The heart is the hardest working muscle in your body. The healthy heart's pumping chamber circulates about 10 pints of blood more than 1400 times a day. When the heart becomes diseased, medical science has many advanced technologies to detect and treat the nation's number one killer. But the best strategy remains prevention of coronary heart disease (CHD).

HOW IS CORONARY HEART DISEASE DETECTED?

Some persons experience a gradual onset of heart disease, developing symptoms of angina (chest pain) and difficulty breathing during exertion. Through timely medical intervention, it may be possible for patients with heart disease to significantly reverse their condition through lifestyle modifications and medications.

HOW IS ANGINA TREATED?

Patients with angina can be treated with medications that relax blood vessels and improve blood flow. Medications are also prescribed to reduce high blood pressure or slow the heart rate, thus reducing the heart's workload. In cases of serious obstruction, invasive techniques can improve the heart's blood supply. First, diagnostic studies are performed to find the blocked portion of the coronary arteries.

WHAT CAN BE DONE FOR A SUDDEN HEART ATTACK?

If a heart attack victim gets to an emergency room as soon as possible after the onset of symptoms, damage to heart muscle can be minimized. An evaluation includes a medical history, physical exam, electrocardiogram and blood tests. "An immediate history and EKG are obtained to determine if a patient is having a heart attack so that appropriate treatment is delivered as soon as possible," explains Patrick Kavanaugh, M.D., chairman, Division of Cardiology at John Muir Medical Center, Concord Campus. "Once the diagnosis of heart attack is established, measures can be undertaken to decrease heart damage."

WHEN A LIFE-THREATENING HEART ATTACK IS CONFIRMED

Administering fast-acting, clot-dissolving drugs may be the first step in treating a diagnosed heart attack. An alternative is emergency balloon angioplasty (to open the blocked artery. Following a heart attack, a nonsurgical or surgical procedure can take place, if necessary, on a scheduled basis to improve blood flow to the heart.

TECHNOLOGIES TO DIAGNOSE AND TREAT HEART DISEASE:

• Exercise stress tests measure symptoms, blood pressure and EKG during exercise.
• Imaging procedures provide still or moving pictures through X-ray, fluoroscopy, MRI or CT scans.
• Electrophysiology studies examine heart rhythm disturbances using electrodes positioned over the patient's heart.
• Cardiac catheterization diagnoses and/or treats an obstruction. (An angiogram introduces dye through a catheter to observe the heart's blood vessel flow by X-ray; a balloon angioplasty procedure uses a tiny balloon-tipped catheter to help unclog blockages.)
• Surgical procedures can bypass clogged arteries, replace valves, insert pacemakers and defibrillators or replace the entire heart.

MANY RECENT ADVANCES

"Today, we can prevent many heart attack deaths with our leading-edge technologies supported by decades of research," says John Krouse, M.D., cardiologist on staff at John Muir Health. "Among our most exciting newer treatments are radio-frequency ablation, transradial cardiac catheterization, and stent placement." In radio-frequency ablation, pathways are cut within the heart using radio waves to correct an irregular heartbeat. Transradial catheterization involves threading a thin wire and tube through a wrist artery to locate and unblock clogged heart arteries. With stent placement there is a greater than 90 percent chance of keeping arteries open long-term and less than a one percent chance of complications requiring immediate surgery.

The stent, a flexible wire mesh tube, is placed over a balloon-tipped catheter and guided through an artery to the blockage. The balloon is then inflated and removed, leaving the stent permanently in place to re-establish blood flow. "The majority of stent procedures are performed through the groin," Dr. Kavanaugh indicates. "With the wrist procedure, patients are able to return home sooner."

ADVANCED TECHNOLOGIES "Today, patients are reaping the benefits of refinements in proven techniques and continually evolving new technologies," Dr. Krouse concludes.