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article imageNew fronts in heart disease: perspectives from a heart surgeon Special

By Michael Krebs     Mar 24, 2013 in Science
While largely under-reported in the popular press, there have been a number of innovations in the diagnosis and treatment of heart disease, and Joan Tryzelaar, MD, FACS, FACCP shared his perspectives on these advances in a recent interview with me.
According to the CDC, there were nearly 600,000 deaths from heart disease in the U.S. in 2010. Additionally, there were nearly 130,000 deaths reported from stroke and cardiovascular diseases cited by the CDC in that same year. And while these figures may not be surprising, there have been numerous advances in the treatment and diagnosis of heart disease that have contributed to keeping these mortality figures lower.
In a telephone interview with Dr. Joan Tryzelaar, a former cardiovascular and thoracic surgeon who has also founded to help the public make informed decisions about their heart care, I asked him about the innovations with the greatest impact in his field.
"The diagnosis of heart disease has come a long way in the last 50 years or so," Tryzelaar said. "And it involves, among other things for instance, the training of EMTs - the technicians that ride on the ambulance and see a patient, who now frequently diagnose acute cardiac events on the spot before they even put the patient in the ambulance. And as a result, they can interact with the physicians in the emergency room almost immediately and start treatment while in the ambulance. I think that's a major innovation and has resulted in saving many many lives, particularly as results in early treatment."
Arming first responders with knowledge and technology to ensure an accurate diagnosis is helping to save lives, and much has been reported on the devastating effects of slow response to desperate heart attack calls.
"We're in a critical period the first hour when you can make the most impact. If you can get someone from symptoms and into lab in under an hour, you can abort many heart attacks before there is significant damage to the heart.” Corey Slovis, M.D. said in a Vanderbilt University Medical Center report.
"The other innovations that have taken place that I think have made a difference is the advent of more and more sophisticated CT scanning and MRI scanning that allows non-invasive methods of rapidly screening a patient for the presence of coronary heart disease," Tryzelaar said.
New technologies that emit lower radiation are being introduced by companies like Siemens and Philips and GE. In June 2012, Siemens announced FDA clearance for its latest generation CT scanner, a development that Siemens believes will increase efficiency and reduce costs.
Many hospital networks are implementing these technologies and marketing their offerings as a testament to their overall expertise. Innovation in technology has allowed hospital groups to visibly differentiate in an increasingly competitive market for healthcare dollars - and these advancements have moved the collective understanding in heart disease forward.
"There has been a lot of progress in the field of cardiology - in the analysis, and therefore the ability, to treat patients with various rhythm disturbances of the heart, particularly those that may result in what is called a sudden cardiac death syndrome where relatively healthy patients might die because of an arrhythmia without any known heart disease in his background," Tryzelaar said. He also noted that new technologies have been developed to interrupt the abnormal stimulus that cause arrhythmic abnormalities and that this development may offer some interesting applications in the future.
The definition and explanation of sudden arrhythmic death syndrome, or SADS, is explained further by, and its tragic existence is something that can be diminished through the promise of advanced monitoring.
"As far as the treatment is concerned," Tryzelaar continued. "I think nowadays no treatment should be started unless all efforts at prevention, which include reduction of risk factors, diet and exercise, etcetera, have been attempted. Now, obviously, in patients that are acutely ill this may not be possible - and the treatment needs to be instituted at the time before any kind of preventive or diet modifications and lifestyle modifications can be instituted."
Americans are certainly more aware of the "diet and exercise" advice that is being reported extensively; the broad prevalence of obesity nationwide; and the profound risks associated with smoking. Taken together, there is evidence that more integrative and holistic medicine practices are emerging to accommodate this broader awareness. In April 2012, The Economist reported on the rise of alternative therapies and its meaning for traditional medicine and science in general, citing that Georgetown University now offers a master's degree in alternative therapies. However, it is not an "alternative" practice for traditional medical doctors to discuss diet and exercise with their patients.
Tryzelaar also sees continued improvements in the development of stent technologies. The latest stent generations are delivering considerably better results than those that were first introduced to the market approximately 25 years ago. One recent innovative example of a new self-expanding stent was reported here at Digital Journal in mid-March, an advancement that has promise for the U.S. market over the next few years.
Absorbable metal stents have demonstrated promise, as an abstract published by NIH explored in 2007, and new materials and applications for stents continue to move forward - including drug eluting varieties.
"However, in the past several years, there have been concerns of the long-term outcome and cost-effectiveness of drug-eluting stents," Scientia Advisors reported last August. "Global market size contracted as a result of discovering late clinical complications, but lately there has been excitement over the latest iteration of stents currently in development."
"On the surgical field, there has been tremendous progress in the ability to repair heart valves when they start to malfunction, and this is nowadays achieved through technologies that involve minimally invasive heart surgeries as well as highly specialized robotic surgery," Tryzelaar said. "For coronary bypass surgeries, technologies have evolved by which procedures can be done without the use of a heart-lung machine, which allows the surgeon to stop the heart temporarily during which he can constitute his bypasses and other procedures. This is called beating heart surgery, developed to avoid some of the complications of traditional bypass surgery such as stroke and post-operative infection."
A heart-lung machine is a highly-specialized "pump" that acts like an alternative heart - oxygenating and circulating the blood while the heart is stopped. An overview definition from the University of Southern California's Keck School of Medicine is provided here.
Across the spectrum of technology and of training, there have been great advances in our understanding of heart disease and of its treatment. But when looking to reduce the mortality figures associated with heart disease, there remains no better alternative than preventative behaviors - and the mantra of "diet and exercise" continues to be the most sound advice.
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