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PrintMatters of the heart
Although heart disease has become a serious threat in Oklahoma, there are ways to protect this vital organ and potentially save a life.
For many Oklahomans, heart disease is an almost certain eventuality. It is the leading cause of death in Oklahoma, accounting for about a third of all deaths in the state.
The state ranks 51 out of 52 for the most deaths from heart disease. Sadly, the primary reason for the bad statistics is a disparity in the health care system: Either because of lack of insurance or lack of courage, not enough patients get to a doctor soon enough to treat their conditions.
If they did go in for treatment earlier, they’d be able to stop and even reverse their heart damage, says Dr. Wayne Leimbach, an interventional cardiologist with Oklahoma Heart Institute.
“You shouldn’t fear going to the doctor because of what we might find,” Leimbach says. “When you think you’re at risk of dying, it’s a huge stress on people, but we can fix most of it without a hospitalization. It’s so different from what it used to be.”
Fortunately for Ruth Boone, technologies were available just in time to help her after a heart attack. The competitive race walker, retired nurse anesthetist and former licensed pilot was taking a three-mile walk in September when she had chest pain.
An EKG in the ambulance showed an artery blockage, and within 20 minutes, she was having a stent inserted in the catheterization lab at St. John Medical Center.
Four days later, she was back home.
“It was truly a miracle and really a point of pride for me,” says her son Richard Boone, president of the St. John Foundation. “I usually see heart procedures from the hallway, but I got the up-close chance to see my mom benefit.”
Today, Ruth Boone is back to her old self — walking about two miles every day.
She has many of the risk factors under control. She exercises, watches her fat and sugar intake and keeps her weight under control.
You, too, can reduce your risk of heart disease and its cousin, cerebrovascular disease — usually called stroke — by watching the following risk factors. And if you already have some heart problems, you can actually reverse the damage if you tackle all the risk factors together.
High blood pressure — When the heart works overtime because of high blood pressure, it becomes thicker and stiffer. High blood pressure not only increases the risk of stroke and heart attack but also kidney failure and congestive heart failure.
High blood cholesterol — Cholesterol is a fatty substance that can accumulate in blood vessels, blocking normal blood flow. As blood cholesterol rises, so does the risk of heart disease. A blood test will tell you exactly what your cholesterol levels are. A total cholesterol of 200 mg/dL is best, with less than 100 being optimal for the bad kind of cholesterol, called LDL.
High blood sugar — Diabetes seriously increases the risk of developing cardiovascular disease, whether your blood sugar levels are controlled or not, but the risks are even greater if blood sugar is not controlled. About three-fourths of people with diabetes die of some form of heart or blood vessel disease, according to the American Heart Association.
Smoking — Cigarettes contain carbon monoxide, which inhibits red blood cells’ ability to carry oxygen, and nicotine, which stimulates the body to produce adrenaline, making the heart beat faster. A smoker’s risk of developing heart disease is two to four times that of nonsmokers.
Inactivity — Even a 10-minute walk every day helps the heart, Leimbach says, and the more vigorous the activity, the greater the benefits.
CRP — This acronym stands for C Reactive Protein, and this relatively new test is essential in determining your risk for heart disease. CRP is a marker for inflammation in the blood and is very accurate in predicting heart problems and stroke, Leimbach says.
Other kinds of chronic inflammation, such as gum disease, gout and rheumatoid arthritis, all can cause the CRP to rise. No matter where you might be experiencing chronic inflammation, it can affect your arteries.
CRP could be the reason why some people with normal cholesterol levels still have heart attacks. Until now, doctors weren’t so sure whether treating inflammation could actually protect the heart.
At the 2008 American Heart Association annual meeting in New Orleans, researchers presented the results of the recent Jupiter Trial, an international study. People with fairly good cholesterol numbers but with bad CRP numbers were put on a statin with anti-inflammatory properties. The medication, called rosuvastatin or Crestor, lowered the LDL cholesterol levels by about half. The study indicates that inflammation hurts the heart and that treating it with a statin helps.
New statin drugs, along with modifications in diet, exercise and quitting smoking, can nearly eliminate the chance of heart attacks, Leimbach says.
Cardiovascular blockage can start early in life — usually in the teens and 20s — not when people actually have a heart attack. It’s never too early, then, Leimbach says, for people to get serious about their hearts.
“It’s preventable. It’s treatable,” he says. “And it’s the No. 1 cause of death. It’s sad we’re not putting all our efforts into changing that.”
When Ruth Boone had chest pain last September, St. John Medical Center set a record in caring for her — just 20 minutes from “door to balloon.”
In only 20 minutes, she was from her door at St. Simeon’s to the catheterization lab at St. John.
It was a testament to Boone’s early recognition of her symptoms, calling 9-1-1 quickly, a fast EMSA response and a hospital ready to help her immediately.
“St. John is actually the only hospital in the Tulsa area currently receiving EMSA EKGs remotely, as St. John is the only hospital that has invested in the necessary equipment upgrade,” EMSA spokeswoman Tina Wells says.
According to the American Heart Association, the movie version of a heart attack, in which a person grasps his or her chest and falls to the ground, is not so common.
Most heart attacks start slowly, with mild pain or discomfort. Too often, victims aren’t sure what’s wrong and wait too long before calling for help.
These are the signs that can mean a heart attack is happening: Chest discomfort
Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body
Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort
Other signs may include:
Breaking out in a cold sweat, nausea or lightheadedness
A woman’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.
Even if you’re not sure what you’re experiencing is a heart attack, tell a doctor. Don’t wait more than five minutes to call 9-1-1.
Medics can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car, according to the American Heart Association.
EMSA staff also are trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMSA for rapid transport to the emergency room.
If you can’t access the emergency medical services, have someone drive you to the hospital right away. If you’re the one having symptoms, don’t drive yourself, unless you have absolutely no other option.
New Technology
A new type of machine has revolutionized the way doctors look at the heart.
Multi-slice computed tomography (CT) scanners are a noninvasive way for doctors to see the coronary arteries and determine whether they’re clogged.
In the past, older types of CT scans have been able to detect calcium in the coronary arteries, but calcium scans aren’t useful in revealing soft plaques that may be blocking the arteries. Both hard and soft plaques can cause narrowing of the heart arteries and possibly lead to a heart attack, says Dr. Gregory Hill, medical director for cardiovascular CT at Saint Francis Hospital. CT angiography, a CT scan of the heart arteries using X-ray dye, can detect both plaques.
In the last few years, however, CT technology has advanced, and today, multi-slice CT machines — basically an X-ray machine that rotates around a patient very quickly while the patient holds his or her breath — can take pictures within milliseconds and in submillimeters.
Computers can put the pictures together as a moving or still image, which then can be rotated on a screen for doctors to examine different areas of the heart. In addition to the CT lab, physicians can even review the images anywhere Internet access is available, Hill says.
Saint Francis has recently installed a multi-slice CT scanner, the Siemens Dual Source CT.
New testing protocols have been developed to accurately acquire images with considerably less X-ray exposure, and newer CT versions are coming out. Siemens announced its latest in November. The new machine, still in testing, is so fast and has such high resolution that patients don’t even have to hold their breath.
Oklahoma Heart Institute now has access to a 64 multi-slice CT scanner. The Oklahoma Heart Institute heart hospital will have a more sophisticated 320 multi-slice CT scanner in about a year, Dr. Wayne Leimbach says.
“It’s absolutely amazing what you can uncover and treat early,” he says.
Hill says that although this technology has many advantages, the tests are not for everyone. The American College of Cardiology and other medical societies have developed recommendations for appropriate use for these tests. For example, a 50-year-old smoker with chest pain and a questionable stress test would be a good candidate. However, a 20-year-old female with fleeting chest pain and no risk factors would not because she would have an extremely low risk for coronary disease; the cause of her pain is most likely chest wall, stomach or digestive problems.
“With such a low risk for heart disease, why expose that patient to X-ray dye or X-ray exposure?” Hill says.
CT angiography has its greatest impact in patients with chest pain for which coronary disease is suspected or in patients with equivocal stress tests, Hill says. These patients often undergo invasive angiography. That procedure requires a catheter to be placed into the artery and fed to the heart to look for arterial blockages. This test also involves IV sedation and a half-day hospital stay. Often, the arteries are found to be normal. CT angiography is a noninvasive way to look at these arteries and requires only 15 minutes to scan the heart, Hill says.
“This technology guides the doctor into fine-tuning management of heart disease,” he says. “It’s a significant tool to better treat our patients.”
