By H. Chris Waterer, III, M.D.
The heart is a very complex muscle. I have learned just how complex it is in my twenty years of practice as an interventional cardiologist at the Jackson Heart Clinic, P.A. I have watched the field of cardiology evolve tremendously over this time period. The biggest changes I have seen are how structural heart problems can be repaired using catheter-based modalities. With February recognized as heart month, it’s a great time to learn not only signs and symptoms that may not be obvious but also the present and future of treating heart disease.
Peripheral arterial disease, also known as PAD or PVD, is a broad term that describes any disease or disorder of the blood vessels that are outside of the heart and the narrowing of the peripheral arteries that bring blood to the body. It is a very common problem affecting one of every twenty Americans over the age of 50. Up to 75% of patients that have PAD will have no symptoms. The diagnosis of PAD also increases the likelihood of a heart attack or stroke. Women, in particular, are increasingly diagnosed with PAD. This parallels the increased rates of obesity among women. Scary, huh?
Now, let’s look at ways to guard our hearts and try to prevent heart disease from affecting so many individuals. Symptoms to look for with PAD include pain in our extremities (arms and legs-mainly in one’s lower extremities); a tired, weak, heavy, or numb feeling; a weaker pulse in one’s legs or feet; hair loss on legs; loss of leg muscle mass; difficulty moving; and an extreme symptom would be the lack of blood flow in tissue, leading to wounds and ulcers, which can lead to amputation. Some risk factors include snoring, diabetes, hypertension (high blood pressure), dyslipidemia (an abnormal amount of lipids in the blood), those over the age of 50, obesity, family history of heart disease and/or vascular disease, and smoking or tobacco use of any kind. Diabetics are four times more likely to have PAD. This is increased even more for those who have a history of smoking.
The first and foremost treatment of any vascular disease is the modification of existing risk factors. The treatment recommended by a cardiologist depends on one’s age and overall health, the severity of one’s PAD, and most importantly, the symptoms that an individual is suffering from. Treatment of PAD may include one or more of the following: lifestyle changes (quit smoking, exercise, diet, and weight loss), medication (treatment of hypertension, high cholesterol, and/or claudication), and revascularization and surgery.
The goal of percutaneous intervention (PCI) is to improve the flow of blood within a blood vessel in a minimally invasive manner. This is done by inserting a catheter in the artery to be treated, and then threading an instrument into the narrowed blood vessel. Angioplasty opens the vessel by inflating and deflating a tiny balloon. Atherectomy involves removal of the atherosclerotic plaque from the body. Stenting involves the insertion of a tiny wire mesh expandable tube (stent) that helps to prop open a blockage. As you can see, PAD/PVD is a prevalent condition that can be treated and some cases prevented with recognition and early treatment.
Another exciting and revolutionary area of diagnosis and treatment is in the treatment of valvular heart disease, particularly the aortic valve and aortic stenosis. There are four valves inside the heart. The aortic valve is the one between the left ventricle and the aorta. The left ventricle is the primary pumping chamber of the heart that pushes oxygenated blood into the aorta, which carries blood throughout its branches to various parts of the body.
Aortic stenosis is the narrowing of the aortic valve, which prevents blood flow out of the left ventricle. It can be related to a congenital abnormality, degenerative process, or an infectious process. Over time this causes increased strain on the left ventricle, ultimately leading to the thickening of the heart muscle, enlargement of the heart, and diminishing pumping function of the left ventricle.
Symptoms of aortic stenosis include chest pain, fainting spells, and congestive heart failure (a variety of symptoms including shortness of breath, swelling, and the inability to lie flat in bed). After the onset of symptoms, survival rates are 50% after two years and 20% after five years. This currently affects about 1.5 million patients.
Treatment options are limited to medical therapy (which does nothing for the valve itself) or repair and/or replacement of the valve. Medical treatments include diuretics (fluid medications) to relieve edema and improve shortness of breath or beta blockers which help the heart muscle relax, slow down, and possibly, decrease thickness over time.
In the past, options for repair or replacement of the valve have been limited to open, surgical replacement treatment. Using a balloon to open the valve has been done for years but has had minimal effects (lasting less than six months 50% of the time). Now available, in limited sites, is the ability to replace the aortic valve using an artificial valve inside a stent that is placed, either from the leg or a small incision in the left side of the chest, inside the diseased valve. This is accomplished by a team of doctors (cardiologists, cardiovascular surgeons, and anesthesiologists) and nurses in a hybrid operating room with advanced imaging equipment that is identical to what is used to perform catheterizations. This procedure is called TAVR (simply stands for transcatheter aortic valve replacement). The Edwards Company has developed the artificial valve and procedure over the last several years. Fortunately, this procedure is now available in the United States. Jackson Heart Clinic, P.A., along with the Baptist Medical Center, is one of the first fifty sites to offer this procedure. After this procedure, patients typically stay 1-2 days in the hospital prior to going home, compared to staying 4-7 days after standard surgery.
During my practice, the advances in medicine, pertaining to cardiology, have been remarkable over the last twenty years, and I can only imagine what the next twenty years will bring.
“Above all else, guard your heart, for everything you do flows from it.”-Proverbs 4:23
“You change your life by changing your heart.”- Max Lucado