Heart disease is still prevalent in our society, but fortunately there are many notable advancements in medicine, nutrition and surgical procedures. Learn how patients are receiving better treatment.
Heart disease is the No. 1 cause of death in both men and women, and it accounts for one in every four deaths in this country, according to the federal Centers for Disease Control and Prevention. Thanks to advances in medicine, nutrition and surgical procedures, we have many tools to fight back.
For those who eat right, exercise appropriately, abstain from smoking and substance use, avoid stress and get enough quality sleep, the odds of developing heart disease are substantially lower. Even with genetic and hereditary tendencies factored in, it’s possible to avoid or postpone heart disease.
Even with the best of intentions, it’s still difficult to sustain a lifestyle that consistently deflects any type of heart condition.
Our heart is an electrically active, muscular pump that circulates blood around the body through blood vessels. A specialized group of cells located in the heart’s upper chamber, or atrium, acts as a pacemaker that generates an electrical impulse. The impulse begins as a sequential electrical stimulation of heart muscle.
This electrical impulse stimulates the atrium such that it contracts and sends blood into the heart’s lower chambers, or ventricles. There’s a slight pause in the electrical signal that allows the ventricles to fill. Then, the ventricles contract, pumping blood throughout the body. Another slight pause allows blood to return to the upper chambers of the heart, in anticipation of the next cycle.
Sometimes, the electrical system of the heart can malfunction and create heart rhythm problems. These malfunctions can manifest as the heart beating too fast, too slow, or irregularly, and they can affect people of all ages. Shortness of breath, fatigue, dizziness or fainting are some of the common symptoms of a heart rhythm problem. An electrophysiologist is a cardiologist who sees and treats patients with heart rhythm problems.
Dr. John Onufer, an electrophysiologist at Northwest Community Hospital in Arlington Heights, finds that arrhythmia is not a rarity.
“In fact, it’s very common, and is a huge catchall term for any heartbeat that does not fall within normal parameters. Almost anyone can have arrhythmia,” Onufer says.
“Some are benign, while others can be serious to life-threatening. The possibility of developing arrhythmia increases with age simply because of modern life, the day-to-day wear and tear on the heart and body, and other cardiac or non-cardiac conditions.”
Examples of underlying causes can include uncontrolled high blood pressure, disruptive sleep apnea, previous damage to heart muscle caused by cardiomyopathy (muscle disease) or heart attacks, viruses, valve disease and congenital conditions.
“Arrhythmia can be treated with anything from reassurance, in mild cases, to medication or ablation of specific cardiac tissue with a catheter,” Onufer says.
“Implantation of pacemakers or defibrillators is also used to control heart rhythms that are either dangerously too fast or too slow.”
One of the most commonly seen cardiac arrhythmias is a condition called atrial fibrillation (A-fib), in which the heart beats at a high rate.
Onufer says blood thinners are essential to helping someone with this condition to prevent strokes.
“A-fib is not necessarily severe, but can be complicated by other conditions,” he says. “It can be associated with not only stroke, but with the risk of heart failure, poorer survival and possibly dementia.”
Onufer stresses that treating A-fib and all other arrhythmia depends entirely on the individual.
“So much is based on the patient’s prior health and history,” Onufer says. “High or low blood pressure, diabetes, weight, age, alcohol and drug abuse, smoking and sleep apnea are all factors. It is vital to help each patient find and maintain a balance. Controlling blood pressure and diabetes, losing weight if necessary, exercising appropriately and establishing a common-sense lifestyle are all important to healing the heart and preventing anything that worsens the patient’s health.”
Heart attacks present a life-threatening situation. When someone enters the hospital with symptoms of heart attack, one of the first lines of treatment is stenting of the heart arteries – a procedure that increases blood flow through clogged channels. Dr. Asim Zaidi is a board-certified interventional cardiologist with Centegra Physician Care in McHenry County and medical director of Centegra Health System’s cardiac catheterization lab at Centegra Hospital-Huntley.
“Narrowing of the coronary arteries that supply the heart with blood can lead to symptoms of chest pain or breathlessness – what we call angina,” Zaidi explains. “A sudden, severe narrowing can result in a heart attack where the heart muscles become damaged because of a lack of blood supply to them.”
Narrowed areas of the arteries typically are formed by plaque, a dense material derived from deposits of fat and cholesterol. Over time, the plaque builds up and starts to cause noticeable symptoms when the heart muscle is straining to pump enough blood.
“When someone is having a heart attack, prompt evaluation and treatment of the blockage, commonly with a stent implanted at the site of the blockage, can save his or her life and help maintain the heart’s pumping function,” Zaidi says. “Angiography is the procedure that detects the buildup of plaque within the arteries.”
Typically, there are three methods of treating coronary artery disease: with medications such as aspirin, with blood pressure medications and cholesterol-lowering medications, and with stents or bypass surgery.
“Coronary stents were developed in the mid-1980s and, since then, they have become more and more refined both in design and composition,” Zaidi says. “Stents are essentially a scaffold wrapped around a balloon. The balloon and stent are placed at the site of a blockage, and the balloon is inflated. This causes the stent to expand, thus trapping the plaque against the blood vessel wall. The balloon is deflated, but the stent remains open, allowing more blood to flow through the artery.”
The patient normally goes home the following day.
“The procedure is traditionally performed via the artery in the upper thigh (femoral artery), but is commonly also performed using the artery in the wrist (radial artery),” Zaidi says. “Newer technologies now allow us to look at the blockage from inside the blood vessel using sophisticated imaging cameras.”
Traditionally, stents have been made of a metal with a coating of a drug to help keep the stent open. But in July 2016, the federal Food and Drug Administration (FDA) approved the next generation of stents. Called a bioabsorbable, these stents no longer use a metal scaffold, instead using a chemical polymer that keeps the blood vessel open. Over two to three years, this polymer absorbs into the vessel wall, essentially disappearing, yet at the same time helping the artery heal itself and remain open.
“Even though this new type of stent is being used widely in many places in the world already, it has only recently been approved by the FDA for use in the U.S.,” Zaidi says. “Currently, Centegra Health System is the only center in the region that is able to offer this new type of stent. The first of these stents was implanted at Centegra Hospital-McHenry, on Oct. 14, by Dr. Douglas Tomasian, our medical director of cardiology.”
Amazing as stenting has proven to be for preventing heart muscle damage and stopping heart attacks, patients with advanced heart disease or with too many blocked arteries may have progressed past the stage where stenting is a viable option.
“If a person is found to have many blockages in more than one of the three major arteries that supplies the heart with blood, then a heart surgeon becomes involved to determine whether there is a better long-term benefit for the patient in having open-heart surgery with bypasses of the blockages, as opposed to multiple stents,” Zaidi says. “Every case is treated on an individual basis, with the patient and family involved in the decision making.”
Stenting, though, is the first choice when cardiologists find blocked arteries. Dr. James Burks, an interventional cardiologist with Presence Saint Joseph Hospital, in Elgin, says the methodology has come a long way in the past two decades.
“We used to do angioplasty, in which a balloon was inserted into the blockage and expanded, pushing the cholesterol into the artery wall, which then stretched the artery open,” Burks says. “But we found that in 30 to 35 percent of cases, the blockage recurred, often in six months. Stenting was developed to address this, placing a mesh support that reduced recurrence down to 15 to 20 percent. When we added medication impregnated into the stent, the blockage recurrence dropped to zero to 3 percent.”
Burks adds that patients with up to 50 percent blockage in one or two arteries can be successfully treated medically with aspirin, blood pressure medications, beta blockers and statins to reduce cholesterol.
“Statins don’t just lower bad cholesterol,” Burks says. “The plaque in the artery also has a rim of inflammation, in addition to bad cholesterol.”
High blood pressure can cause the edges of the blockage to become inflamed. As the blood rushes over the area, the edges can lift up and irritate the artery. Statins have an anti-inflammatory effect on the blockage area. They soothe the inflammation, lower tryglicerides and bad LDS, and enhance the good HDL cholesterol. With medications, over time, it’s possible to actually reverse heart disease, Burks says.
Citing a recent study on plaque regression, Burks says there are strong indications that consistent medication, combined with proper diet and appropriate exercise, cessation of smoking, well-controlled diabetes and blood pressure, reduction in stress, and implementation of other healthy practices can help patients avoid surgery.
However, some patients come in with blockages that cannot be resolved with stenting.
“If a patient is found to have one or two coronary arteries blocked by 70 percent or more, we can use stenting to resolve the problem,” Burks says. “When we find three, four or five arteries with 70 percent or more blockages, the best possible solution may be bypass surgery.”
Bypass surgery has also undergone tremendous advances in the recent past.
“The development of the bypass pump was a major breakthrough,” Burkes says. “But now, by using newer, minimally invasive techniques and by accessing the chest cavity from the side instead of the front, we are able to do multiple bypass procedures that improve the patient’s outcome considerably.”
There once was a time when a bypass surgery patient was considered disabled, but today’s patient can expect a full, active lifestyle following recovery, says Burks.
Aside from bypass surgery, an operation may be required for patients experiencing valvular disease and a dysfunctioning heart valve. Genetics, aging and past health issues such as rheumatic fever can adversely affect the heart’s valves, causing them to fail.
“In many cases, aortic valve disease is similar to artery blockage,” Burks says. “While the arteries are narrowed by plaque, the valves can become damaged by plaque thickening or scarred tissue. In addition, high blood pressure and cholesterol may cause the valves to malfunction over time.”
At this point, patients may require valve replacement surgery, in which the faulty valve is replaced either through open-heart procedures or more-advanced catheter-based methods.
“Today, patients with heart or valve disease are living longer and more productive lives thanks to the advances in care and medication over the past 50 years,” Burks says. “However, it is totally possible to prevent or postpone heart disease if a patient has a common-sense approach to their everyday health, including diet, exercise and avoidance of excessive alcohol and smoking. And I cannot stress enough the need to keep diabetes controlled and maintained. That’s one of the most important things a patient can do to help his or her heart continue to function well.”
Not only has the field of cardiology undergone tremendous advances in the past 50 years, but it also has extended the life expectancy of people well into their 90s.
Along with the development of statins and sophisticated blood thinners, surgical procedures have increasingly become less invasive, with fewer requiring open-heart surgery.
The end result is that patients well into their 80s and 90s recover not only more quickly, but more completely, giving them the opportunity to continue to live full, active lives.