By Stephanie Vaccaro, Special Writer
Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control. It is an umbrella term for a host of illness that includes valvular issues, structural wall issues and coronary blockage. Treatment for the various forms of heart disease has advanced in recent years.
Rapid revascularization of blocked arteries
From an emergency care perspective, Dr. Craig Gronczewski, chairman of emergency medicine at University Medical Center of Princeton at Plainsboro, said, “The newest treatment for (heart attacks) is rapid revascularization of those blocked coronary arteries. So, when we talk about acute coronary syndrome or unstable angina or acute myocardial infarction, which is a fancy term for a heart attack, we’re really referring to the ability to rapidly open those blocked arteries to allow oxygenated blood flow to pass that blockage and profuse the ischemic area of the heart muscle, the myocardium.”
When a blockage causes a disruption in the flow of oxygenated blood, a portion of the heart muscle is starved for oxygen, therefore preventing proper functioning. If the condition persists long enough, that part of the heart will die, Dr. Gronczewski says.
”If you are able to open up that clotted blood vessel, you can restore blood flow to that portion of the heart muscle and save it,” Dr. Gronczewski says.
Although angioplasty and stent technology has been in use for some time, it only recently has been readily available at area hospitals. The procedure involves sliding a catheter up through the artery of the groin through the entrance of the heart and injecting die that will fill the coronary arteries and will allow the point of blockage to be identified. Afterward, emergency angioplasty can be performed, which involves dilating the blocked blood vessel and inserting a stent to open up the blocked area.
”It’s critical that patients get treated promptly with that intervention,” Dr. Gronczewski says. He cited a phrase in medicine that applies: time means muscle. “What that refers to is the urgency of this intervention, so the sooner that you have emergency angioplasty performed the better the outcome, the more likely thephysician is to save that dying heart muscle.”
”Our door-to-intervention time is 90 minutes,” Dr. Gronczewski says.
Therapeutic Hypothermia
Hospitals have another recent technology that sounds like something out of a Hollywood movie. If an unconscious patient is brought into the hospital after suffering cardiac arrest and experiences a return of spontaneous circulation, one method of treatment — therapeutic hypothermia — has shown positive results.
Essentially, the patient is placed in a machine that cools body temperature to 90 degrees for 24 hours.
”That will reduce their metabolic rate and also reduce the rate of reprofusion injury, chemical apoptosis, which is early cell death,” says Dr. Gronczewski.
”We just had a 31-year-old who collapsed — ventricular cardiac arrest — while playing soccer, and he came in essentially functionally dead,”
Dr. Gronczewski says. “We revived him and put him in a therapeutic hypothermia program.”
After a few days, the 31-year-old made a full recovery and walked outof the hospital.
He likened it to stories of children falling through the surfaces of frozen ponds, where the recovery takes half an hour, but the child miraculously lives and has a full neurological recovery.
Aortic valve replacement for inoperable patients
Advancements also have been made to the way certain procedures are done. Dr. Fredrick Weinberg, chief of cardiology for the University Medical Center of Princeton at Plainsboro, said, “One that’s getting a lot of play these days is the ability in many patients to replace an aortic valve much easier. Instead of the old-fashioned way, which is an open-chest operation, people can have the valve replacement done as a stent procedure, done through the blood vessel, snaking the valve backwards, putting it into the right position, expanding it and having an aortic valve that works.”
Although the technology is mainly used for patients who are not fit for the traditional open-chest operation, there are ongoing studies that are looking at patients who are at more moderate risk levels.
”The idea is to study whether one can do it simpler and as well as the open surgical technique,” Dr. Weinberg said.
”The FDA approval for the valve is about a year,” Dr. Weinberg says. “This has generated a lot of excitement and quite a few cases are being done.”
Four to five years ago, Columbia was doing one procedure per week, Dr. Weinberg says. Now its doing four per day.
”Right now, the open chest technique has a very good track record,” Dr. Weinberg says. It means that the new technology is up against steep competition. “For those who are inoperable, this may be a godsend. For the older high-risk patient, who could have an operation but prefers not to, this is considered a reasonable approach.”
MRI-Compatible Pacemaker
Patients with pacemakers know they cannot have MRIs because of the possible impact on the pacemaker’s battery life. Medtronic, a medical device company, has designed a pacemaker now that will allow patients to have access to this diagnostic tool.
”The fact is that as we all get older and capable of getting different diseases, an MRI may be a very useful diagnostic test to figure out what’s wrong, be it in your chest, belly or joints or brain.” Dr. Weinberg says.
”The difference is that the battery of the pacemaker is effectively shielded from the magnetic forces,” Dr. Weinberg says.

