can almost see my PCI patients shaking their heads in disbelief. Most often, PCI eliminated their chest pains or improved every day life, often when drugs did not. I worry that many individuals considering PCI, and their family members, may get the wrong idea from those headlines.
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We already know angioplasty and stenting are life-savers if you’re having a heart attack or have other unstable forms of coronary artery disease. For the patient in the midst of a heart attack, the procedure opens the clogged artery and immediately restores blood flow, literally stopping the heart attack.

For patients with stable angina, however, treatment options are not always so black and white. For these patients, there is good news this week: a new sub-study from the COURAGE trial titled “Effect of PCI on Quality of Life in Patients with Stable Coronary Disease” and published in The New England Journal of Medicine confirms that stable angina patients benefit from PCI (angioplasty and stenting) for up to two years or more when compared with patients being treated only with drugs.

To put these study results in perspective, I think it is important first to understand what is meant by “stable angina,” given the confusion that seems to persist around cardiac health. “Stable” does not imply a benign condition, as is often the misperception. Patients with stable angina may suffer extreme chest pain and shortness of breath that can severely impact their lives. They may not be able to walk up a flight of stairs, play with their grandchildren, ride a bike, or push a cart at the grocery store. It does not mean they experience mild discomfort. It means only that their symptoms are predictable and generally respond to rest and nitroglycerin. To tell a patient that a stent can immediately restore his or her quality of life for at least two years is significant. That is the take-away message from this study.
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In medicine, as with many fields, one advancement often builds on another. As we learn more about diseases and conditions, treatments evolve. Such is the case in the development of stents – the tiny, wire-mesh tubes that are placed in the arteries to help keep blockages open.

Thirty years ago, physicians in Switzerland made the first successful attempt to open a patient’s blocked artery with angioplasty, the procedure in which a small tube (catheter) with a balloon on the end is threaded through the patient’s artery to the blockage; when the balloon is inflated, it pushes open the blockage to restore blood flow. Unfortunately, in the early days of angioplasty, blockages would often close again, requiring repeat procedures.

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The new recommendations by the American Academy of Pediatrics (AAP) regarding the use of medications (statins) in children 8 years of age and older to control elevated serum cholesterol levels are aggressive, not well substantiated by scientific evidence, and may lead the public to believe that obesity can be solved with a medication.

These days, it is difficult for children and adults alike not to be overweight. Calorie-rich and nutrient-poor food is abundant and cheap at home, school, work, and everywhere we go. This dilemma is compounded by the tendency to use cars and elevators and to entertain ourselves with television and video games over walking and playing outdoors.

And, once a child is overweight, measures to reverse the course are hard to find. Medical facilities are poorly equipped to manage effectively a problem that, if left unresolved, will result in adding one more victim to the swelling masses of those dying from stroke and cardiac disease, the leading causes of death in the United States.

It is odd that in a country with a leading medical health system, health insurances pay handsomely for management of elevated cholesterol-related complications, but not for preventive measures. One would think that paying for prevention would be much cheaper. Read all »

The New York Times recently brought the use of CT scans in diagnosing heart disease to the attention of America when it ran a lengthy front-page article titled, “Weighing the Costs of a CT Scan’s Look Inside the Heart.” The article, by Alex Berenson and Reed Abelson, suggests cardiac CT is a risky, expensive test of unproven benefit prescribed both too often and often for the wrong reasons. If you or someone you love has heart disease, I suspect you now have questions and concerns about cardiac CT.

What Is Cardiac CT?
Cardiac CT (or CT) is a test that physicians can use to obtain very detailed and precise images of a patient’s beating heart and arteries. The images physicians obtain from cardiac CT provide a great deal of information about how well the heart and arteries are functioning. While not appropriate for every patient, the CT scan is unprecedented in its depth and accuracy. Cardiac CT is a significant medical advance because it helps doctors diagnose and treat heart disease — the number-one killer of men and women worldwide. In short, CT scans help cardiologists detect heart disease and develop treatment plans that save lives. Read all »

Patients and physicians alike should be reassured that drug-eluting stents are at least as safe as bare metal stents, according to a major study published this week.

While many heart disease patients may be unaware that there are different types of stents, the tiny mesh tubes used to prop open and keep open clogged arteries after they are cleared by a procedure called angioplasty, the topic of what kind of stent is best for patients has been much discussed recently in the medical community. This new study is important because it helps us evaluate what is the best and most appropriate therapy for our patients.

According to the study, published in the June 25th issue of the Journal of the American Medical Association (JAMA), the widespread use of drug-eluting stents over bare metal stents in recent years has led to a significant decline in the need for repeat procedures to unblock coronary arteries. Even more important, the study indicates that drug-eluting stents do not increase the risk of death.
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Almost a year ago, the cardiology community celebrated the 30th anniversary of the first angioplasty – a medical breakthrough that brought with it the promise of stopping heart attacks. Over the past three decades, advances in interventional cardiology have been credited with saving countless lives. According to the National Center for Health Statistics, the death rate from heart attack dropped by one-third from 1994 to 2004. This is exciting for patients and health providers alike, but what’s even better are the advances still to come.

Today, we are on the verge of a new milestone in interventional cardiology: the “brain attack” era. Some 750,000 people experience a “brain attack,” or stroke, each year in the United States, and that number is expected to rise in coming years as our population ages. Strokes are the third most common killer of men and women in America, and the top cause of disability among adults.

Just as a “heart attack” occurs when a clot cuts off blood flow to the heart, a “brain attack” (most commonly) occurs when a clot cuts off blood flow to the brain. In both cases, quick intervention can mean the difference between a full recovery and disability or even death. That is why it is so important for patients and physicians to recognize symptoms as soon as possible. While we now have powerful tools and procedures to battle brain attacks, too few physicians are trained in these tools and procedures, and too few patients understand the causes and symptoms of stroke.

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We mourn the tragic and sudden death of Tim Russert, the NBC newsman famous for his role as host of the “Meet the Press” Sunday talk show.

It is a story as shocking as it is familiar: A man in the prime of his life suddenly the victim of a fatal heart attack, leaving family and friends – in his case, a whole nation – grieving.

This story is all too familiar because coronary artery disease is the No. 1 killer of both men and women. About half of all deaths due to this disease are sudden, like Mr. Russert’s. While we do not know firsthand the specifics of Mr. Russert’s condition or how it was being treated, we do know sufferers of coronary artery disease can take steps to protect themselves. And when those steps are not enough, there are additional therapies your physician can prescribe – including medication, diagnostic procedures, and therapeutic devices – to provide further protection.

First, you need to know if you are at risk for coronary artery disease. You are at risk if you have unhealthy cholesterol levels (particularly high levels of “bad” or low-density lipoprotein, or LDL), high blood pressure, or a family history of cardiovascular disease. Other risk factors include: use of tobacco products, being overweight, chronic stress, and getting little exercise. Men who are over 50 years old are considered at risk, as are women who are over 55 years old. Read all »

The commonly used blood-thinner called heparin has received a good deal of attention lately, following the discovery that batches of the drug were contaminated, potentially causing patient deaths.

Heparin is a blood-thinner primarily used in interventional procedures, such as percutaneous coronary intervention (PCI), in patients with heart attacks and angina, and before or after surgeries to prevent the formation of clots in leg veins. The drug is also given to patients undergoing kidney dialysis and to prevent other serious medical conditions that are caused from blood clotting inappropriately. In addition, heparin is also used to coat a variety of medical devices and diagnostic products. Although it is typically delivered intravenously, heparin can also by delivered by an injection just under the skin. Because of its diverse uses in health care, heparin is a drug used very often in hospitals.

After the news broke about the contaminated heparin, manufacturers and distributors of heparin, under the oversight of the U.S. Food and Drug Administration (FDA), recalled batches of heparin to ensure patient safety. It was determined that the contaminants came from sources in China, where key ingredients in heparin were manufactured, and that the contamination may have caused up to 81 deaths.

Given this recent flurry of news on a drug that was previously little known outside the medical community, we think it is important to provide perspective on what these issues have to do with you. Patients may be uncertain about whether heparin will continue to be used and whether contamination continues to be a threat. The good news is that most health care providers, and certainly the interventional cardiology community (angioplasty doctors), are aware of the recent issues surrounding heparin. More good news is that there are other blood-thinners available for patient care, including a promising new blood-thinner called bivalirudin (Angiomax®) that has been shown to produce fewer instances of major bleeding complications than heparin and a group of blood-thinners called low molecular weight heparins.

If you are worried about an upcoming procedure that may involve the use of heparin or blood-thinners in general, be sure to discuss your concerns with your doctor. Surgery and noninvasive procedures alike can be emotionally and physically stressful enough for patients; as doctors, we don’t want concerns about your patient safety to add to what can already be a difficult time for you and your family.

J. Jeffrey Marshall, M.D., FSCAI
Editor-in-Chief, Seconds-Count.org
President, Northeast Georgia Heart Center
Director, Cardiac Catheterization Lab
Northeast Georgia Medical Center
Gainesville, Georgia

Physicians use a wide range of tests in order to diagnose and develop the best treatment plans for patients with cardiovascular disease. Among these tests are two newer imaging procedures that you may have heard about – cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI). These high-tech tests have received a lot of attention in the media in part because they let physicians see the heart and surrounding blood vessels in amazing detail, providing insights into both the structure and functioning of the patient’s cardiovascular system. After talking with and examining you, your cardiologist might opt for these non-invasive tests to help diagnose and develop an appropriate treatment plan for you.

Today, there is debate in the medical community and among regulators in Washington, D.C., about which physicians should perform cardiac CT, cardiac MRI, and other tests, and where these tests should be offered. As an interventional cardiologist who has spearheaded educational and certification efforts in cardiac CT, I believe that what is most important is the quality of care that patients receive. I believe that achieving quality of care in cardiac imaging comes down to three key points:
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