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Wednesday, March 10, 2010

30 Years of Miracles - Heart Disease


The other day while I was working, we had a man come in who was having a massive heart attack. We sprang into action, administered life saving treatment, administered drugs to open his blocked coronary artery, and had him out of our ER and on his way to the tertiary hospital and the cardiac cath lab for definitive treatment in less than 50 minutes. When he arrived at our place he appeared near death. By the time he left, he was pain free and smiling and joking with the nurses.

I mentioned to the staff how lucky this man was to have had his heart attack today and not 20 years ago. I am entering my 30th year as a physician and this moment gave me some time to reflect on some of the true miracles I have seen happen in medicine in the relatively short time I have been a doctor. I’d like to share some of my observations with you.

Lets start with:

HEART DISEASE

When I first became a doctor, if you had a heart attack, we would stick you in an ICU somewhere. We’d give you nitroglycerine and morphine. If you didn’t die right away, you’d lay in the hospital “resting” for days or even weeks. In the meantime your blocked coronary artery would remain blocked and while you were “resting” and you’d croak off a significant amount of your heart muscle. If you didn’t croak off too much of it, you might be able to return to a relatively normal life until another one of your blocked coronary arteries got your goat. If you lost a lot of heart muscle, you’d spend the remainder of your days in a rather miserable existence in unrelenting and progressive congestive heart failure.

Bypass surgery was pretty new. A few patients got bypass, but in many cases, the damage was already done.

When I was a new doctor, if you had a heart attack, your outlook was usually pretty grim. My father suffered this fate. If we had had the technology in the 1970’s that we have today, my father would have survived a lot longer.

I remember in the 1980’s we began to see “interventional cardiologists” coming on the scene, and then we began seeing some of these cardiologists taking recent heart attacks to the “cath lab” where they would run a catheter up the patient’s groin to the heart, squirt some dye in the coronary arteries, and then put a balloon (angioplasty) into the blockage and actually open the offending blockage. At last, a way to definitively treat the problem. Unfortunately in many many cases the treatment was temporary and the diseased area would quickly become blocked again. A better solution was needed.

There was hope for us in the primary care area as well. New drugs were invented that we could give patients in a simple IV that would miraculously dissolve blood clots that formed in coronary arteries. We found that we could actually abort or reverse a heart attack in many of these patients. I can remember scores of people who would become pain free after these drugs and their grossly abnormal EKG’s would return to normal before our eyes. They still had to go to the tertiary hospital for either angioplasty or bypass surgery, but it was immediately obvious to us that we were giving hope to many who would have had no hope before.


Since balloon angioplasty frequently would fail after a short time it wasn’t long before the idea of the stent came along. The stent is simply a little flexible tube made of metal mesh. After the blocked artery is ballooned open, the stent is inserted and expanded into the blocked area. Although stents do clot off more times than we would like, the success rate was much higher than with angioplasty alone. More lives saved and more lifestyles enhanced! Many patients who had gone to bypass before could have angioplasty and a stent and be back to living life in a very short time.

Many new drugs have come on the scene as well. The statin agents which effectively reduce cholesterol have been a Godsend. In the old days, we used to torture people with ridiculous diets that most would not follow and I had my doubts about their effectiveness of them anyway. High cholesterol is for the most part genetic. Your eating habits probably have only a minor and secondary roll. The statin drugs have given us an effective way to manage the problem.

We have developed better understanding of drugs such as beta blockers, ACE inhibitors, and anticoagulant drugs and their relation to coronary disease. We know that when these drugs are properly used and prescribed that positive outcomes result in people with heart disease.

Today, even our small hospital is an accredited chest pain center. We have undergone many hours of training and developed protocols and relationships with the tertiary hospitals. The goal is to have patients at the cath lab within 90 minutes of the onset of their symptoms and in the interim provide life saving treatments that 30 years ago would have seemed like science fiction. We understand that “time is muscle”. The faster the blocked coronary artery can be opened, the better the outcome.
The advances in the care of heart disease in the last 30 years have indeed been miraculous. The work never stops. Seems like almost everyday we discover something new which makes life better for all.

I’ll cut it off here and come back with another installment where I talk about new miracles in diabetes care.

11 comments:

  1. It is amazing how things have changed. I'm so thankful for modern miracles, especially in heart disease. It is no respecter of persons, young, old, those who watch their diets and those who don't.

    Debbie
    Right Truth
    http://wwwl.righttruth.typepad.com

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  2. Hi Grouch!

    You're right...I'm a lucky man!

    Having recently had a heart attack ( Feb. 11th), I had a chance to experience these medical miracles first hand.

    Regards,
    Rob Miller

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  3. And here it comes, just in time for ObamaCare and managed health by the government:

    Too many patients are getting angiograms:
    From USA Today.

    " A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests.

    The researchers said the findings suggest doctors must do better in determining which patients should be subjected to the cost and risks of an angiogram. The test carries a small but real risk — less than 1% — of causing a stroke or heart attack, and also entails radiation exposure."

    http://www.usatoday.com/news/health/2010-03-10-heart-angiograms_N.htm

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  4. Think of this one Grouch: My Grandmother of Blessed Memory, passed away in 1969 after having her 8th Heart Attack in 40 years.

    At no time was she ever hospitalized for any attack, the doctor came 3 times a day to see her, once he stayed overnight to watch her, and she outlived 5 doctors.

    Times were different then. Doctors practiced differently too. They cared more about the patient, less about lawsuits.

    Grandma was 92 when she passed, peacefully, with her daughters surrounding her, in her own home. The doctor's bill was $350. Yes it was steep for the day, but the doctor made 3 housecalls a day for 10 days.

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  5. Freedom Fighter, I hope sll goes well for you until your troubles are resolved.

    Findalis, you are correct, things were a lot different back when your grandmother was alive, much more personal. In those days medical decision were between the patient and the doctor......and then the federal gubment took it upon itself to become involved. From that point, we have enjoyed a downhill slide in the patient-doctor relationship.

    When I first started I made housecalls. I did this until I discovered that the federal gubment would pay a nurse a lot more than me to see a patient at home. It made no sense from a bidness standpoint to continue to make housecalls.

    There ya go.......thanks federal gubment.

    In spite of gubment intrusion, idea and innovation have continued. I fear if Barack and his facists have their way, this may no longer be the case.

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  6. Well, Grouch,
    As you know, I hab been keeping tabs on heart attack/disease firsthand. You oughta well member when I had my first (and only) heart attack. Oct. 31, 1990. I had an idjit cardiologist (patientwise, not technology wise). Anyhow, after surviving him and the Heart Attack, 9 years later, when the elephant tiptoed acrost my chest again, I runned to the ER. I had 4 bypasses, even tho I DID NOT have a heart attack. Heart technology HAS COME A LONG WAY IN THE LAST 20 years. I sincerely hope it continues to progress at the same rate.
    In closing, Good Post.
    See ya at Dayton!

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  7. Yeah, Lizzard, when are you and Booger gonna pick me up?

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  8. We should think more about the eating habits we have ... more fruits and vegetables and less junk food would not be bad ... also exercise would be very good on our part ... thank you

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  9. I get so tired of hearing people that don't want change. The fact is that many other countries have socialized medicine. This legislation, while long, is not even socialized. It will not take effect for awhile and ultimately so many alterations were made that it is practically useless. It is easy for the members of Congress to waste a year talking, because they have the best insurance (government by the way). People like Dick Cheney are totally covered even though he clearly needs to make life style changes. I say that Congress should have the same rules as anyone else and those like Dick Cheney should refuse insurance to prove a point. You might say, "Hey, they work." First, who cares? Second, lots of Americans work and don't have insurance and/or have to pay through the nose in premiums and co-pays. By the way, I will take that Medicare. It isn't that bad. These docs are greedy. The fact is if they practiced more modestly, house calls are paid plenty for. I know. I had a doctor that billed insurance for house visits. If you are greedy as anything, perhaps the $90 for a 20-30 minute appointment isn't enough. By the way, pretty high for a phone consult too. I am grateful to have insurance.

    Last comment: The people first to want insurance and access to government programs when in a bind are those who are opposed to government help until they need it. I have a friend who is "Republican." She went on public aid after conceiving out of wed lock (not that I care about the baby being born this way), but it is hypocritical. She also got WIC, assistance for housing, and yes money and food stamps. I also have another "Republican" friend. He wanted to take advantage of the Weatherization program in our county. Geez! He had money. Take a position. I was shocked. But it reminds me of a saying: "Where you stand depends on where you sit." Translated, your position on issues depends upon your situation.

    As for "Obamacare," the private insurance companies are loving this one. The reason is that federal subsidies will be granted to low income persons and those will go to the private health care industry, which equals lots of profit. Sorry, this isn't really nationalized health care. HMOs became popular after Nixon, who liked Kaiser because it allowed profit for medical care. It is on tape, because he didn't know better than to not tape himself. So, yes, the premiums are going up. The less people insured, the higher the rate. It is simple economics. I say everyone should lose coverage for about a month, especially the self-righteous. Then, we will see how you feel. Here is a final question: Do you care if a small child dies due to lack of health care? Ask yourself if you would want a child to die. If you are "pro-life," think about the answer carefully. I am sick of this kind of information. Docs make plenty of money. Not all of them are this greedy though.

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  10. HOW IS ANGIOPLASTY CARRIED OUT


    In today’s modern world, changing lifestyles are leading to increase in the number of diseases related to the heart. With that, many techniques of surgery for the heart have come up. Of all the available options for surgery, Angioplasty has proved to be one of the safest ways.

    Angioplasty was first used in the late 70’s. It involves the widening of an obstructed blood artery, which has happened because of atherosclerosis, by mechanical means. A balloon catheter, which is an empty one and is collapsed, is taken and it is passed through the location where the surgery is to be done. Then the catheter is inflated by pressure which is around 200 times compared to that of the blood pressure.

    The inflated balloon has sufficient pressure in it to crush most of the fatty deposits on the sides of the artery walls. Thus, the artery opens up properly and the flow becomes proper and the obstruction is now minimal. After this is done, the catheter is collapsed and made empty and is finally withdrawn.

    Angioplasty is of several types based on the location of the arteries which have been blocked. Some of these are Renal, Cerebral, Coronary, etc.

    Once Angioplasty is done, the patient is kept under observation for a day or two. The blood pressure is monitored continuously along with the heart beat rate. Proper medications are given if necessary.

    Since the time from which it has been put to use, Angioplasty has helped lot of patients and has saved their life. The best outcome of it is the prevention of heart attacks and bypass surgeries.

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