The Record Special Sections Health Quarterly 02-16-2020 | Page 12

12 ❚ SUNDAY, FEBRUARY 16, 2020 ❚ THE RECORD
HEALTH QUARTERLY / ADVERTISING SECTION
COVER STORY
Coronary Artery Disease:
Symptoms, Treatment and Technology
CONTINUED FROM PAGE 1
— nuclear stress tests and echocardiog-
raphy — both considered functional tests
given they do not visualize the coronary
anatomy, but serve as alternatives to iden-
tify potential blockages. A nuclear stress
test is a diagnostic test that creates images
to show blood flow to the heart. During the
test, a small amount of radioactive tracer
is injected into a vein. Combined with exer-
cise, the test can help determine if there
is adequate blood flow to the heart during
activity versus at rest. An echocardiogram
uses sound waves to produce images
of your heart. During an echocardiogram,
your doctor can determine whether all
parts of the heart wall are contributing
normally to your heart’s pumping activity.
Today a grow-
ing number of
medical authori-
ties see stress
tests as a thing of
the past. A coro-
nary CT angiogra-
phy is a relatively
new way to image
the coronary
arteries to identify
blockages. This
anatomical test is
not only quick and
Dr. Aalap, Chokshi,
now readily avail-
cardiologist,
able, but quite
Englewood Health
accurate. Contrast
is injected intravenously to generate imag-
es of the heart arteries. A non-invasive pro-
cedure with CT angiography is a test that
uses X-rays to provide detailed pictures of
the heart and the blood vessels that go to
the heart, lung, brain, kidneys, head, neck,
legs and arms.
“My area of expertise is in cardiac imag-
ing,” says Dr. Aalap Chokshi, cardiologist,
Englewood Health. “In the last decade, we
have been utilizing the coronary artery
calcium score to help in risk stratification.
Anyone with a strong family history of
heart disease should get the test. It is a CT
of the heart without contrast dye or medi-
cations that objectifies the amount of cal-
cium in the coronary arteries. The test has
been clearly showing that the higher the
calcium score, the higher the risk of having
a heart attack within five years. And in my
opinion a tool that should be in the hands
of every primary care physician.”
ANGIOPLASTY/STENT
vs. BYPASS SURGERY
Once a diagnosis of coronary artery
disease is made, the next question is how
best to treat the condition. Heart special-
ists generally make a determination based
on two criteria.
Symptoms
vs. no symptoms
— when someone
shows evidence
of symptoms
such as angina
or shortness of
breath without
improvement
using medical
therapies, the
blockages must
be opened up.
However, if a
Dr. Alex Zapolanski,
patient shows no
cardiac surgeon,
symptoms, the
Valley Health System
risk of doing an
invasive procedure may be greater than
the benefits.
The second factor is the location and
severity of the blockages in the coronary
tree. If there is significant disease in the left
main artery to the left anterior descending
artery or the patient is diabetic and has
multiple severe blockages in the arteries,
cardiac specialists recommend bypass sur-
gery over multiple stents due to improved
outcome in the long run.
A multidisciplinary approach has been
proven effective in the management of
patients with coronary heart disease. “Not
everyone is the same and not all cases are
clear cut. In those instances, we use a mul-
tidisciplinary evaluation whereby a general
cardiologist, an interventional cardiologist
and a cardiac surgeon come together to
discuss the best option for revasculariza-
tion,” notes Dr. Chokshi.
Heart bypass is one of two techniques
used in the treatment of coronary artery dis-
ease; the other is angioplasty and stenting.
Both aim to improve the flow of oxygen-rich
blood to the heart. The first heart bypass
was introduced in 1967, and the first coro-
nary angioplasty was performed in Zurich in
in 1977, followed by the first coronary stent
insertion in 1986. Both procedures have had
their own evolutions.
Angioplasty is a minimally invasive
method of widening a coronary artery
using a balloon catheter. However, in a
significant number of cases, the balloon
would collapse and re-blocking occurred.
This brought about the introduction of the
stent, a tiny tube that a doctor can insert
into a blocked passageway to keep it open.
By ‘opening up’ the blocked artery and
restoring blood flow, the stent can stop
damage to the heart muscle and reduce
the chances of suffering heart failure.
Angioplasty is often used for people with
less-severe coronary artery disease.
Bypass surgery involves removing a
blood vessel from the chest, arm or leg
and using it to create a detour or bypass
around the blockage to allow blood to
reach the heart again. “The most common
vessels used for grafts are from the leg and
from the arm. In working with the Cleveland
Clinic Heart and Vascular Institute, we have
learned over time that it’s best to use arter-
ies from the chest wall for a longer lasting
bypass,” explains Dr. Alex Zapolanski,
cardiac surgeon, Valley Health System.
Off-pump bypass surgery, often known as
beating heart surgery, is a relatively newer
minimally invasive procedure to the tradi-
tional On-pump surgery. Off-pump doesn’t
require the use of the cardiopulmonary
bypass machine so that the heart continues
to provide blood to the rest of the body
during surgery. “Research
conducted at The Valley
Hospital has demon-
strated that off-
pump coronary
artery bypass
surgery helps
reduce mortality due
to stroke compared
to traditional bypass
surgery,” continues
Dr. Zapolanski.
There are, of
course, pros and
cons to each
type of surgery.
The decision
depends on the
The Impella 5.5
patient’s overall health
and the degree of coronary disease.
Randomized studies have concluded the
more complex the coronary disease, sur-
gery provides the better survival outcomes.
Hackensack University Medical Center is
the first in the U.S. to perform cardiovascular
procedures using the pioneering Impella 5.5
heart pump device. “A minimally invasive,
forward flow, fully unloading heart pump that
is designed for
surgery is game-
changing,” says
Dr. Mark Anderson,
chief of the Division
of Cardiac Surgery
and cardiothor-
acic surgeon
at the Heart and
Vascular Hospital
at Hackensack
University
Medical Center
and Hackensack Dr. Mark Anderson,
Meridian Health. cardiothoracic
surgeon, HUMC
“This gives car-
diac surgeons a new and potentially better
option that can provide the benefits of heart
recovery to some of our sickest patients.”
The Impella 5.5 — used for the treatment
of cardiogenic
shock — tempo-
rarily assists the
pumping function
of the heart and
can be used up to
14 days to ensure
that the heart can
pump enough
blood for the
body while reduc-
ing strain during
recovery. “This
minimally-invasive Dr. Joseph Parrillo,
treatment option chairman, Heart
enables a patient’s and Vascular, HUMC
heart to rest and ultimately recover, improv-
ing long-term quality of life compared to other
therapies,” adds Dr. Joseph Parrillo,
chairman of the Heart and Vascular Hospital
at Hackensack University Medical Center.
PREVENTION
Thanks to advances in diagnosis and
treatment, patients with coronary heart
disease can be returned to good health,
living long and active lives. The best pre-
ventative therapy is following a common-
sense, healthy diet and exercise regimen.
Patients with a family history should
be mindful of controlling hypertension and
cholesterol levels. Illnesses such as diabe-
tes, high cholesterol and high blood pres-
sure are underestimated. They do not have
a day-to-day effect, but are accelerators
of cholesterol in the arteries and must be
monitored by the primary care physician.
The very basic EKG and stress test can be an
important first step in exposing the disease.