Technology and Cardiology: New ideas can mean a new life

Mr. Smith was leaving his new job and planning to start an exercise program to improve his level of physical fitness so that he could go hiking with his daughter in northern Minnesota. As he entered the parking lot, a pressure gripped his chest like a vise, so sudden that he lost his breath. He awoke in an ambulance and was told he was having a heart attack. The cardiologist listened to the man's history and after an exam, knew the path that had to be taken to get this patient the best result possible. Emergency cardiac catheterization was needed to find the culprit blockage in the heart artery (coronary artery) and open it up as quickly as possible to restore normal blood flow to the heart muscle and subsequently minimize the damage to the man's heart.

Modern cardiac catheterization has improved with smaller tubes (catheters), better contrast, and improved X-ray technology reducing the risk of a complication from the procedure to less than half of a percent. Advances in technology to open up a blocked coronary artery came from improvements in the medications used to prevent blood clots, implementation of small guides (tubes to pass along the wires, balloons, and stents), better wires, newer devices to remove the blood clot that caused the heart attack, small and more flexible balloons, small and more flexible stents, drug eluting stents, and devices to close the puncture site in the femoral artery (leg artery) that allowed access for the guide, wires, balloons, and stents. If the patient's blood pressure had dropped during the coronary angiogram or per cutaneous coronary intervention (angioplasty or stent) due to poor heart function, there are better tools to augment the heart function, with smaller intra aortic balloon pump devices (that inflates during the relaxation phase of the heart increasing blood flow to the heart arteries).

Unfortunately, the patient is still unable to walk up a flight of stairs after several months of medical treatment. He undergoes several non-invasive diagnostic tests, which are better than ever before. A cardiac MRI defines, with great accuracy, how well the heart can squeeze (or the ejection fraction). Echocardiography, which is portable and readily accessible at the bedside, has allowed for rapid analysis of the patient's heart valves, heart chamber sizes, function of the right and left ventricle, intracardiac and central venous pressures, and the pericardium (the sac surrounding the heart). Advances in the realm of heart rhythm therapies have propelled pacemaker and defibrillator technology to smaller and better devices that can make the heart beat better and prevent death. However, despite all this technology (maximal medical management and device therapies), he may still not get better after several more months. Luckily, heart transplantation is now more accessible but organs remain scarce and the patient may not survive the long wait for a heart transplant. He now has the option of being bridged with a left ventricular assist device that still allows him to walk holding the small device on a sling over his shoulder. The last two decades of advancement in cardiac technology give Mr. Smith the possibility of still going on that hike with his daughter.

We are entering another paradigm shift in medicine. People are worried not only about maintaining health and treating disease, but the price of the available diagnostic and therapeutic technology to achieve these goals is becoming the focus today more than ever before. Medical progress is initiated by novel ideas, hundreds or thousands of them that often fail. Through the perseverance of those who are idealistic and driven, some ideas succeed in the early rounds only to be dashed to the rocks with larger randomized controlled trials. The few that survive are truly rare, and then others latch on to the idea to modify and improve upon the design, and more importantly, drive down prices yet provide better care with the novel treatment. New technology, spawned by new ideas in cardiology, provides not just a business opportunity but for those less fortunate a chance to truly have a new life.

Carmelo Panetta, MD,
Park Nicollet Heart & Vascular Center