Understanding more about heart disease is a critical first step in identifying your risk factors. Heart disease is actually a blanket term that includes several more specific heart conditions, such as angina, arrhythmia, and heart valve disease, among others. They all restrict or block adequate blood flow to the heart, which could result in death. The most common type of heart disease in the U.S., coronary artery disease, most often leads to heart attack. Almost two million people in the United States suffer heart attacks each year, resulting in more than 500,000 deaths. The risk of coronary heart disease can be reduced by taking steps to prevent and control adverse factors that put people at greater risk, such as high blood pressure, being overweight, diabetes, and physical inactivity.
Dr. John Harper, a cardiologist at Texas Health Presbyterian Hospital Dallas and inpatient director of cardiovascular services, says more people are becoming aware of the severity of heart disease as well as the effects of a heart attack and are finally following their doctors’ orders about taking preventive measures that can reduce their risk.
“Cardiologists spend a lot of time with their patients educating them about heart disease,” Dr. Harper says. “Our patients are finally getting the message that they’ll have a much greater chance to reduce their risk of heart disease if they’ll adopt a heart healthy lifestyle early on. Patients already diagnosed with heart disease, or those with a family history or other risk factors, also have a greater chance of overcoming it by seeking treatment early.”
One risk factor of heart disease everyone faces is simply getting older. The latest preventive and intervention procedures are keeping cardiac patients alive much longer. “Not as many people die of acute heart attacks as they once did,” Dr. Harper says. “However, they wind up living with their heart condition longer, which keeps them at a continual level of risk. If someone has suffered a heart attack, the damage to the heart is still there, so they must remain proactive in their health care for the rest of their lives.”
The nation’s authority on healthy hearts, the American Heart Association, recommends that heart attack prevention begin by age 20. Because first-ever heart attacks or strokes can be fatal or disabling, prevention is critical. Some risk factors for heart disease can be modified, treated, or controlled; others can’t. Major risk factors that can’t be changed include increasing age (82 percent of people who die of coronary heart disease are 65 or older), gender (males tend to have a greater risk of heart disease, although more women die from it), and heredity. Risk factors that can be modified include smoking tobacco, high blood cholesterol, high blood pressure, physical inactivity, obesity and being overweight, and diabetes mellitus. Then there are contributing factors to heart disease that don’t necessarily cause the disease but can negatively affect it such as stress, alcohol consumption, and poor diet and nutrition.
Heart disease can be identified earlier than ever before thanks to the latest noninvasive procedures. With early intervention measures and preventive lifestyle changes, cardiac patients can pause or even reverse the effects of heart disease and hopefully avoid invasive heart surgery altogether. In fact, recent studies show that because of the latest detection technologies, bypass surgery rates are on the decline for the first time in years.
DIAGNOSING HEART DISEASEYour cardiologist may request one or more of the following tests to determine whether or not you have heart disease or to identify its stage and severity so you can get the most effective treatment.
Nuclear Stress Test
A nuclear stress test determines blood flow and blockage of arteries supplying the heart muscle. It is done by injecting medically safe levels of a tracer substance that is evaluated by pictures of the heart taken before and after stress testing. A nuclear scan is done to accurately determine blood flow and heart muscle function in a person suspected of coronary artery blockage.
Conventional & 3D Echocardiogram
Echocardiograms can identify the size and shape of a heart, its pumping capacity, and the extent and location of any damage to heart tissues. It’s an especially helpful tool to assess heart valve diseases and detection of coronary artery disease and to determine whether chest pain may be related to heart disease. A conventional echocardiogram offers a two-dimensional view, but the latest ultrasound systems now offer three-dimensional imaging. Physicians with Methodist Dallas Medical Center have incorporated 3D technology into the hospital’s echocardiogram program. Applying 3D technology to heart disease treatment provides physicians and patients a chance to expand and improve on cardiac diagnostics. Dr. Imran Afridi, an independently practicing cardiologist on the Methodist medical staff, says the use of real-time, three-dimensional echocardiography can help fine tune a diagnosis in situations where traditional echocardiograms are not completely clear. Such assessments are vital for the physician and patient in making medical and surgical decisions.
The new Hamon Tower at Texas Health Presbyterian Hospital Dallas is the first facility in Texas and among the first in the country to begin using Flash CT, the world’s fastest CAT scanner that eliminates the need for some exploratory surgeries and helps doctors diagnose life-threatening conditions in seconds.
The 128-slice scanner captures high definition images so rapidly that radiation exposure is significantly reduced, representing an important advancement in CT scan diagnostics. For cardiac scans, radiation dosage can be reduced by more than 90 percent.
The “shutter speed” of Flash CT’s $2 million camera is so quick that an entire chest scan can be done in a half second so patients don’t have to hold their breath or take medications to slow their heart rates. It’s called ‘flash’ because that’s how long it takes to get detailed, three-dimensional images of the inside of the body. The result is double resolution, double speed, and twice the power, while lowering radiation doses.
The detail provided by Flash CT allows physicians to see some cardiac blockages that, in the past, required intravascular cardiac catheterization procedures to diagnose. In some cases, the patient may not have a blockage or serious condition at all. In other instances, chest pain can be caused by pote- ntially deadly non-cardiac complications, like an aortic aneurysm or a blood clot in the lungs.
Now, in a matter of minutes, physicians will be able to rule out possible causes of some conditions, possibly allowing some patients who would have otherwise spent hours or days in the hospital to go home the same afternoon.
Cardiac Magnetic Resonance Imaging
Cardiac MRI uses a strong magnetic field and radio frequency pulses to provide clear and detailed diagnostic images of internal body organs and tissues. MRI is a valuable tool for the diagnosis of heart disease or to determine the extent of heart disease prior to surgery. A cardiac MRI can scan the heart, aorta, coronary arteries, and blood vessels. Using MRI, doctors can examine the size and thickness of the chambers of the heart and also determine the extent of damage caused by a heart attack or heart disease. Southwest Diagnostic Imaging Center frequently uses cardiac MRI to evaluate heart disease.
“Using MRI, cardiologists can determine whether or not the heart can be repaired or to determine which procedure is best for the patient’s condition,” says Cynthia Sherry, M.D., FACR and general radiologist with Southwest Diagnostic Imaging Center. “The MRI is better at looking at the heart muscles, and the CT is better for looking at the coronary arteries. We can fuse them together to get a nice picture of what’s going on with a patient’s heart.”
TREATING HEART DISEASE“Most likely, you won’t completely overcome heart disease just because you follow every recommended guideline, take the right medicines, eat right, and exercise,” Dr. Harper says. “But doing all of this, along with receiving the latest diagnostic and treatment procedures, will give you an improved chance of prolonging your life. Doctors want their heart patients to have both quantity and quality of life. Fortunately, today’s cardiac patients have the opportunity for both.”
Some of the latest interventional cardiology measures taking place in Dallas area hospitals include:
Approximately eight to 12 million Americans have peripheral artery disease, a circulatory disorder that occurs when plaque clogs leg arteries. Left untreated, peripheral artery disease can lead to heart attack and stroke. And because patients with PAD tend to seek treatment at the later stages of the disease, amputation remains the most common treatment.
CryoPlasty, or cryo-balloon angioplasty, is a new type of therapy for peripheral vascular disease. Clogged or narrowed arteries can be opened using this new vascular therapy that cools and dilates the vessel at the same time. CryoPlasty appears to be promising in combating the stubborn problems of arteries reclogging. The CryoPlasty technique is similar to angioplasty procedures used in heart vessels, except stents are not used to keep the blood vessel open. Fortunately, CryoPlasty offers a safe, minimally invasive alternative for treating PAD. This treatment – a novel form of balloon angioplasty – restores blood flow to the leg by “freezing” the plaque as it opens up the blocked artery. Patients who undergo the procedure typically go home within a few hours.
“About 40 percent of patients treated with angioplasty or stenting need to be treated again within a year,” says Dr. Tony Das, an interventional cardiologist with Texas Health Dallas “This reappearance of a blood-flow obstruction is referred to as ‘restenosis.’ We’re investigating whether CryoPlasty could inactivate those cells that produce scar tissue following traditional balloon angioplasty. Initial research suggests CryoPlasty could reduce the number of patients needing revascularization to 15 percent, a significant improvement.”
A chronic total occlusion is as an artery that has been completely blocked for more than 30 days. Chronically occluded coronary arteries account for approximately 20 to 30 percent of the documented coronary disease encountered in coronary catheterization labs today. Currently, there are three methods for treatment of chronic total occlusion–percutaneous intervention, coronary artery bypass, or medical management. Dr. Das has been investigating the effectiveness of other less invasive techn- ologies to treat once impenetrable blockages, such as the Crosser System, a type of catheter that utilizes high frequency, mechanical vibration to help breach or cross dense block-ages allowing for balloon angioplasty and stent placement.
“Thus far, these devices have been far better at opening up blocked arteries,” he says. “They’re helping achieve the goal of finding better ways to effectively treat chronic occlusions while limiting impact on patients. We know that angioplasty and stent placements are some of the best tools in the world to open clogged arteries, but chronic total occlusions have always created an additional challenge. To use these tried and true methods, we have to be able to get through the blockage with the guide wire, which isn’t always possible. These new technologies are helping us do that in more and more cases every day.”
Angioplasty is used to prevent the occurrence of angina or a heart attack. The term angioplasty means remodeling of an artery. Coronary angioplasty refers to the use of one or more techniques to open a diseased coronary artery. Various angioplasty techniques have been developed to enlarge narrowed arteries without having to perform surgery. The goal is to reestablish good blood flow to all areas of the heart muscle.
A heart attack can occur when blood flow to the heart is restricted due to plaque. If blockages occur in your arteries, your doctor will order a cardiac catheterization. This is a specialized diagnostic procedure designed to determine specific functions of your heart. It involves a small catheter being inserted into a groin (leg) artery and advanced up to the heart. Dye is then injected into the coronary arteries to visualize the blood flow. If any blockages are found, the doctor may choose to perform a balloon angioplasty to open the vessel. A stent may be used at this time to maintain an open artery. When the catheter is removed, the artery is more widely open and good blood flow to the heart is restored.
HEART HEALTH: WHERE TO TURN FOR HELPMethodist Dallas Medical Center
The Sam & Anne Kesner Heart Center at Methodist Dallas offers some of the most advanced cardiac care and cardiology services available in Dallas-Fort Worth. More than 20,000 square feet of space located in Pavilion II of the Methodist Dallas Medical Center campus is dedicated solely to providing patients with heart care and procedures.
Four specialized labs form the foundation of cardiology services at the Heart Center. Two of these labs are devoted to cardiac catheterization and interventional cardiology procedures. Two additional labs at the Heart Center are devoted to electrophysiology, which deals specifically with diagnosing and treating electrical abnormalities and arrhythmias of the heart.
The Sam & Anne Kesner Heart Center at Methodist Dallas also offer cardiac procedures, heart surgeries, and comprehensive cardiac rehabilitation to help people return to full health after heart attacks.
Southwest Diagnostic Imaging Center is located in a 25,000-square-foot facility on the Texas Health Presbyterian Dallas campus. SWDIC primarily serves private medical practices, insurance companies, and more than 75 managed care companies. SWDIC’s state-of-the-art equipment includes four magnetic resonance imaging (MRI) scanners comprised of the new GE Signa EXCITE HDx 3.0T and three high field 1.5 Tesla Units; three Computed Tomography (CT) scanners with slip ring technology, allowing spiral or helical scanning; a Bone Densitometer (DEXA); and a full range of ultrasound, radiology, fluoroscopy, mammography, and tomography systems. Staffed with more than 240 highly skilled health care professionals, imaging services are provided by two highly qualified associations of physicians, one specializing in general radiology and the other in neuroradiology. The goal of SWDIC’s technologists, nurses, management, administration, and office personnel is to facilitate the physicians and health care providers in every way to ensure every patient receives the highest possible degree of care.
Texas Health Dallas
More than 30 cardiologists and cardiothoracic surgeons are on the medical staff of Texas Health Presbyterian Hospital Dallas. These physicians lead multidisciplinary teams that include nurses, technicians, physiologists, scientists and researchers, rehabilitation specialists, and other trained and skilled personnel. Physicians on the medical staff at Texas Health Dallas are committed to assessing the effectiveness of newly developed technologies in the fight against heart disease.
Because of its active participation in ongoing medical research, Texas Health Dallas has been selected as the site for numerous clinical trials that serve to evaluate the efficacy of various cardiac therapies. The hospital has operating suites dedicated to cardiovascular surgery, plus multiple telemetry beds for specialized monitoring of cardiac patients. There is also a separate section of the emergency department at Texas Health Dallas devoted to triaging and treating patients suffering from chest pain and other symptoms of heart attack.
Texas Health Dallas is the first local hospital and one of a handful in the country to be named a Cycle III Chest Pain Center by the Society of Chest Pain Centers — the highest accreditation for heart attack treatment.
In addition to the chest pain accreditation, Texas Health Dallas has recently implemented several advances in cardiac care, including a regional treatment and transfer system for heart attack victims and a congestive heart failure unit.
UT Southwestern Medical Center is widely recognized as one of the nation’s leading heart disease treatment centers. UT Southwestern provides patients with individualized care within an environment that is home to one of the pre-eminent health care facilities for heart conditions. Physicians work in unison with heart disease researchers to provide the most advanced therapeutic techniques available to treat heart conditions.
UT Southwestern’s diagnostic and treatment facilities enable cardiologists and other specialists to offer advanced cardiac catheterization procedures, cardiac computer tomography scans, echocardiogram and electrophysiology tests, magnetic resonance imaging, nuclear imaging, positron emission tomography, cardiac surgery, and other procedures that lead to improved cardiovascular health. The staff provides vital diagnostic procedures and interventional therapies needed to improve, cure, and prevent heart disease. UTSW’s dedication to excellence in cardiovascular health care is exemplified by the consistent results achieved by its heart transplant program, which exceeds national averages for one-, five- and 10-year survival rates. The department of cardiovascular and thoracic surgery is also actively involved in groundbreaking clinical and research activities that continually advance the science of diagnosis and treatment.