Good for the Heart




Technological innovations at N.H. hospitals are saving lives This time of year, romantic cardiac references are inevitable. Depending on Cupid's fickle arrow, some hearts will pound and flutter, while others are left feeling achy-breaky. Practically speaking, of course, none of these symptoms is good, but perhaps the imagery in songs and verse will serve as a subtle reminder of the importance of cardiac health. Despite some gains toward improved heart health, heart disease continues to loom large for Americans. It is the most common cause of death in the United States, bringing nearly 700,000 deaths each year, according to the Centers for Disease Control and Prevention. The good news is, technological innovations are leading to better outcomes for patients with physically troubled hearts. Cool it For instance, here in New Hampshire, patients are fortunate to have access to a body-cooling system that has been shown to dramatically improve survival and brain recovery following cardiac arrest. "The brain can subsist just a few minutes without oxygen," says Thomas P. Wharton Jr., M.D., director of the Division of Cardiology and the Cardiac Cath Lab at Exeter Hospital. A lack of oxygen triggers a cascade of events that leads to further brain tissue damage, even after oxygen and blood flow are restored, he explains. Cooling slows brain metabolism, helping to reduce the neurological damage that can occur after cardiac arrest has stopped blood flow to the brain. New cooling technology allows physicians to easily and rapidly lower a patient's body temperature from the normal 98.6 degrees to about 92 degrees. Water-filled adhesive pads are wrapped around the patient's torso and thighs, and a connected machine automatically adjusts the water circulation as necessary to quickly lower the patient's body temperature, maintain that temperature for 12 to 24 hours, and then gradually raise it back to normal when the treatment is complete. Research shows that properly lowering the body temperature greatly improves the patient's odds of favorable brain function as well as survival, and Wharton's personal experience with patients has left him "amazed" by what cooling can do. Despite compelling results, though, and even requirements in some cities that patients resuscitated from out-of-hospital cardiac arrest be transported to hospitals with cooling systems, cooling technology is not widely available at American hospitals. Some hospitals might be slow to adopt cooling, Wharton guesses, because in the past cooling procedures were cumbersome, but the new technology is "trivial" to use, he says, and its results are remarkable. "It's very dramatic. It's like walking into a ward of pneumonia patients with a new drug called penicillin." Keep it steady Implanted cardioverter defibrillators (ICDs) are another technological advance that offers life-saving implications for cardiac patients. Put simply, an ICD monitors a patient's heart rhythms and delivers shocks as necessary to keep rhythms out of the danger zone. "The device will only react if the patient has an arrhythmia that would otherwise be fatal. Its main purpose is to abort, to stop, a sudden cardiac arrest," says Daniel M. Philbin, M.D., cardiac electrophysiologist at Catholic Medical Center's New England Heart Institute. Originally a bulky device, today's ICDs are about the size of a pager and are implanted in the shoulder. A wire leads from the ICD through a vein to the heart, allowing physicians to implant an ICD in a minimally invasive way that avoids major surgery on the chest. The newest versions of ICDs have a transmitter that allows physicians to "wirelessly interrogate" the device, Philbin says. "The information that the system sees, we can see. It monitors every heartbeat, and if it sees heartbeats that are fast or irregular, it will time and date stamp what it sees." The device also has the ability to wirelessly transmit information through the patient's home phone line to the physician, allowing the patient to convalesce at home and be remotely monitored, which is an especially valuable option to have in New Hampshire, where the population is relatively widely dispersed, Philbin says. "It gives us a way to monitor people at a relatively long distance without making them trek all the way back down [to Manchester] for an appointment," he says, noting that Catholic Medical Center has ICD patients scattered throughout the farthest corners of the state. There is concern, though, that many patients who could benefit from an ICD don't have one, Philbin says, probably partly due to the fact that people who are at risk for sudden cardiac arrest often feel pretty well day-to-day and don't believe they need an ICD. Reluctance to consider further treatment is one problem, Philbin says; news headlines about faulty defibrillators are another. Although recently recalled defibrillators "failed to react when they were called upon to react - at an extraordinarily low rate," Philbin says, they did not harm anyone. The very high life-saving potential of an ICD far outweighs the very low likelihood of it not working when it is needed, Philbin says, who points out that only about 15 percent of people who have a cardiac arrest make it to the hospital alive, and of those, about half die before discharge. ICDs are "very safe," he says, and can reduce the likelihood of dying from cardiac arrest in some patients by 30 percent. Philbin also urges patients who have had a heart attack to familiarize themselves with their ejection fraction, which is an estimate of how much blood the heart's main pumping chamber pushes out with each beat. Even if patients don't feel particularly limited by their heart disease, if their ejection fraction is low, their risk for having a cardiac arrest is quite high, Philbin says, and they should discuss ICDs with their doctor. Life-Saving Facts: Some women are "shocked when they find out that their chances of dying from heart disease are greater than their chances of dying not only of breast cancer but of all forms of cancer combined," says Kate Pendergast, director of the "Go Red for Women" campaign for the American Heart Association (AHA)-New Hampshire. The AHA initiated the campaign to help raise awareness and offers ongoing events throughout the year, as well as an online heart health assessment at www.goredforwomen.org. In an Emergency: In a cardiac emergency, do not be afraid to use an automatic external ventricular defibrillator (AED), available in many public spaces nowadays. An AED provides a jolt of electricity to help a cardiac arrest patient's heart to resume a normal rhythm, and is easy enough for a child to use, says Exeter Hospital's Dr. Thomas Wharton. AEDs include directions and some have voice prompts. Some of us who learned cardiopulmonary resuscitation (CPR) years ago might hesitate to apply the technique, as we struggle to recall the recommended rhythm and number of chest compressions per breaths. However, research shows that effective chest massage only - without the breaths - for the first five or six minutes is all that is needed, Wharton says. And if you want a handy way to remember the proper pumping beat, think of (believe it or not) the Bee Gees disco hit "Stayin' Alive." Experts say the song provides an ideal pumping rhythm of about 100 beats per minute. NH

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