D.K. came to Bay’s cardiac catheterization lab directly from the Emergency Department. He’d been experiencing off-and-on chest pain for the past few weeks, but shrugged it off to the long hours preparing for several court trials. Today, the pain was more intense and persistent, and one of his colleagues drove him to Bay Regional’s Emergency Department.

Several tests were done that confirmed he was having a heart attack. He gave consent for cardiac catheterization intervention, and within minutes he was being prepped and lightly anesthetized for a procedure that would open up two plaque-clogged arteries.

Dan Lee, M.D., one of nine cardiologists who perform cases at Bay Regional, was on duty. The procedure involves passing a catheter, or thin, flexible tube into an artery in the arm, or near the groin, and guiding it to the coronary artery. Dye is injected, and fluoroscopically (via an X-ray camera in the lab), the catheter is then directed to the blockage sites. Mounted on the catheter is a deflated balloon that is inflated once inside each of the two clogged arteries. The balloon compresses the fatty plaque against the artery’s walls, and is withdrawn.

The time to open up both arteries was just 45 minutes, only half the time estimated by the American Heart Association needed to open up one occluded artery. "Time is muscle," says Scott Fylling, Registered Catheterization Intervention Specialist (RCIS), Manager, Cardiac Catheterization labs. "It’s important to get in and get out quickly, so damage to the heart muscle is minimized, and blood flow is re-established in the affected arteries." D.K., like most patients who undergo interventional catheterizations, will remain overnight for monitoring.

"It’s usually a 10-15 minute procedure for diagnostic catheterizations," adds Susan Stoffel, RN, RCIS, Cath Lab Educator. "These are usually done as outpatient procedures, with the patient being discharged the same day. Depending on the extent – or lack – of disease, the patient may be scheduled to come back for the interventional procedure. The patient, for example, may have been referred by his/her family physician, and we want to ‘connect the dots’ with the patient and physician first."

Both Fylling and Stoffel emphasize the concerted effort that has taken place between interventional cardiologists and radiologists and the Cardiac Cath Lab team to work cohesively, efficiently and safely. "We see thousands of cases annually," says Fylling, "and we’ve been fortunate to acquire some of the latest diagnostic imaging equipment. We were one of the first cardiology programs to perform cold ablation of lesions near the atrial ventricular node – particularly important for patients that have a pacemaker."

Interventional cardiologist Dan Lee, M.D., adds that Bay Regional has been in the lead for peripheral vascular stenting – an extremely under-diagnosed cardiac condition, where fatty plaques cut off blood flow to the lower extremities, including the kidneys.

"We have become very proactive," says Dr. Lee, "in educating our colleagues across disciplines about the early warning signs of peripheral vascular disease (PVD). All too often, the patient experiences pain in the lower extremities, and delays making an appointment with the primary care physician. We want to significantly reduce the number of patients who come with such advanced disease that amputation or dialysis are all we can offer.

"Some of the early warning signs include:

• A prior history of heart disease. Thirty to 50% of individuals with previous heart history will get peripheral vascular disease. Cholesterol plaques sufficient to block blood flow is a very diffuse process. It doesn’t just happen in the coronary arteries;
• Hair loss and wounds that don’t heal (particularly if the patient is diabetic);
• Inability to walk any distance. The person experiences pain, tightness and fatigue with exertion;
• High blood pressure even with medication (an indicator for possible kidney disease).

"We’re now diagnosing PVD much earlier, and three of our cardiologists, including myself, have advanced training in opening up lower extremity arteries that previously would have required surgery. What would have required a five-day hospital stay and two months off from work is now a same-day procedure, with the patient able to resume normal activity within 24 hours. There is very little scar tissue formation in the extremities; so drug-eluting stents are not used in PVD procedures.

"Interventional cardiology is expanding into arenas that even five years ago were sent to surgery. Over the next two to five years, we will be expanding our diagnostic capabilities in three-dimensional arterial imaging. We have the equipment now, but we would like to see more clarity in imaging from a beating heart. Three-dimensional imaging allows us to precisely see where blockages are, treat those directly, and bypass radioisotope dye injections.

"Stents are becoming more flexible with a lower profile, allowing us to stent hard-to-reach arteries. Research is continuing on how stents can be used to open up 100% blocked arteries, and to interventionally go through the groin to replace faulty heart valves.

"Clinical trials are ongoing about stenting the main trunk of the heart artery. Such advances will offer greater safety, reduce post-surgery infection rates, and allow patients to return to a positive quality of life more quickly. Even with all these opportunities-in-waiting, the patient still must hold up his/her end, with a change in diet, regular aerobic exercise, stress reduction, quitting smoking, and strict compliance with any medications prescribed to keep cholesterol or high blood pressure in check."