Share Our Mission to Heal

Holy Cross Hospital is seeking studio audience members for A Mission to Heal, a new show all about the heart.  

Needed: 75 audience members for each show; Mix of demographics. No children under 18; Community groups are encouraged to have representation in the audience, as well as community leaders.

Where
A studio in Davie, FL. Details will be provided to audience members upon selection.

When
September 30, 2010; Refreshments will be served. 

The show is not “live” but it is being recorded “live” so it will be edited and shown at a later date. Audience members should dress comfortably for long periods of sitting. No white blouses, shirts, hats or sweaters.

Please email info@holy-cross.com and put A Mission to Heal in the subject field OR call 954-776-3244 if you are interested in being part of the studio audience.

Please provide your full name, phone number, e-mail address, age range (20s, 30s, 40s, 50+) and race/ethnicity. Someone will be in touch to let you know if you have been selected and provide additional information.

Posted in Acute Coronary Syndrome, Adult Stem / Cell Treatment, Angioplasty, Aortic Aneurysms /Stents / Grafts, Atherosclerotic Heart Disease, Atrial Fibrillation, Cardiac Imaging, Cardiac Surgery, Carotid Disease, Cholesterol, Chronic Angina, Clinical trials, Coronary Artery Disease, Heart Failure, High Blood Pressure, Myocardial Infarction, Pacemaker / AICDs, Peripheral Artery Disease, diabetes | 1 Comment »

Does Medicine Really Work?

It is all well and good to tell patients to take a handful of pills every morning and to insist that they spend a considerable amount of money on them…but do they really work?  At the present time, five classes of drugs have been found to improve the prognosis of patients sustaining a myocardial infarction.  These include aspirin, beta blockers such as Lopressor, renin angiotensin converting inhibitors such as Lisinopril, statins such as Lipitor and thienopyridines such as Plavix.  What happens when you take all five of the classes?

This study was recently reported and published in Heart 2010.  The study encompassed two groups and a total of 5,353 patients with acute myocardial infarctions over the years 2003-2004.  The primary outcome was mortality adjusted for patient risk at baseline.

In the “optimal” group referred to as OMT, the mean age was 66.3 years and in the “suboptimal” group, the mean age was 70.5 years.  Roughly 63% had angioplasty in each group and 5% had bypass surgery.  At discharge, 89% received aspirin, 90% beta blockers, 84% statins, 81% renin blockers, 70% Plavix.; 6.2% received all five classes of OMT.  These patients were younger, had more risk factors and were more likely male.

There was an astounding 74% reduction in mortality in the group that had OMT.  Diabetics were the only subgroup showing no benefit.  Most importantly, the withdrawal of beta blockers or withdrawing aspirin/Plavix from the OMT group abolished the benefit.  Like I always say, don’t stop your Plavix!

This study is groundbreaking and shows how mortality benefit could possibly be improved.  Only 50% of the patients received OMT so there seems to be a substantial room for improvement.  Some of these drugs are what is known as Quality Indicators and are reported to Medicare and there is a grading system in place.  Obviously the cost may be worth the benefit and most of these drugs are generic so the costs can be minimized.  Plavix will go generic in 2011.

So when your doctor hands you 5 prescriptions just take them.  It may save your life.

Tags: beta blockers, inhibitors, Myocardial Infarction, risk factors, Statins
Posted in Angioplasty, Myocardial Infarction | No Comments »

Now We Can Do It!

The use of the Impella device has significantly expanded what can be done in the cath lab, while at the same time significantly increasing the safety of some angioplasty procedures.

Let me give you some examples of recent cases that I have done with the help of my surgical colleagues.  An 88-year-old man, who I have known for sometime, presented to Holy Cross Hospital with disabling angina.  He is known to have advanced coronary disease and was recently turned down for cath at another facility.  This individual has a totally occluded left anterior descending artery, in other words, the artery to the front of his heart.  In addition, he has a totally occluded artery to the bottom of his heart the right coronary artery.  He is living on collaterals and his one remaining artery, the artery to the back of his heart the circumflex.

He was completely active before this occurred but has been getting more symptomatic over time.  After discussion about how to proceed, he underwent catheterization and was found to now have in addition to his other lesions, a new lesion in his circumflex of 95%. 

It is just not possible to work in someone’s last remaining heart artery because the heart doesn’t tolerate having no blood going to its muscle and conduction system.  My surgical colleagues were not anxious to operate given his age and the distal bypass targets.   The Impella device provided the answer.  After being placed, I was able to take the time necessary to perform the angioplasty and at the conclusion of the procedure, he was so stable that I was able to remove the device in the cath lab.

A second recent case was a 52-year-old patient who was 18 years post surgery and had a severely low ejection fraction.  He presented with unstable angina and cath showed him to have a 99% lesion in his vein graft to a very large right coronary artery territory.  As this area of his heart was the area working best any problems with the graft would have caused hemodynamic collapse and likely his death, as we would not have been able to get him to surgery in a stable condition.  After placing the Impella, I was able to proceed with the angioplasty with complete control of the situation and if the worst happened he would have a chance of getting into the operating room.

This blog does not do this device justice.  Although I have tried to relate to you the importance of this device in providing us a measure of safety in our procedures it has remarkably expanded our ability to spare patient’s surgery, which in these cases is generally followed by a long and arduous recovery.  Its ease of use and placement is a testimony to the company which developed it.  It is American medicine at its best.

Tags: Angioplasty, cardiac catherterization, catheterization, impella
Posted in Angioplasty | No Comments »

An Important Advance

Medicine in general moves slowly in fits and starts until the rough spots are smoothed out.  At times, physicians can use a drug for years, and only after it’s been around for so long that it’s almost off of patent, we come to find out we don’t even know how to dose it, Plavix anyone?  At other times, a change is so important as to open up areas of patient care that we have been struggling with for the beginning of angioplasty.

Stents are an example.  The effect was so striking that it arguably rescued angioplasty, which although it worked, would never have the acceptance that it does today.  The goal of full cardiovascular support for failing hearts has been a dream for many years and multiple companies have tried and failed to provide physicians with a machine to do the job.  Many of these companies were destroyed in the process.

Physicians now have such a device.  This device is known as an Impella and was developed by Abiomed.  The more powerful version of this device, the 5.0 Liter is used by the cardiovascular surgeons and the interventional cardiologists use the 2.5 Liter version. 

The 2.5 liter device can be placed in a leg artery in a standard fashion for us, and the resulting incision can be easily closed in spite of its diameter.  The larger 5.0 must have a surgical placement.  The 2.5 device gives a patient a cardiac output of 2.5 liters, which is more than enough to hemodynamically stabilize a patient in shock from any cardiovascular condition.  The device is placed through the aortic valve over a wire just like we place any catheter and then sucks blood out of the heart with a spinner which creates a venturi flow which propels the blood through the body.

The surgeons can completely support a failed heart with the 5.0 machine and this allows the heart to rest and recover while the kidney, liver and brain sustain maximum support.  This allows coronary bypass and some valve operations to be performed that were not possible before this development. 

Only a handful of these machines and the doctors that can use them are in South Florida.  We at Holy Cross were the first in Florida to have the 5.0 device because of our experience with the 2.5 version.

Next…what we do with it in the cath lab

Tags: Angioplasty, impella, stents
Posted in Angioplasty, Aortic Aneurysms /Stents / Grafts, Cardiac Surgery | No Comments »