>> FEBRUARY IS HEART MONTH, AND IN THIS SEGMENT WE TAKE A LOOK
AT THE NEWEST PROCEDURES TO HELP PEOPLE WITH HEART DISEASE, AND
TALK PREVENTION WITH MEDICAL EXPERTS.
CAROLEE MCGRATH SAT DOWN WITH DR.
AARON KUGELMASS, VICE PRESIDENT AND MEDICAL DIRECTOR
OF THE HEART AND VASCULAR PROGRAM AT BAYSTATE MEDICAL
CENTER AND DR.
THOMAS SCHWANN, ASSOCIATE DIRECTOR OF THE HEART
AND VASCULAR PROGRAM AT BAYSTATE, TO LEARN MORE.
>> THE BIGGEST ISSUE IN THE UNITED STATES IS AND HAS BEEN
FOR A LONG TIME WHAT WE CALL CORONARY ARTERY DISEASE THEN THE
PROBLEMS THAT FOLLOW IT.
WHICH REALLY REFERS TO IS A BUILD UP OF CHOLESTEROL AND
OTHER THINGS IN THE WALLS OF THE ARTERIES THAT FEED THE HEART.
THAT IS WHAT TYPICALLY CAUSES HEART ATTACKS.
ONCE HEART ATTACK OCCURS, THE HEART MUSCLE ITSELF BASICALLY
DIES, ONCE THAT HAPPENS THINGS LINE CONGESTIVE HEART FAILURE
CAN ENSUE.
IF YOU CAN GET TO THE BOTTOM OF THE CORONARY ARTERY DISEASE
PROBLEM YOU CAN FEND OFF A LOT OF DIFFERENT PROBLEMS.
>> DOES CONGESTIVE HEART FAILURE HAVE TO FOLLOW A HEART ATTACK OR
CAN THAT BE SEPARATE.
CAN YOU EXPLAIN IT?
>> THEY ARE BASICALLY BREAK CONGESTIVE HEART FAILURE DOWN
INTO DO DIFFERENT TYPES.
TYPE WHERE THE HEART MUSCLE IS WEAKENED IT CANNOT PUMP.
A DIFFERENT TYPE WHERE THE HEART MUSS MUSCLE FAILS TO RELAX
ADEQUATELY AND DRIVES PRESSURE IN THE HEART HIGHER THEN IMPACTS
THE LUNGS MAKES IT DIFFICULT TO BREATHE.
IF YOU CAN HAVE HEART FAILURE AT TWO ENDS OF THE SPECTRUM.
ONE WHERE THE HEART WON'T PUMP AND ONE WHERE HEART WON'T RELAX.
>> WHEN YOU'RE TALKING ABOUT CORONARY DISEASE YOU'RE TALKING
ABOUT -- HOW CAN YOU REVERSE THAT, PRETTY SIMPLE WAYS TO
AVOID THAT OR TO REVERSE THOSE SIGNS?
>> BEST WAY TO AVOID IS TO AVOID THINGS THAT ARE -- HAVE KNOWN
IMPACTS ON THE BUILD UP OF CHOLESTEROL INSIDE.
THE HEART ARTERIES, WHICH WOULD INCLUDE HIGH CHOLESTEROL LEVELS
ITSELF, SMOKING, HIGH BLOOD PRESSURE, INACTIVITY IS EMERGING
AS A RISK FACTOR AS WELL.
ONCE THAT HAS OCCURRED, THE KEY IS TO STABILIZE THAT CHOLESTEROL
BUILD UP TO MAKE SURE THAT THAT PLAQUE OR CHOLESTEROL BUILD UP
DOESN'T RUPTURE AND CAUSE A BLOOD CLOT TO FORM.
THE NEW CLASSES OF DRUGS, THE STAT TINS, REALLY HAVE BEEN
SHOWN TO STABILIZE PLAQUE AS WELL AS REVERSE SPIN CASES.
THERE'S A NEW CELT OF DRUGS THAT ARE EVEN MORE POTENT.
THOSE NEED TO BE INJECTED ARE STILL RESTRICTED TO PEOPLE WHO
HAVE REALLY SERIOUS CHOLESTEROL PROBLEMS OTHERWISE CAN'T
CONTROL.
>> DR.
SHA JUAN, WHAT ARE SOME OF THE LATEST ADVANCES IN
HELPING PEOPLE YOU KNOW WHO HAVE HAD A HEART ATTACK SOME OF
THE NEW SURGICAL PROCEDURES?
>> THERE ARTERY DISEASE NUMBER OF APPROACHES, NUMBER ONE.
IS THAT WE CAN GIVE THEM MEDICATIONS.
NUMBER TWO, IS IF THE CORONARY DISEASE IS MILD TO MODERATE, WE
CAN SUBJECT THESE PATIENTS TO A STENT PROCEDURE WHERE WE CRUSH
THE BLOCKAGE ITSELF AND REOPEN THE BLOOD VESSEL AND REOPEN.
THOSE FOLKS WHO HAVE EXTENSIVE AND VERY ADVANCED CORONARY
DISEASE, PARTICULARLY IN DIABETICS AND PARTICULARLY IN
THOSE INDIVIDUALS WHO HAVE HAD A HEART ATTACK, WHOSE HEART
FUNCTION IS DIMINISHED, ON THE DOSE CIRCUMSTANCES, BEST LONG
TERM APPROACH IS TO HAVE BYPASS OPERATION.
THE OPERATION IS EXACTLY AS ITS NAME IMPLIES.
WE TAKE BLOOD VESSELS FROM OTHER PARTS OF THE BODY WE TRANSPOSE
THOSE INTO THE HEART CIRCULATION SO THAT BLOOD FLOW THROUGH
NATIVE DISEASED BLOOD VESSELS WILL STAY THE SAME.
THEN THEY CAN COME FROM THE LEGS, FROM INSIDE THE BREAST
BONE OR ALTERNATIVELY FROM THE UPPER EXTREMITIES.
TRADITIONALLY, THE OPERATION THAT 90% OF THE PATIENTS IN THE
UNITED STATES GET TODAY IS USING ONE ARTERY FROM UNDERNEATH THE
BREAST BONE THEN SUPPLEMENTAL VEINS FROM THE LEGS.
WHAT WE HAVE PIONEERED, WHAT WE HAVE FOUND IS THAT INCREASING
THE NUMBER OF ARTERIAL BYPASSES TO FIX THE ARTERIES IN THE HEART
AS OPPOSED TO VENOUS CHANNELS INCREASES THE PATIENT'S LIFE
EXPECT TEN SEES AND IMPROVE THE PATIENT'S OUTCOMES.
>> CARDIOVASCULAR DISEASE IS NUMBER ONE LEADING CAUSE OF
DEATH FOR BOTH MEN AND WOMEN.
I THINK THAT STILL SURPRISES PEOPLE ESPECIALLY WHEN YOU ADD
WOMEN INTO THE MIX ON THAT.
>> I THINK WHAT WE CAN SAY IS THAT THE NATURE OF THE DISEASE
HAS CHANGED OVER THE DECADES.
THE TYPES OF PATIENTS WHO TYPICALLY WILL PRESENT WITH A
HEART ATTACK IN 2020 ARE VERY DIFFERENT THAN PROFILE OF THE
40-YEAR-OLD MAN IN 1960s.
WE HAVE NOT ABOLISHED HEART DISEASE.
WE HAVE REDUCED WHAT IT OTHERWISE WOULD HAVE BEEN AND IN
MANY WAYS WE HAVE DELAYED IT UNTIL MUCH LATER STAGE OF LIFE.
AND WOMEN ARE THOUGHT OF AS BEING PROTECTED UP THROUGH
MENOPAUSE.
AS THE TIMELINE OF ATHEROCARDIOVASCULAR DISEASE.
WOMEN NOW ARE JOINED BY MEN.
>> HOW DO YOU KNOW WHEN TO CALL THE DOCTOR OR EVEN 911.
BECAUSE I THINK SOME PEOPLE MIGHT BE RELUCTANT, I DON'T WANT
TO CAUSE ALARM.
HOW DO YOU KNOW THE RIGHT TIME TO DO THAT?
>> WOMEN TYPICALLY THINK, I SHOULDN'T BE CAUSING ALARM,
THERE ARE MORE WORRIED ABOUT THEIR HUSBAND THAN THEY NEED TO
BE WORRIED ABOUT THEMSELVES BECAUSE IF THEY'RE NOT AROUND
AFTER HEART ATTACK THERE WON'T BE ANYBODY TO WORRY ABOUT THEIR
HUSBAND.
WE'RE A TIME IN MEDICAL SCIENCE NOW WHERE WE HAVE VERY EFFECTIVE
TREATMENTS FOR HEART ATTACKS.
AND THE QUICKER WE CAN APPLY THOSE, THE QUICK ARE RERESTORE
BLOOD FLOW LESS OVERALL DAMAGE.
IF YOU THINK BACK TO WHAT WE TALKED ABOUT TO THE HEART MUSCLE
DYING WE CAN PREVENT THAT IF WE CAN GET THAT BLOOD CLOT REMOVED
AND PUSHED OUT OF THE WAY QUICK ENOUGH.
AT THIS POINT WE'VE MADE A LOT OF PROGRESS HOW WE DELIVER THAT
CARE INSIDE THE HOSPITAL AND EVEN HOW WE CONNECT BETWEEN
EMERGENCY MEDICAL SERVICES AND THE HOSPITAL.
THE BIGGEST DELAY NOW AND BIGGEST CHALLENGE WE FACE IS
WHAT YOU JUST SAID, GETTING PEOPLE TO CONTACT MEDICAL
CONTACT.
IF YOU HAVE SYMPTOMS LIKE SQUEEZING CHEST DISCOMFORT, YOU
CAN'T BREATHE SUDDENLY, YOU PASS OUT, I THINK THAT IS CAUSE TO
CALL 911.
IF YOU'RE NOT FEELING RIGHT GOING UP THE HILL ON WALKING THE
DOG IS NOT WHAT IT USED TO BE IT'S TIME TO SEE YOUR DOCTOR.
>> SOMETHING THAT ALSO SURPRISES PEOPLE, TOO, I'M SURE YOU CAN
TALK ABOUT THIS.
IS THAT WHEN YOU HAVE SOMEBODY WHO IS EXTREMELY ATHLETIC, MAYBE
MIDDLE AGE PERSON BUT WE HEAR THOSE CASES WHERE, OH, MY, GOSH,
THEY WERE IN PERFECT SHAPE, HOW COULD THEY SUDDENLY HAVE A HEART
ATTACK.
EVEN IN THOSE SITUATIONS, YOU HAVE TO LOOK BACK AT FAMILY
HISTORY?
HOW CAN YOU HELP ADVISE PEOPLE ON WHAT TO LOOK FOR.
>> THERE'S A WHOLE SPECTRUM OF HOW PATIENTS PRESENT WITH HEART
DISEASE.
SOME FOLKS PRESENT WITH PROGRESSIVE CHEST PAIN M. FOLKS
PRESENT WITH CARDIAC EVENT SUCH AS ARTERY DISEASE ATTACK SOME
FOLKS UNFORTUNATELY FIRST MANIFESTATION OF THEIR
UNDERLYING HEART DISEASE IS SUDDEN CARDIAC ARREST AND SUDDEN
CARDIAC DEATH.
THAT'S WHY IT'S IMPORTANT AND LOT OF SORT OF PUBLIC HEALTH
FOCUS HAS BEEN SPENT ON DEVELOPING BYSTANDER CPR BECAUSE
FASTER WE CAN RESUSCITATE THOSE PATIENTS AT THE SITE OF THE
EVENT WHICH TYPICALLY OCCURS OUTSIDE OF THE HOSPITAL, THE
BETTER THE LIKELIHOOD OF SURVIVAL.
AS AGGRESSIVE AS WE HAVE BEEN, THE CHANCES FOR OUT OF THE
HOSPITAL ARREST, PATIENT SURVIVING LESS THAN 5%.
WE HAVE STILL A LONG WAY TO GO.
BUT I THINK THAT WHAT I WANTED TO EMPHASIZE AGAIN IS THAT WE
HAVE MADE DRAMATIC PROGRESS OVER LAST YEARS, WE DEVELOPED
INTERVENTIONS, MEDICATIONS, WE HAD VERY AGGRESSIVE PUBLIC
HEALTH EVENT TRYING TO MAKE PEOPLE AWARE THAT HEALTHY
LIFESTYLE IS REALLY IMPORTANT.
ALSO LEARNED A LOT FROM THE VIETNAM WAR, WHERE A LOT OF
YOUNG FOLKS WERE SUBJECTED TO CASUALTIES AND WE FOUND THAT
THIS HEART DISEASE REALLY BEGINS VERY, VERY EARLY.
MUCH MORE SO THAN WE HAD ANTICIPATED.
SO, THESE -- THESE FATTY STREAKS THAT OCCUR WHICH IS THE
PRECURSORS OF ATHEROSCLEROTIC PLAQUE CAN OCCUR AS EARLY IN THE
LATE TEENS AND EARLY 20s.
SO, THIS IS A CHRONIC PROBLEM THAT IS REFLECTIONS OF OUR
LIFESTYLE, I THINK THAT IT'S ABSOLUTELY ESSENTIAL THAT WE DO
WHAT WE CAN POSSIBLY DO TO CONTROL THE ENVIRONMENTAL
FACTORS, BECAUSE THE GENETICS WE'RE NOT GOING TO CHANGE IN THE
FORESEEABLE FUTURE.
MAYBE WITH SOME GENETIC MANIPULATION WE CAN MODIFY THAT.
BUT TODAY THE ENVIRONMENTAL FACTORS ARE GOING TO BE THE
FACTORS THAT ARE GOING TO BE MOST IMPORTANT IN TERMS OF
TRYING TO EXTEND THE LIFE EXPECTANCY.