Six Ways to Heal a Heart
Engage a young, healthy person in a discussion about the heart and you’ll likely be talking about true love, the nature of the soul or other such lofty philosophical topics. But broach the subject with someone over the age of 40 and it’s likely to veer in an entirely different direction, one that has more to do with medications than meditations on the meaning of life.
Heart disease affects people young and old, of course, but age itself is a major risk factor—the heart is a hardworking organ, after all, and eventually it does begin to wear out. Nearly three-quarters of Americans over the age of 60 have some form of heart disease, and the treatments are many, varied and ever more sophisticated. Today’s cardiologists, electrophysiologists and cardiovascular surgeons have access to a wide range of highly effective heart therapies—some incredibly complex, others surprisingly simple. We take a look at some of the fascinating new ways hearts are being healed in hospitals around the state.
A Cool New Treatment for Cardiac-Arrest Patients
Cardiac arrest (when the heart suddenly and unexpectedly stops beating) kills an estimated 325,000 people in this country every year. Those who survive often suffer severe brain damage.
Now, however, a remarkably low-tech treatment reduces the odds that brain damage will occur. St. Vincent’s Medical Center in Bridgeport, along with many top hospitals around the country, gives patients who’ve suffered cardiac arrest what might be described as a very “chilly” reception. They spend 24 hours or so literally packed in ice (or wrapped in a cooling blanket or put on an IV of chilled saline) to bring their body temperature down to between 90 and 93 degrees Fahrenheit. Called therapeutic hypothermia, this technique has been shown to help prevent brain and organ damage in one out of every six patients by temporarily and dramatically reducing the body’s need for oxygen.
Therapeutic hypothermia actually dates back to the days of Hippocrates, according to St. Vincent’s pulmonologist James Peppim, M.D., but it has only recently come back in favor. Cooling the bodies of cardiac-arrest patients helps prevent the cell death that would otherwise occur when the brain refills with blood after a period of deprivation. That triggers a “free-radical release that leads to programmed cell death,” Peppim says.
Though the treatment may sound extreme, Listy Thomas, M.D., a board-certified emergency physician at St. Vincent’s, says the therapy is actually quite effective. The most dramatic case she has seen, she says, occurred several years ago when a 17-year-old boy suffered cardiac arrest in his high school gym. “The coach used an AED to get his heart started again and when he was brought in, we started the hypothermia right away,” she recalls. “He was, amazingly, able to walk out of the hospital afterward with no brain damage whatsoever.”
Two-In-One: Hybrid Ablation for A-Fib
Atrial fibrillation (a-fib) describes a heart-rhythm disorder that affects the upper chambers of the heart in an estimated 2.5 million Americans. It is caused by abnormal electrical impulses that disrupt a person’s normal heartbeat. According to Murali Chiravuri, M.D., Ph.D, an electrophysiologist and cardiologist at Bridgeport Hospital, it can cause stroke, fatigue and other problems that make people feel quite sick.
A-fib is treated with a technique called ablation, essentially a form of cauterization that creates a scar-tissue barrier to block the abnormal signals. It can be done either with a catheter sent to the heart from a vein in the groin or with more invasive procedures, with advantages and disadvantages to each. But at Bridgeport Hospital doctors now use a new technique called “hybrid ablation” in which both are combined into one procedure. One doctor works on the heart from the inside as the other operates on the surface, providing a more effective, comprehensive ablation.
In addition to Chiravuri, the surgical team at Bridgeport Hospital’s Connecticut Cardiac Arrhythmia Center includes Robert Winslow, M.D., and cardiothoracic surgeon M. Clive Robinson, M.D. The team performed New England’s first hybrid ablation last June and the number of procedures performed successfully is now close to 20.
Not So Shocking Treatment for Ventricular Arrythmias
Less common but more dangerous are cardiac arrhythmias that affect the lower chambers (ventricles) of the heart. These can be fatal and are the most common cause of cardiac arrest, says Joseph G. Akar, M.D., director of the complex ablation program at Yale-New Haven Hospital and associate professor of medicine at the Yale University School of Medicine.
Drugs can help, but they don’t always work and often have side effects, so the standard treatment for ventricular tachycardia (as the condition is called) is implanting a defibrillator in a patient’s chest wall, where it remains, ready to shock the heart back into action if the need arises. These are important lifesaving devices, says Akar, but the shocks can be painful both physically and emotionally. “It’s like a punch to the chest that comes without warning,” he says. As a result, many patients suffer debilitating anxiety, living in constant fear of receiving a shock—some even develop a mild form of post-traumatic stress disorder.
As with a-fib, ablation can be an effective treatment, too, but as many as one-quarter of patients have damage to the outer surface of the heart (epicardium) that can be addressed only through open-heart surgery. Or, at least, that used to be the case. Now Yale-New Haven Hospital is one of just a few places in the country where surgeons can perform nonsurgical ablation to the epicardium through a needle introduced just beneath the ribcage. The needle is maneuvered into the very small space (a few millimeters) between the sac surrounding the heart and the muscle itself. Since there’s no way to determine whether a patient will require ablation to the interior or exterior of the heart, Akar starts procedures prepared to treat his patient in whatever way proves necessary.
He notes that while it is important to provide lifesaving defibrillators, it’s also important to be able to offer this treatment, which can help sidestep the pain and anxiety associated with multiple defibrillator shocks.
Putting the Squeeze on Angina Pain
While doctors can and often do perform surgical miracles on patients with heart disease, not everyone is willing or able to tolerate surgery. That doesn’t mean nothing can be done, however. Griffin Hospital in Derby offers a gentler, nonsurgical therapy called Enhanced External Counter-pulsation (EECP) that provides significant relief to as many as 85 percent of those treated.
Despite the complex name, EECP is simple and straightforward: While the patient rests comfortably in bed, wraps that resemble large blood pressure cuffs are wrapped around his/her legs. These cuffs inflate and deflate in rhythm with the patient’s heartbeat, compressing and then relaxing blood vessels so blood can flow more freely. This boost in circulation helps relieve the chest pain and discomfort experienced by these patients while also making it easier for them to exercise, which of course is better for their health.
According to Kenneth Schwartz, M.D., director of cardiology at Griffin Hospital, “EECP can be very beneficial for people who have run out of options, or who choose not to have invasive procedures like angioplasty or surgery.” In order to be able to tell his patients what it is like, Schwartz has himself tried EECP—he describes it as feeling “sort of funny but not painful.”
About half the patients who receive EECP therapy at Griffin have decided on alternative therapies like this because they don’t want invasive treatments, Schwartz says, while for the rest it is a treatment of last resort. “Most people get at least some relief,” he notes.
Opening the Door to Better Quality of Life
At Hartford Hospital a new procedure brings new hope for heart patients who have a serious, debilitating condition called aortic stenosis, but are not considered strong enough to undergo conventional open-heart surgery for heart-valve replacement. Called
Transcatheter Aortic Valve Replacement (TAVR), the procedure involves using a catheter to send a replacement valve to the site of the damaged one. The malfunctioning valve is ballooned open and the new one put in its place, leaving patients with better blood flow.
TAVR makes a dramatic difference in the quality of life in patients for whom nothing could previously be done, says Detlef Wencker, M.D., director of the heart failure program at Hartford Hospital. Likening the aortic valve to a door that must be able to open and close, he explains that “with aortic- stenosis patients, that door can’t open more than a crack, so very little blood is able to flow through it. TAVR opens the door completely.” Patients feel better almost immediately, he adds.
While TAVR is brand-new, Paul Thompson, M.D., director of cardiology at Hartford Hospital, believes it is likely to become commonplace in years to come. As people live into their 80s and 90s, he says, they are likely to have calcifications that tighten down their arteries. Surgery is often too risky for them, he notes, leading to his prediction that “TAVR will become one of the means of successful aging, a way we can actually extend the lives of a lot of people with heart disease.”
Rehab for a Damaged Heart
Cardiac rehabilitation uses exercise training to strengthen the hearts of patients who’ve either suffered a heart attack or are at serious risk of having one—and it is highly effective, reducing the risk of death within four years by half.
Stamford Hospital has recently amped up its cardiac-rehab program by doubling the number of sessions from the standard 36 to 72. Now in its second year, the Dr. Dean Ornish Intensive Cardiac Rehabilitation Program (one of just two in the U.S.) adds nutritional counseling, stress management, yoga and group support in an approach so successful that Medicare has agreed to cover the cost. Private insurers are now climbing on board as well, according to Steven F. Horowitz, M.D., the hospital’s director of cardiology.
According to Horowitz, “Deaths from heart disease have decreased over the last three decades, but only about half is due to medical innovations. Pacemakers, stents, bypass surgery and critical-care units are lifesaving, especially for acutely ill patients, but simple measures like activity and weight loss will save the lives of the other half.”
One problem with cardiac rehab? Most of those who should go, don’t. “Only 20 percent of people who’ve had a heart attack attend cardiac rehab, and of those, only 20 percent actually complete the program,” says Horowitz.