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UM Capital Region Health’s Cardiac Catheterization Lab Offers Minimally Invasive Procedures for A Range of Heart And Vascular Problems

For months, Albert Walton, 74, didn’t feel up to par. “I was just lethargic and lazy,” says the Scottish-born retired electrical maintenance worker in College Park. “I was having trouble breathing. I’d go out to cut the grass, and after 10 minutes I’d need to go sit down.”

Walton complained about his symptoms to his doctor. Tests revealed a blockage in one of the arteries to his heart—the kind that can lead to a heart attack—and he ended up at the Cardiac Catheterization Lab at UM Capital Region Health. There, Rajendra (Raj) Shetty, MD, the lab’s medical director, cleared Walton’s artery of dangerous plaque, improving the blood flow to his heart.

Walton, who was awake but sedated for the procedure, felt a difference almost immediately. “It was the best I’d felt in a long time,” he says. Walton is just one of the thousands of patients who gained a new lease on life after treatment at the catheterization lab, or cath lab. The lab specializes in minimally invasive procedures to diagnose and treat heart and vascular disease—advanced techniques that don’t require open surgery.

“Not every hospital is able to provide these procedures,” Dr. Shetty says. “Our technology and expertise allow us to achieve excellent outcomes for our patients.” Adds interventional cardiologist Vivek Bahl, MD: “We have outstanding cath lab staff and nurses, very well-trained physicians and the option of sending a patient for cardiac surgery if a catheter approach isn’t appropriate.”

One of the most common procedures the lab performs is the one Walton had: angioplasty. While a patient is lightly sedated, the doctor threads a catheter— a thin, flexible tube—with a small inflatable balloon at the tip through an artery to the site of the blockage. The doctor uses special X-rays to guide insertion of the catheter through the arteries and injects dye to reveal narrow or blocked areas. The balloon is then inflated to compress the plaque against the artery wall, allowing blood to flow more easily.

Usually a stent is inserted. “The stent shores up the blood vessel and prevents it from collapsing again,” Dr. Shetty says.

Cardiologists can insert the catheter into an artery in a patient’s leg to access the blockage. But accessing it through the wrist, called radial access, offers advantages. “There’s a growing trend, and many of our providers do the majority of their procedures that way,” Dr. Bahl says. “It’s more comfortable for the patient. And the risk of bleeding complications goes down substantially.”

LIFESAVING CARE FOR HEART ATTACKS

Walton’s treatment probably prevented him from having a heart attack, but other patients aren’t as fortunate. Many who find themselves in the cath lab are actually having a heart attack. When an artery is blocked, blood can’t get to the heart muscle, and muscle tissue begins to die within hours. Even if patients survive, damaged heart muscle can compromise their heart function and lower their quality of life.

UM Capital Region Health is a designated STEMI center, part of a nationwide initiative developed by the American College of Cardiology and the American Heart Association to improve the treatment of patients with heart attack symptoms. (STEMI stands for ST-segment elevation myocardial infarction, a severe type of heart attack that occurs when the coronary artery is completely blocked.)

Through the program, the hospital’s Emergency Department and cardiologists work together with emergency medical services to ensure that patients experiencing heart attacks are diagnosed and treated quickly, providing these services 24/7.

“Care starts when you call 911,” says the lab’s interim director, Sonia Brown, DNP. “When paramedics arrive, they can do an EKG in the field and transmit that to the hospital. If that EKG is showing an ST elevation, our team is activated before the patient gets to the hospital.” That’s one reason it’s important to call 911 when symptoms emerge rather than drive yourself or a loved one to the hospital.

By assembling quickly, the catheterization team can shorten the time from when a patient comes in the door to when the artery is opened. The optimal “door-to-balloon” time is no more than 90 minutes. UM Capital Region Health often betters that time. The hospital’s median door-to-balloon time is 71 minutes. “We’ve been doing this for a while, and we do it well,” Brown says.

A TEAM APPROACH TO MANAGING HEART PROBLEMS

Determining whether a patient is a candidate for angioplasty isn’t always straightforward, however. “If somebody presents acutely with a heart attack, then obviously stenting is the best approach,” Dr. Shetty says. “But if a patient has multiple blockages, instead of putting in multiple stents, heart bypass surgery may be a better choice.”

If a bypass operation is needed, UM Capital Region Health has the option to refer patients to its nationally ranked cardiac surgery program headed by James M. Brown, MD, associate professor of cardiac surgery at the University of Maryland School of Medicine. “We put our heads together with the entire heart team—the surgeons, the cardiologists, the patients and the patient’s family—to come up with the best approach for an individual patient,” Dr. Shetty says.

In addition to clearing blockages in arteries feeding the heart, cath lab physicians use similar techniques to open blocked blood vessels in the arms, legs and other peripheral areas of the body. “We have the same kind of balloons and stents,” says Alysia Falby, manager of the cath lab. “They are longer and larger, but they provide the same kind of support to increase blood flow to the tissue that’s not getting much oxygen because of the blockage.”

A FULL ARRAY OF DIAGNOSTIC CAPABILITIES

The cath lab performs a variety of procedures to diagnose heart and vascular problems, including angiography. That’s when doctors thread a catheter through an artery, then inject dye to watch how it moves through the artery and see whether there are blockages. This is the first part of angioplasty. In addition, “we have tools to define the blockage better,” Dr. Bahl says. For instance, doctors can perform intravascular ultrasound, in which doctors use a catheter and an ultrasound wand to create pictures of the inside of patients’ arteries using sound waves.

A similar tool, called optical coherence tomography, uses light waves instead of sound waves to get a better picture of the heart. “It can look at the vessels from within and help to optimize the placement of the stent and make sure it is well-deployed,” Dr. Bahl says. With fractional flow reserve testing, doctors measure blood pressure and flow through the narrowest arteries of a patient’s heart. “It measures the severity of the blockage to help us determine whether an obstruction we see on an angiogram needs a stent or not,” Dr. Bahl says.

ADVANCED CARDIAC TREATMENTS

The cath lab is on the forefront of other treatment technologies. For instance, in some cases, blockages in arteries are too hard to allow a stent to be placed. Such patients may be candidates for a technology called atherectomy. Doctors wind a catheter equipped with a tiny drill through the artery to the blockage, and a rotating device breaks down the calcified plaque, restoring blood flow, Dr. Bahl says.

The lab performs tests for arrhythmias—or abnormal heartbeat—such as atrial fibrillation. This includes studies of the electrical activity of a patient’s heart, which help to find where an arrhythmia is coming from.

To treat the arrhythmia, doctors may perform ablation, which uses radio frequency energy to destroy the “hot spots” of heart tissue that are sending abnormal electrical impulses and triggering the rhythm problem. “Doctors are trying to keep there from being too many places of excitability in the heart,” Falby says.

The lab’s doctors can also use catheters to implant pacemakers and implantable defibrillators, which deliver electrical impulses to the heart to restore normal rhythm. And they can perform electrocardioversion, in which electrodes deliver a mild electric shock to the heart to get it back in rhythm. Patients are sedated for each of these procedures.

THE ROAD TO RECOVERY

After their hospital stays, many cath lab patients are encouraged to go to cardiac rehabilitation, a 12-week program of supervised exercise and education that helps patients learn heart-friendly lifestyle habits.

Walton took full advantage of the program. Now, he says, “I’m back to doing all my normal things—cutting the grass, raking the leaves, fixing the dishwasher—and I’m feeling much better. I have nothing but praise for the hospital and the staff. I recommend it to everyone.”