Heart smart: new technology at Indiana's heart centers.

• Author: Held, Shari
• Position: HOSPITALS & CLINICS

THE STATISTICS ARE chilling. According to the National Heart Blood and Lung Institute, each year about 515,000 people in the U.S. will die from a heart attack; nearly half of them die within one hour of the time symptoms begin.

Current ER protocol for a patient experiencing chest pain goes something like this: The patient is given an electrocardiogram (EKG) to see if there are abnormalities suggesting a heart problem and a series of blood tests are drawn over a period of one-and-a-half to two-hour intervals to check enzyme levels which can indicate heart damage.

"If the blood tests are abnormal, we keep them overnight in the hospital and on the following day we either do a cardiac catheterization or a stress test," says Dr. Edward Harlamert, interventional cardiologist with Heart Partners of Indiana in practice at The Indiana Heart Hospital, located on the northeast side of Indianapolis.

Patients who fail the stress test are slated for a cardiac catheterization. Patients who pass the stress test, have normal EKG results and are no longer experiencing chest pain are referred to their primary-care physician for follow-up.

"The approach is different when you are talking about screening studies versus people who have chest pain, versus people who have unstable chest pain," says Dr. Eric Williams, cardiologist with the Krannert Institute of Cardiology and Clarian Cardiovascular Center in Indianapolis. "The patient who has a history of chest discomfort but is clinically stable when you see them is the more common scenario. The whole idea is to determine, first of all, whether there is a coronary blockage and second, whether the patient is in a risk category where he would benefit from doing the more definitive study, which would be the heart catheterization."

As emerging technologies come into play, that protocol may become very different.

"In what I like to describe as the New World in ER medicine, we will get an EKG, draw one set of enzyme markers and then do a cardiac CT scan," says Harlamert, "and within the hour we are going to know whether or not this person has heart disease."

That "cardiac CT scan" is the new 64-slice computed tomography (CT) scan. It, along with the latest advances in cardiac magnetic resonance imaging (MRI), are being heralded as opening the new frontier in screening for cardiac disease, where the clock starts ticking from the time the patient enters the front door.

"We are actively trying to minimize that 'door to balloon time' (referring to balloon catheterization) because time is muscle," says Dr. Juan Weksler, a cardiologist with Indiana Heart Physicians in practice at St. Francis Cardiac & Vascular Care Center in Indianapolis.

The hope is that superior technology will yield superior results.

"The better job we can do in terms of diagnosing, the better job, hopefully, that we can do in non-surgical intervention," says Vincent Caponi, CEO of St. Vincent Health. "If we can catch heart disease in its early stages, we can treat it a little more aggressively. I think it is just going to be better patient care, better patient outcomes and probably less complications."

The Heart...