Oct 23

Heart Health: Changing for the Better

by Dillon Kato

Heart problems and cardiovascular disease are some of the leading health issues experienced as a person ages, with heart disease now the No. 1 cause of death in the United States. New medical developments at hospitals across the state are making cutting edge treatments for these health issues available to Montanans aging into their prime.

Dr. Brian Rah, an interventional cardiologist at Billings Clinic, said congestive heart failure is a common condition people begin to experience as they age. It occurs when heart muscles are not able to pump enough blood to supply the demands of the body. For patients with a severe amount of heart failure, open bypass surgery or traditional stenting procedures are often deemed too high a risk.

Rah and the cardiology department at the Billings Clinic have recently started to lessen that risk using a very big development in cardiology treatment. Or, more accurately, it’s a very, very small one.

Last year, the Billings Clinic began to use a new technology, the smallest heart pump in the world, to aid and allow heart surgery in patients where it would not normally have been an option.

The pump is inserted through a patient’s femoral artery and up into the left ventricle of the heart, and can supplement the amount a heart pumps closer to normal. Surgeons are then able to more safely perform a permanent operation, after which the pump is removed.

Rah said hypertension, heart attacks and strokes are some of the other common issues that he sees. He stressed that diet and exercise are essential preventative tools, in addition to annual exams.

The Mediterranean diet, focusing on foods like nuts, olive oil, fish and other lean proteins, has been shown to be very effective at decreasing the risk of heart attacks, he said.

“Studies have shown these diets can give a 20 to 25 percent decrease in heart attack risk. That’s similar to what we see with heart medications,” he said. “People living in the Mediterranean and in Japan, another place where a lot of fish is eaten, have some of the longest life spans. Clearly diet plays a big role.”

The Billings Clinic has also recently started performing laser lead extractions, allowing removal of obsolete hardware from a pacemaker or defibrillator, and is building a new cardiology outpatient facility with a large
cardiatric rehab area that should open early next year, Rah said.

In Great Falls, Pam Crisp, registered nurse and coordinator of the CardioPulmonary Rehab department at Benefis Health Systems, said part of her job is encouraging people to be their own best advocates.

“It’s about being able to read what your body is telling you,” Crisp said. That means knowing what your normal numbers are for things like cholesterol and blood pressure, so that you know when something it abnormal.

The important time to be taking good care of yourself, from eating better to exercising, is when you are in good health, and not to wait until something starts to go wrong, she said.

Benefis has made major advances in reducing the time it takes to treat patients suffering from cardiac arrest of heart attack symptoms. This “door to balloon time” is the period from when a patient reaches the emergency room door to when doctors can put a device into a blood vessel.

The national benchmark is 90 minutes. In the last two years, changes in how the hospital works and responds have taken Benefis’ door to balloon time to about 55 minutes. In the last two months, it has had multiple response times of less than 30 minutes.

Changes include outfitting ambulances with electrocardiograms, which allow EMTs to transfer data back to the hospital while on route, so the ER can make informed preparations. Crisp said the important factor is people calling an ambulance when they are experiencing a heart attack. “Don’t drive yourself, call 911.

We always talk about how time is muscle. Every minute wasted loses valuable heart muscle.”

Benefis also sends cardiologists and nurses on outreach visits to clinics in smaller towns in the area, bringing mobile echocardiogram machines to people who otherwise might have to drive hours to have tests done.

Billings and Great Falls aren’t the only places in Montana on the medical cutting cutting edge. Carolyn Bellamah, a nurse with the International Heart Institute of Montana, said a new treatment for a deadly heart disease, aortic stenosis, is now available in Missoula.

Aortic stenosis is a progressive disease where the aortic valve in the heart begins to narrow, primarily  through calcification or deterioration around the valve, cutting off oxygenated blood to the body.

The symptoms of aortic stenosis include chest pains, shortness of breath with minimal exertion, and dizziness. Often it can be diagnosed by a physician seeing a murmur in the heart.

Severe aortic stenosis, which affects around 250,000 Americans, can go for years without showing symptoms, but when symptoms do materialize, the mortality rate is very high. Bellamah said within 3 years of showing symptoms, half of the untreated victims of aortic stenosis die.

While the symptoms of aortic stenosis can be managed with medication, the only real fix is surgery.

Bellamah said while the gold standard of treatment is still full open heart surgery, that is often not an option for the sickest of patients, who are deemed too risky for that type of procedure. Since March, the IHI has started using a new, far less invasive procedure for these patients.

The procedure, called Transcatheter Aortic Valve Replacement or TAVR, allows physicians to mount an artificial valve on a catheter, which is inserted through a small incision in a patient’s groin area and up into the patient’s heart. Bellamah is the clinical coordinator of the TAVR program at the International Heart Institute of Montana, a part of St Patrick Hospital.

While TAVR is only currently approved for the highest risk cases, Bellamah said studies are currently being done to see the procedure approved for a more wider range of patients.

“We are very lucky to be in a pretty rural state and have access to this type of advanced care,” Bellamah said.

 

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