Heart disease is the number one killer in the US, just ahead of infectious diseases and cancer. A new research study by Dr. Tobias Reichlin, M.D., of University Hospital Basel, Switzerland, and his colleagues provides a fantastic process for quick evaluation of “acute” MI (myocardial Infarction), but there are inherent problems with the process being used for the purposes intended by the study.
Number one, the insurance industry makes Cardiologists jump through hoops to get expensive testing done without pre-approval. And you can believe that this type of procedure will be expensive. Their response is that there are cheaper, more effective, time proven tests that show similar results, and the term “acute” means sudden onset. And that limits pre-approval. Medicaid is no better. The majority of people presenting with these types of symptoms are senior citizens and younger, basically from 40 years old on upward. Additionally, Medicaid is paying Doctors less and less, and withholding approval for more and more procedures.
The idea of the research study is that a new strategy using an algorithm that incorporates high-sensitivity cardiac troponin T (hs-cTnT) testing values will determine in 45 minutes to 1 hour if “acute” MI is indicated. An angiogram currently can be administered in a similar amount of time, with dramatically better results. The angiogram can provide for angioplasty and the procedure can also evaluate left ventricular function, assess cardiomyopathy and valvular heart disease, determine the full extent of CAD, verify and support the non-invasive data, and determine the need for surgical correction of any of the above. All from one procedure. Amazing isn’t it.
In other words, when a person experiences “acute” angina (chest pain) they should immediately present themselves at their local ER for admission. The immediate response for this “acute” angina is what they refer to as M.O.N.A. A strategy of Morphine, oxygen, nitroglycerin and aspirin. This plan of action has been modified over the years, to exclude the nitroglycerin to some degree, but basically it remains the same.
“Chronic” angina associated with MI is an area where Doctors may have an opportunity to advance this new technology. But again, most insurance companies will go with the tried and true methods, an echocardiogram first, EKG, a nuclear or treadmill stress test, and then if certain indicators are present, an angiogram. Because MI is associated with coronary artery disease (CAD), if an angiogram is performed, the Cardiologist can put a “stent” in place while performing the angiogram, turning the procedure into an “angioplasty.”
That is why “acute” Myocardial Infarction specifically, and heart attacks in general are the “silent” killer. Let me explain to the layman a few things about heart attacks, Myocardial Infarction and coronary artery disease. There are more than one type of heart attack, MI being the most prevalent. An MI is almost assuredly caused by coronary artery occlusion (blockage). This happens when plaque (cholesterol) deposits onto a blood platelet (blood plasma) and then sticks to the lining of one of your coronary arteries, as well as you regular arteries and veins, but that’s another story. Once you have build-up, more and more plaque sticks, and when it presents as an 80 to 90% blockage, angina happens, and is thus termed “acute onset MI,” in general terms.
Other types of heart attacks include, but are not limited to, heart failure, left or right side, hypertrophic cardiomyopathy, and ischemic heart disease, to name a few.
Now the heart is a muscle, and every muscle, organ and all tissue in the human body needs blood, and the nutrients and oxygen that is carried with it, to survive. And the heart is no different. Denial of blood flow to the heart is what causes MI. Most people assume that the heart gets its blood from inside itself, in the pumping chambers (the ventricles and atriums.) This is not so.
The heart gets the blood it needs from a system of arteries called “coronary arteries,” that cover the surface of the heart, and run between the epicardial and myocardial layers of the surface of the heart. Coronary arteries that run deeper into the heart are referred to as subendocardial. These arteries are the first two branches off of the ascending aorta, the main artery that carries blood to the human body, between the aortic root and the aortic valve, in an area called the sinuses of valsalva. So if the coronary arteries get blocked, the supply of blood to the myocardium stops, thereby restricting the pumping ability of the heart to pump blood to the body, and in turn , the oxygen your body demands and a heart attack occurs.
If they catch it in time, before a total occlusion occurs, Percutaneous Transluminal Coronary Angioplasty (PTCA) or Angioplasty for short is indicated. A guide wire is inserted into an artery somewhere in the hip region of your body, and it is guided towards the heart to the area of occlusion and a balloon is inflated over the plaque, and it is “plastered’ down to the wall of the artery. Hence the term Angio-“plasty” A stent is then placed over the plaque, to keep it in place because if a piece breaks free, it could end up in your lungs eventually and would become a pulmonary embolism. But that’s another story also. If the occlusion is 100%, coronary artery bypass is indicated. Then you have to have open heart surgery, and a new segment of artery is grafted in place of the occluded artery, to supply the area of the myocardium with blood flow, allowing it to pump properly. Whew, that was a mouthful. I hope everyone got the basic idea, because I didn’t tell you everything I could have, as it would be very confusing to most people.
So listen to your Doctor, watch your cholesterol level, take an aspirin every day if he tells you to. Or you could try eating healthy, lose a little weight, exercise some, stay away from junk food, quit smoking and you will extend your life and your QUALITY of life to some degree. Remember, you get out what you put in.
My advice to anyone that reads this article is if you feel a gnawing, grinding pressure in your chest, not necessarily on the left side, but anywhere from the upper diaphragm to the jawbone, GO TO THE ER. Don’t take any chances. Don’t take an antacid and go to sleep. That is what most people do, pass it off as heartburn, take something for it, maybe take a sleeping pill, and go to sleep and die. And if you have heartburn up into your jawbone, ESPECIALLY WOMEN, DO NOT WASTE ANY TIME, GO DIRECTLY TO THE ER. These are the major signs of ACUTE ONSET MYOCARDIAL INFARCTION (MI).
Time is not on your side, so don’t delay.
The life you save may be your own.
Words to live by.
I would like to personally thank Susan King Dewitt, BS, RDCS, RCS, for writing her fantastic book, ECHOCARDIOGRAPHY …From a Sonographer’s Perspective. Everything I know about the heart I learned from her book and all the material herein is attributed to her, respectfully. Thank you.
I would also like to thank Mr. Manny Arias, my friend, founder and CEO of The American Institute of Medical Sonography. Thank you for all the wonderful knowledge. You are the best.
The Author of this article, Jim Donahue, is the General Manager of the Guardian Express newspaper, and an Echocardiographer.
Mr. Donahue had a massive MI in January 2011 and survived. He was lucky. You may not be. Pay attention.
He is a graduate of the American Institute of Medical Sonography in Las Vegas, NV.
For more information about becoming an ultrasound technician, contact the school:
American Institute of Medical Sonography
5450 West Sahara Avenue #320
Las Vegas, NV 89146