Seeing You Better
Ultrafast CT scans are getting even faster. This is important because the constant beating of your heart leads to fuzzy pictures unless the scanning device is moving very quickly. The newest generation devices are so fast that we can see all the way into your heart arteries. This gives us non-invasive insights into your heart that historically only were the purview of surgeons.
When catheters were first placed in to the heart in the 1970’s, few imagined that over 1 million of these procedures could be done annually. Part of the success is the remarkable durability of the newer stent designs. These metallic devices look like the metal spring in a ballpoint pen, but they cost a bit more. Coating the stents with medications to prevent aggressive attacking of the metal by the body has further reduced the chance of complications from re-stenosis. The procedures are exceedingly safe and are very quick. Best of all, the recovery is measured in hours rather than weeks. On the other hand, the long-term results are often inferior to surgery.
Good Ol' Heart Surgery
The first coronary artery bypass grafting (CABG) procedures were done in the 1960’s, and they have advanced dramatically with success rates now hovering around 98 percent. The indications have narrowed since stents and angioplasty can treat many without invasive surgery, but surgery continues to innovate as well. Less invasive surgery in the form of off-pump bypass surgery avoids the use of the heart-lung machine. Although this newer technique has not proven to offer large advantages, clinical trials may one day show benefits including reduced incidence of stroke.
Pump Me Up
Mechanical devices to support the failing human heart have gained FDA approval and are being implanted with increasing frequency in the many Americans who suffer from heart failure. This is a very expensive disease to treat and the long-term benefits are often marginal. Ventricular assist devices (VADs) offer an alternative that may one day outshine today’s gold standard—the heart transplant.
Statins in the Water
Further research has proven that lowering cholesterol with statin medications helps high-risk populations survive longer and better. Some members of the recent NCAP group recommended that folks with prior heart disease seek LDL-cholesterol levels less than 70. For primary prevention (i.e. folks who are healthy today), the guidelines are less easy to define, but doctors become uncomfortable with LDL-cholesterol greater than 160.
Major medical journals are proving that tremendous stress can cause heart failure from overload of our stress hormones. In other words, we can suffer from broken hearts! The more we understand about the subtleties of the human body, the more the role of the mind-body relationship finds a niche. For example, we now know that depression is a major predictor of death after a heart attack. Who would have thought? The next major research frontier may be this low-tech alternative to the high-tech options above.