World Health Day

World Health Day

HEART NEWS

America’s heart problem is now the World’s

Heart disease is no longer an American problem

World Health Day is a global health awareness day celebrated every year on April 7th, under the sponsorship of the World Health Organization (WHO), to call attention to the advancement of health in all people. This year, I sat down with Dr. Brion Winston, who in addition to being a board-certified cardiologist, also has an area of interest in public health. Our discussion began with data from WHO that in 2016, more people died of heart disease than of AIDS/HIV, malaria, and tuberculosis. Heart disease is responsible for one-third of all global deaths.

Why is heart disease exploding in developing countries?

At least three-quarters of the world’s deaths from cardiovascular disease (CVD), or heart disease, occur in low- and middle-income countries. Heart disease very treatable and preventable if caught early. One factor affecting the poorest people in these places is the lack of detection. Dr. Winston explained how the diagnostic evaluation of heart disease in developing countries would be pretty basic, at best. “You would be able to find electrocardiography in many clinics but remember, in poor and developing nations, the standard of health care delivery is often a fee for service. If someone has a severe health problem, they will show up to the emergency department, often accompanied by their family, they will talk with the doctor and the patient. The doctor will say, ‘this is what I think is going on, and this is what it will cost’ and there is a fee for service right up front. With that in mind, the choices for diagnostic evaluation may be limited in some places.”

“Taking to the later phases of treatment, surgical treatment for heart disease in poorer nations are quite limited, maybe to aspirin, things like catheterization labs – you’ll find poorer countries don’t have them,” stated Dr. Winston. Treatment and procedures of heart disease like balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), coronary artery bypass or valve repair and replacement is costly once heart disease advances. “But, with the example of India, they have many hospitals which have prospered with the economic development over the last 30 years, these sites are considered ‘medical tourism’ where Americans will travel overseas for heart procedures in India. These are for-profit hospitals that run efficiently, conducting a high volume of surgical procedures. The costs of some of these procedures would be a fraction of what a patient would pay and there are some people willing to travel for this.”

Awareness and education are an important component that is missing in developing countries. The most important behavioral risk factors of heart disease and stroke are an unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Americans are bombarded with public health messages informing us of the increased risks of a poor diet, smoking, and lack of exercise; this is not the case in other parts of the world. “In my practice and taking with my colleagues, many of whom are from South Asia (India and Pakistan), there is a high incidence of heart disease in people from these lands when they come to the US, if they follow a US diet that is high in fat, then we may see development of heart disease even earlier,” says Dr. Winston. “Overall, while we have made substantial improvements in reducing smoking in the United States but in South Asia and China, there is still a large amount of that population that still smokes, combine that with a richer diet – that will add to this problem as well.”

A “better life” might be a slow killer

Economics is an underlying cause of fostering the bad behavior that leads to heart disease. In some countries, soda is cheaper than bottled water. This year, Canada recently updated its Food Guide to offer advice on what to eat, what not to eat, and how to eat. Half of the plate is fruits and vegetables, a quarter for whole grain foods, the final quarter for protein. They also removed dairy as a category, urging citizens to have a glass of water with meals. In the African nations of Tanzania and Zambia, clean water does not flow from their taps. A can of Coke is less than and safer than clean water. This choice adds up; according to the Human Sciences Research Council the cost of eating healthy in South Africa is 69% more than the alternative.

The opposite is true in other parts of the world. “As standards of living have improved in South Asia as well as in China, people are following more of what we tend to think of as a Western Diet, a high fat, high energy diet – we rating to see more diabetes and related heart disease. It’s both an issue that we have made progress of infectious disease as well as the economic shift which has lead to people eating richer diets putting them at greater risk for heart disease,” notes Dr. Winston.

A global problem

Heart disease is the number one killer of men and women in America. It is also responsible for one-third of all global deaths. This global problem is going to need a large solution that addresses access to health care and preventative treatment. A WHO report estimates that Africa has about one doctor for every 5000 people. In underdeveloped nations, community health care workers fill the void of serving patient’s who don’t have access to a doctor or even a hospital. In South Africa, Mexico, and Guatemala, a study shows that these health care workers were able to screen adults for cardiovascular disease when access to a physician was not available. Armed with a mobile app, instead of traditional paper, these volunteer professionals were able to diagnose patients efficiently and at less cost compared to standard care.

There is hope in solving the global heart health problem. While there will certainly be a growing demand for cardiologists worldwide, it wasn’t that long ago that the HIV/AIDS crisis seemed impossible to contain. Money for research, governments pushing for public health policies, and dedicated medical professionals will need to unite around the world to fight heart disease – together.

Written by: Michael Arce, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Luke Perry Stroke

Luke Perry Stroke

PATIENT EDUCATION

Stroke is no longer
an “old age” risk

Adults as young as
40 are now at risk.

Here’s what you need
to ask your doctor.

Luke Perry’s death, just four days after FOX announced that it would be re-booting “Beverly Hills, 90210”, the TV show that made him 90’s icon, came as a surprise to fans who were hoping he would return as “Dylan McKay.” This role cemented Perry’s iconic image as the standard of cool for the generation who grew up after Jim Stark, the troublemaking teen played by James Dean in the epic 1955 film “Rebel Without A Cause.” The two characters not only shared similar backstories, dangerous loners who lived on the edge; the actors also shared a striking similarity in appearance.

The news report that The Los Angeles Fire Department responded to a “medical assistance” call at Perry’s home on Wednesday, February 27, dominated the headlines. At first, officials say Perry was talking to first responders and was fully conscious. This was just days after TV announcement; fans were shocked to learn that the star, at 52 years old was hospitalized due to a massive stroke. We were all saddened when the news broke the following Monday of his passing.

Redefining stroke

Stroke, as with many other forms of heart disease, is often thought of as an “old person’s” health concern. While there are more than 200,000 stroke cases in the US every year, making it the fifth leading cause of death in our country, the primary age affected is 60 years old and up. However, recent health trends have shown a growth in diagnosis with adults aged 41-60. “People can have strokes at any age,” says Maryellen King, Nurse Practitioner at Capital Cardiology Associates. Ultimately, if you have a concern about your risk of stroke, heart attack, or heart disease make an appointment with your doctor or primary care provider, today.

The traditional factors that put you at risk for stroke are lifestyle, diet, physical activity – which are controllable — tobacco use and smoking double the risk of stroke when compared to a nonsmoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque buildup in the arteries. Abusing alcohol and drugs (cocaine, amphetamines, and heroin) have been associated with an increased risk of stroke. The uncontrollable risk factors are your family history, age, race, gender, and prior heart health history.

There are also uncommon causes of stroke which are usually congenital (birth disorders) or rare vascular blood vessel diseases.

The recommendations for adults in their 40’s who are concerned about lowering their risk of stroke, heart attack or heart disease are:

• Eat a healthy diet, including reducing salt intake.
• Engage in regular physical activity and maintain a healthy weight.
• Manage stress.
• Avoid tobacco smoke.
• Take your medication as prescribed.
• Limit your alcohol consumption.

What is a stroke?

The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. “There are different types of stroke, hemorrhagic (bleeding in the brain), embolic (a blood clot that travels),” says King. Hemorrhagic strokes are less common; only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. They can occur as a cerebral aneurysm, a congenital malformation of the arteries in the brain that can rupture. “There is no way to know if you have an aneurysm or not. If it ruptures, you can have bleeding on the brain, and people can die from that. They would experience sudden severe headache, the bleeding in the brain, patients will say the worst headache of their life. It’s not a warning sign, that’s a symptom,” stated King.

The other form of stroke is called an ischemic stroke. This can happen when a sticky, fatty material called “plaque” builds up in a blood vessel in your brain. Plaque slows your blood flow. It may cause your blood to clot. This can stop the flow of blood completely. This kind of stroke can also happen when a clot travels to your brain from another part of your body, even if you don’t have plaque buildup in your vessels. The most common cause of this type of stroke is A-Fib (atrial fibrillation) when your heart has an abnormal rhythm that produces the opportunity for a clot to form in the left side of the heart, dislodge and travels up and through to the brain.

A patent foramen ovale (above) is a hole in the heart that didn’t close the way it should after birth. The condition affects about 25% of Americans, but many do not know it.

The other type of embolic stroke would be a patent foramen ovale (PFO) or some different kind of congenital hole in the right and left sides of the heart. “The sides of your heart are supposed to be separate; blood comes from the right side of the heart is pushed to the lungs. It comes to the left side of the heart and gets pushed through the body. When there is a hole between the two sides, clots form and can travel from one side to the other,” said King. Most patients with a PFO do not have any symptoms. However, the condition may play a role in migraine headaches and it increases the risk of stroke, transient ischemic attack and heart attack.

Advances in testing

For patients who present stroke symptoms (Numbness or weakness in your face, arm, or leg, especially on one side. Confusion or trouble understanding other people. Difficulty speaking. Trouble seeing with one or both eyes. Problems walking, staying balanced, or loss of coordination. Dizziness. Severe headaches that come for no reason.) there are testing procedures. “The only way to find the holes in the heart would be with an echocardiogram, an ultrasound of the heart, to evaluate to see if a PFO has formed,” said King. Echo tests are performed by specially trained technicians at Capital Cardiology Associates. The test is painless, has no side effects, and usually takes an hour. “Using an echocardiogram (ECG) we can inject ‘fizz’ essentially, a trace amount of agitated saline that we call a ‘Bubble Study.’ These tiny bubbles can be seen on an ECG moving across the septum,” King explained. An ECG allows a physician to view the heart’s structure and check how the heart functions.

The other test available is the Transcranial Doppler (TCD), a non-invasive ultrasound method used to examine the blood circulation within the brain. A specially trained technician at Capital Cardiology Associates Imaging Suite performs this test to determine the amount of blood flow to specific areas of your brain. “The main reason that we started doing this is to detect a shunt or a hole in the heart,” shared Dr. Jeffrey Uzzilia of Capital Cardiology. “Patients that had a stroke, one of the reasons why they had a stroke that is not obvious at the time, is they can have a hole in their heart where a blood clot can form somewhere in the body and cross through that hole from the right side of the heart to the left. Once that blood clot is on the left side of the body it can travel anywhere in the body, including the brain and cause a stroke. Something like a PFO that everyone is born with, for most people it will close, for about 25% of people it will stay open. The TDP is the most accurate, sensitive test to detect that. It’s a very easy thing to see. There’s a good portion of patients, like Luke Perry, that you are shocked as to how young they are when they have a massive stroke,” said Dr. Uzzilia.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

The Life of Heart Transplant Survivor

The Life of Heart Transplant Survivor

PATIENT STORY

The Life of Heart
Transplant Survivor

How a new heart changed one man’s life

The phone rang at my desk. It was Dr. Sullenberger. “Mike, you should come upstairs. There is a patient I want you to meet, David Gray. He has a story you need to hear.” I grabbed my recorder and walked upstairs to the 4th floor of our Corporate Woods location, unsure what to expect. This was the first time I had been called to meet a patient. Dr. Sullenberger introduced me to David Gray, a normal looking man wearing a hoodie sweatshirt and blue jeans. He smiled, we sat down, and David started opening up. He shared his remarkable survival story with the passion that makes you sit up and take notice.

David Gray (left) with Dr. Lance Sullenberger (right)

David Gray is a heart transplant survivor. His life changed forever in the summer of 2010, September 23rd to be exact. He speaks with such detail, you feel like you were in the hospital room when he received the diagnosis from Drs. Jeffrey Uzzilia and Lance Sullenberger that, what he thought were allergies, was in fact, viral cardiomyopathy, a disease of the heart muscle that causes it to become enlarged, thick or rigid. When David says cardiomyopathy, it just rolls right off his tongue. “Then I met Dr. Ian Santoro, my injection fraction was at 34%, it was recommended that I get a defibrillator, I got that. Glad I did because it saved my life. I fell on the floor and it shocked me four times, it brought me back to life!”

It was at that point, that I realized that David is going on his ninth year of telling this story. His journey continued after getting an Implantable Cardioverter Defibrillator (ICD). He blinked a few times, and the smile that was on his face cleared as a more serious tone came over his demeanor. He mentally focused as he shared this part of his story. Five years after receiving his implant, David’s ICD saved his life.

“I had just gotten done mowing the lawn,” David began. He went to sit in his chair in the garage to watch TV to cool off. “I said to my wife, ‘Hey, do you want anything from Stewart’s? I’m going to play the Lotto.” He looked right at me and stated the exact time and date; it was 5:30 pm on May the 30th. “She was like, ‘Naw, I don’t want anything.’ I told her, ‘Don’t leave, something is wrong.’ Next thing I remember, she’s in my ear saying, ‘I’m calling 911! Are you okay?” David recalls getting up and sitting in the chair but doesn’t remember falling to his garage floor, his forehead narrowly missing the snowblower parked nearby.

His defibrillator saved his life.

He sat in the chair in his garage for 20 minutes before going to the store. That’s when he got a call. “They told me that I was in full cardiac arrest and needed to come in right now. That started my summer off,” said David. “Dr. Sullenberger brought me in July of 2015 and said we needed to have a family meeting. I brought my wife and two kids in, I remember saying, ‘Really? I need a heart transplant evaluation! Are you serious?’ I was perfectly healthy my whole life. I thought I was just getting old.” David’s heart condition was degrading. A heart transplant was needed to save his life. We talked about what happens after you get this kind of diagnosis. How mind-boggling the news, terminology, and explanation can all be. The worst part is when you get home with a head full of questions left unanswered, so you get on the computer. “I googled heart transplant surgery — biggest mistake in my life, I didn’t need to know that. And I googled organ donation,” he said.

David rattled off facts so matter of factly, that after speaking with him, I realized was part of his impeccable memory recall. When it comes to organ donation in the United States, “New York is number 50 in the country. We’re at about 25% of per capita registered, we’re on the bottom of the pile. A New Yorker dies every 18 hours waiting for a transplant,” David stated. At the end of January 2016, an Intra Aortic Balloon Pump was inserted through Dave’s shoulder, another temporary solution until his open-heart surgery to implant a left ventricular assist device (LVAD).

“I knew nothing, absolutely zero about the heart or cardiology. Now I know more than I ever wanted to know in life!”

David Gray

Heart Transplant Survivor, Patient of Capital Cardiology Associates

Hear David's Story

On HeartTalk presented by Capital Cardiology Associates

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“I smiled, I stayed strong during the entire process,” he recalls. The implant of an artificial heart made it possible for David walk his daughter down the aisle for her wedding, his major goal for that summer. He was able to return home, live a “normal life”, get back to the things that kept him busy, and most importantly, be with his family. Now David waited for a heart donor. Four months later, he got a phone call in late August that changed his life: a heart had been found for him. The next day he underwent surgery and on September 14th, he was discharged from the Westchester Medical Hospital. His body had accepted the new heart.

Today, David Gray lives like most retirees in the Capital Region. He keeps busy with his projects. David makes beer, cans jam and tends to his five beehives. “This year I have 42 pounds of honey!” he exclaimed. He fishes in the summer and hunts in the fall. But there is one thing that makes David quite unique to men his age: he’s survived heart failure, open-heart surgery, and in his mid-50’s, David is a patient advocate. “I have always helped people, it’s just different now,” David said.

He started small, working with support groups online and in person. He volunteers his time with several organ donor groups, New York State Donate Life, the Center for Donation and Transplant at Albany Med, the American Heart Association, “but my number one priority is with Westchester Medical Hospital”, he said, where he visits on a weekly basis. “My new life is that I visit patients. I talk with patients who come through from Capital Cardiology, I spend twelve hours a day down there.” This year he started visiting area high school students, sharing his story with young people.

David Gray walking with his daughter at her wedding

In a 2012 study, researchers found that the average life expectancy in heart transplant recipients was a little over 9 years, although researchers found a “relatively high quality of life even 10 years after surgery.” For David Gray, it’s obvious to anyone who speaks or meets with him for any amount of time that he is making the most of his new heart. He writes to politicians, celebrities and speaks to anyone who will listen about the need for organ donors. Personally, he has thanked everyone involved with his heart transplant, from the first nurse who saw him at the beginning of his diagnosis to the mother of his heart donor. An estimated 2,000 donor hearts become available in the United States each year. There is a tremendous need for donors across the country. Approximately 3,000 people are on a heart transplant waiting list at any given time, according to the University of Michigan. “We need more heroes, that’s all I can say,” David said. Anyone 16 years old or older can enroll in the New York State Donate Life Registry. Learn more by clicking here.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Study Links Weight History With Congestive Heart Failure

Study Links Weight History With Congestive Heart Failure

PATIENT EDUCATION

Study Links
Weight History
With Congestive
Heart Failure

Why patients are being
diagnosed with heart failure
at 50 years old and what you
can do to lower your risk

One in five people worldwide run the risk of developing congestive heart failure, and this prevalence increases with age. At its base, congestive heart failure implies that your heart, which is a pump, cannot adequately provide the circulatory support required to maintain profusion to all of your organs. As there is no cure for the ailment, patients can only monitor their health closely with lifestyle changes or medication to prevent their heart function from deteriorating irreversibly.

On top of their being no cure for congestive heart failure, the condition is one of the most common infirmities affecting adults over 40 years old with more than 200,000 cases being diagnosed in the US every year. “Unfortunately what we are seeing more common these days are patients in their 50’s and 60’s with congestive heart failure,” states Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates. And for younger patients who receive the diagnosis, “The real scary thing is the overall expected lifespan is five years.”

Some people present no congestive heart failure symptoms. For others, they can experience shortness of breath when doing a light activity like walking around the supermarket, dizziness, fatigue, fluid retention (causing swelling in the lower extremities), sudden weight gain, and changes in their heartbeat. To diagnosis congestive heart failure your doctor will order a series of tests beginning with a blood test, echocardiogram, electrocardiogram x-rays, CT scan, stress test — all designed to show your heart’s function.

Causes

“The problem with congestive heart failure is that it covers such a wide swath of sub diseases,” states Dr. Healey. While you can’t prevent heart disease, for young adults looking to minimize their risk of developing heart attack, stroke, and heart disease that means avoiding lifestyle choices like excessive alcohol use, cigarette smoking, poor dieting, minimal to little physical activity/exercise, and poor sleeping habits. “The heart is an organ; it can’t live forever, it will exhibit age-related changes in your life,” he says. You should also have a regular conversation with your primary care provider, who can map out an individual assessment of risk and prevention plan. “The best thing you can do is to avoid getting congestive heart disease in the first place.”

Types of Congestive Heart Failure

Congestive heart failure is traditionally into two different aspects: systolic and diastolic.

Systolic congestive heart failure implies that the pumping of the heart is weak. As Dr. Healey explains, “We refer to that by the injection fraction which is a useful piece of information for patients to know and to ask their doctor, ‘What is my ejection fraction?'” Ejection fraction (EF) refers to how much blood in the heart, per pump, exits the heart and travels through the body. Most times, EF refers to the amount of blood being pumped out of the left ventricle, the heart’s main pumping chamber, each time it contracts.

Ejection fraction is expressed as a percentage. “A normal value is between 55 and 70%,” says Dr. Healey. “That might not be a great score on an exam but for an EF that is pretty good. Anything less around 40-50% is systolic congestive heart failure.” Your EF can go up and down, based on your heart condition and how well your treatment works.

The other group is diastolic heart failure which means the lower left chamber of the heart (left ventricle) is not able to fill correctly with blood during the diastolic phase, reducing the amount of blood pumped out to the body. “This is a normal EF, but the heart doesn’t function quite as well because it is stiff,” notes Dr. Healey. Over time, this causes blood to build up inside the left atrium, and then in the lungs, leading to lymphatic congestion and symptoms of heart failure. “This is generally related to inflammation and fibrosis which can be caused by any number of factors.”

The American College of Cardiology along with the American Heart Association have collaborated to categorize the four stages of heart failure (HF).

Stage A

The American Heart Association describes Stage A as, “At high risk for HF but without structural heart disease or symptoms of HF.” This diagnosis is typically for patients with hypertension, diabetes, or obesity. “If you have risk factors without actually congestive heart failure, we still label you as Stage A because we want you to be aware of how serious this diagnosis is and to prevent you from progressing to that next stage which is having congestive heart failure,” said Dr. Healey. The risk factors for Stage A include atrial fibrillation (A-Fib), hypertension, coronary artery disease (which involves diet, cholesterol, exercise), and sleep apnea. “AFib is a big risk for diastolic congestive heart failure because if you have a stiff heart, and now you are losing the coordination that occurs with AFib, now you have an inefficient heart with chambers squeezing at inappropriate times, leaving the remaining chambers to try to pick up the slack.”

Your doctor will talk with you about embracing a heart-healthy lifestyle as part of our treatment goals and may prescribe medications (like a statin) to treat vascular disease, diabetes, or high cholesterol.

Stage B

Stage B is outlined as, “Structural heart disease but without signs or symptoms of HF.” Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. “We’ve made the diagnosis after an ultra-sound of your heart which is generally the way we make the diagnosis along with clinical symptoms,” describes Dr. Healey. “You have parameters that suggest your heart is not functioning properly; it’s either weak or inefficient. Again, you’re not symptomatic, so we have time to intervene before it becomes a point where it’s affecting your life.”

Stage C

Patients diagnosed with Stage C have heart failure. “Stage C is the bulk of patients which is symptomatic,” commented Dr. Healey. They will be prescribed many medications to relieve their symptoms. They are placed on low sodium diets. They could also have pacemakers implanted or be put on implantable cardiac defibrillator (ICD) therapy.

Stage D

“Stage D is the end stage of heart failure,” begins Dr. Healey. “Typically that’s systolic congestive heart failure where your pump is completely inadequate. Essentially, you cannot get up and walk more than 20 feet without getting a significant shortage of breath where you have to stop.” Treatment options at this stage include heart transplant, surgery, and research therapies.

Watching Your Weight

A report published in November of 2018 examined a patient’s risk of heart disease compared to their weight history. From the age of 20-40, participants had their weight and body mass index (BMI) score recorded. The team found a 34% increased likelihood of heart disease for every 5 BMI points. “Weight has such a negative impact on many cardiac functions. Most notably I would say, congestive heart failure,” said Dr. Healey. The study authors concluded that “control of BMI throughout the lifetime is important for reducing the risk of heart failure.”

This is why patients are weighed at the beginning of every appointment or office visit. “If we start seeing 5, 10-pound weight gains between visits, that’s something we need to address.” In the weight history study, the authors noted that “the prevalence of obesity in the United States is strikingly high, seen in 36% of adults.” Experts link obesity as a warning sign for younger generations and a contributor to early heart disease diagnosis. “I think as Westerners, in general, we have become accustomed to living at this higher weight, that we think it’s a commonplace, that’s how the body is supposed to be. Well, no, that’s not the case. We need to reverse the attitudes we have about diet, weight, and healthy living,” said Dr. Healey.

“The goal is that patient’s come in for wellness visits. To talk with them about their lives and all of the wonderful things that they are doing. Helping them minimize medications, then the flip side, seeing them after the hospital visit after they’ve been in for congestive heart failure, after a heart attack, and now we are trying to play catch up.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Inside Open Heart Surgery

Inside Open Heart Surgery

PATIENT EDUCATION

Inside Open
Heart Surgery

The steps leading to one of the most common heart procedures: Coronary Artery Bypass Graft

The Texas Heart Institute reports that, “Thousands of heart surgeries are performed every day in the United States. In fact, in a recent year, surgeons performed 500,000 coronary bypass procedures.” Coronary Artery Bypass Graft (CABG, pronounced “cabbage”) Surgery is the most common procedure performed to bypasses a severely blocked artery in the heart with a healthy blood vessel. This surgery restores vital blood flow to the heart muscle.

Since the late 19th century, surgeons have been performing cardiac surgery. On May 6, 1953, the first successful open-heart operation was performed on an 18-year-old woman in Philadelphia with a heart defect. What was once a new, unknown, scary procedure is now one of the best known, most studied and most effective surgeries of the modern age. Today, more than 95 percent of people who undergo coronary bypass surgery do not experience serious complications, and the risk of death immediately after the procedure is only 1–2 percent. The list of famous bypass recipients includes celebrities like Elizabeth Taylor, David Letterman, and Larry King to former President Bill Clinton and Vice President Dick Cheney.

Even with this reassurance, there are still concerns and questions surrounding bypass surgery. Dr. Lance Sullenberger is board certified in Internal Medicine, Cardiovascular Disease, and Advanced Heart Failure/Transplant Cardiology. He regularly consults his patients on CABG surgeries. “I would say there are two major ways a patient would present the need for an open heart surgery procedure or CABG,” he said. “The first would begin with a visit to your cardiologist.”

Doctors can determine when someone needs open-heart surgery by performing specific tests. This would begin with a patient who presents typical warning signs, chest pain, shortness of breath or palpitations. People with coronary heart disease sometimes experience buildups of plaque — a combination of fat, calcium, cholesterol and other cellular junk — on the insides of their arteries. This can restrict blood flow and cause clots. The most common symptom of a clogged artery is chest pain. In this case, the physician would order a stress test.

Doctors can determine when someone needs open-heart surgery by performing specific tests. This would begin with a patient who presents typical warning signs, chest pain, shortness of breath or palpitations. People with coronary heart disease sometimes experience buildups of plaque — a combination of fat, calcium, cholesterol and other cellular junk — on the insides of their arteries. This can restrict blood flow and cause clots. The most common symptom of a clogged artery is chest pain. In this case, the physician would order a stress test.

Testing

The heart performs differently at rest than it does during exercise. An exercise stress test – also known as a treadmill test – is designed to help your doctor learn how your heart performs during exercise or other activities that would make the heart work harder. For patients that are unable to use a treadmill or to get a deeper look, your doctor could order a nuclear stress test to help in the diagnosis of coronary artery disease or other heart conditions.

If the result of the stress test is abnormal, that patient would then be placed on medication and referred for catheterization, performed by an interventional cardiologist. “They do a diagnostic cardiac catheterization to look at the arteries that supply the heart with blood to see if that stress test was accurate,” noted Dr. Sullenberger. Again, with this test, physicians are looking for buildups that cause blockage of blood flow. Typically, arteries that are not blocked over 60 to 70% would be treated with medical therapy (medications, alterations in diets, changes in sleep habits, increased physical activity, stress reduction and more).

There could be one or maybe two arteries that have a blockage in them. “In that case, the decision would be made whether or not to use medicines or perhaps put stents in,” said Dr. Sullenberger. The stenting procedure could occur at that moment at the time of the catheterization. “When you start dealing with more than two arteries that are blocked or if there are special situations, such as the main artery on the left is blocked then you have to take a step back and ask, ‘Is this somebody who would be better served by stents or by bypass surgery?’ This is when the cardiologist and the cardiac surgeon would meet to discuss the options involved,” he shared.

The other major situation in which the decision has to be made between stenting and bypass is when a patient presents with a heart attack. “They are coming in with chest pain, losing heart muscle, most of those patients end up immediately in the Cath lab where an interventional cardiologist will look to see which artery is blocked and causing the heart attack, at that moment,” says Dr. Sullenberger. Most of those patients will receive a stent at that moment. A stent is a tiny wire mesh tube that is inserted inside a clogged artery through a tube procedure that does not require open-heart surgery. It props open an artery and is left there permanently.

The other major situation in which the decision has to be made between stenting and bypass is when a patient presents with a heart attack. “They are coming in with chest pain, losing heart muscle, most of those patients end up immediately in the Cath lab where an interventional cardiologist will look to see which artery is blocked and causing the heart attack, at that moment,” says Dr. Sullenberger. Most of those patients will receive a stent at that moment. A stent is a tiny wire mesh tube that is inserted inside a clogged artery through a tube procedure that does not require open-heart surgery. It props open an artery and is left there permanently.

For patients who present blocked arteries that cannot be corrected with stenting, Sullenberger states that the patient is stabilized in the coronary care unit while the cardiologist and surgeon meet to discuss the next best step. “Most good cardiologists have an idea beforehand if this person is going to end up needing a bypass or if they have valve disease,” he says. The timeline on when to operate depends on the patient’s condition. For an out-patient, surgery is performed within weeks. For heart attack patients, those decisions are made in a day, 48-hours at the most.

Surgical Procedure

According to the Agency for Healthcare Research and Quality statistical brief, published in March 2014, about 213,700 Americans have a CABG procedure every year. When someone has bypass surgery, they are in the operating room for several hours, on average about six hours. Most of that time is spent prepping the patient and getting them ready. The actual bypass surgery itself is about a two-hour procedure which can go longer or shorter based on what needs to be done.

In a typical procedure, the surgeon harvests a healthy blood vessel from a donor site. This is called a graft. The graft is commonly taken from the patient’s leg or arm. The surgeon opens the patient’s chest to expose the heart. The patient’s blood flow is diverted to a heart-lung machine. This machine temporarily takes over the lung’s function of oxygenating the blood and the heart’s function of pumping blood to the body. Medication is administered to stop the patient’s heart and preserve it during the surgery. After the bypass is complete, the surgeon removes the clamp from the aorta and allows the heart to resume beating on its own. The surgeon may insert a temporary pacing wire. This wire can be connected to a pacemaker if needed.

The patient then goes to a surgical ICU for recovery, made especially for cardiothoracic patients that receive specialized nursing care. That’s when cardiologists would see the patient. “In a best-case scenario,” Sullenberger begins, “you stay in the ICU about 48-hours after surgery, then you go to a step-down floor for another five days or so. Expect about a week in the hospital. Then you are discharged to go home and will follow up with your cardiologist within a week, and the cardiothoracic surgeon within a week or two, then you don’t see your surgeon anymore.” Unless there is a problem, you won’t see your surgeon again, but you will continue to see your cardiologist on a regular appointment basis.

Prevention

The need for CABG surgeries is expected to expand by just over 5% in the seven years due to stress, obesity, sedentary lifestyle, and unhealthy habits. “For everyone [reading this] now, you never want to have to see a cardiologist or a cardiothoracic surgeon. The way you avoid that is doing everything you can to keep a healthy lifestyle,” advises Dr. Sullenberger. The American Heart Association strongly recommends eating a balanced diet, maintain reasonable body weight, stay at least moderately physically active (within your limits), and to check your cholesterol level regularly, especially if your family has a history of heart disease. Additionally, quitting smoking significantly reduces your risk of developing heart disease, heart attack, and stroke.

Prevention

The need for CABG surgeries is expected to expand by just over 5% in the seven years due to stress, obesity, sedentary lifestyle, and unhealthy habits. “For everyone [reading this] now, you never want to have to see a cardiologist or a cardiothoracic surgeon. The way you avoid that is doing everything you can to keep a healthy lifestyle,” advises Dr. Sullenberger. The American Heart Association strongly recommends eating a balanced diet, maintain reasonable body weight, stay at least moderately physically active (within your limits), and to check your cholesterol level regularly, especially if your family has a history of heart disease. Additionally, quitting smoking significantly reduces your risk of developing heart disease, heart attack, and stroke.

Written by: Michael Arce, Media Specialist
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.