Heart Trouble

Business Week ^ | OCTOBER 29, 2007 | Arlene Weintraub

[neverdem]

The tiny stent sparked a lucrative industry--and made Dr. Samin Sharma a star. Then questions arose about the device's safety and efficacy.

On a sweltering summer morning, Dr. Samin K. Sharma marches into the cardiology wing of Mount Sinai Hospital in New York, prepared for a 16-hour day in which he will clear and repair the arteries of 18 patients. Sharma specializes in installing stents, tiny metal devices that hold open blocked blood vessels. As he'll be the first to note, he does more stent procedures than anyone else in doctor-rich New York and possibly in the entire country. An immigrant from India who had to plead for his first cardiology job here, he has played a critical role in popularizing the stent as an alternative to drugs. In the process, he has helped fuel a booming stent market and revive the fortunes of Mount Sinai, a prestigious old institution that just a few years ago was stumbling financially.

But this morning a slight shadow of doubt hangs over the court of the King of Stents. On the table, patient David Viggiano is asking questions. (Although sedated, stent patients remain awake.) Viggiano, a 42-year-old security guard with colorful tattoos on his arms, suffered a heart attack three years ago near his home in suburban New York. He was riding his bicycle through a cemetery, a setting that still haunts him. As he awaits his procedure, Viggiano is aware that qualms have arisen over certain kinds of stents. "I heard they had problems," he says, as an X-ray machine whirs back and forth over his chest.

Sharma considers the patient's hazy anxiety. Since Viggiano is relatively young, and potent drugs may interfere with his active lifestyle, the doctor sticks with his preferred treatment and installs a stent. "Everything looks good," Sharma...

[Conservativegreatgrandma]

I personally know of three runners who died running. They were all young. Two were women.

[Retired COB]

I got my stents when they were experimental in January of 1993. I'm 61 now (in a few days), and just remarried. We honeymooned in Scotland and walked over most of the country (at least it seemed that way).

When they scheduled my operation, they had initially sent me to have another experimental procedure - using a laser to clean the walls of the blood vessels. I don't hear any more about that program, so I may be lucky that I got the system that worked.

[Retired COB]

Naw, it can all be solved with a class-action suit, in which 10,000 lawyers represent all the thousands of patients who have undergone the procedure, collecting some 75% of the actual disbursements from the malpractice insurance companies, distributing the remaining 25% to the members of the class, and totally eliminating this procedure from practice ever again in this country.

I wish you had needed a Sarcasm Tag for your reply, but sadly it's too close to the truth.

[SunkenCiv]

One problems with stents (and this is anecdotal, and probably unusual) is that they come loose and kill the patient. This happened to one of my coworker’s sisters. The stent wasn’t where it had been installed when she was checked, and of course she was dead, so there wasn’t any point looking for it.

[neverdem]

What a tragedy! If something didn't look right, why induce a heart attack by having him take a stress test? The smarter thing to do would be to schedule an appointment with a heart surgeon immediately. Not give the guy a test that would kill him.

While coronary artery disease(CAD) is thought to be responsible for the majority of sudden cardiac deaths, there are other causes. Simple stress testing by cardiologists is the cheapest test to start with to rule in or out CAD, IIRC.

This website has a fairly comprehensive list of cardiac pathology. I only read the first part about sudden cardiac deaths. Many of the other diagnoses will have caused prior symptoms and not be a sudden death out of the blue.

IMHO, a cardiothoracic surgeon would still get a cardiology consultation before doing anything.

[goodnesswins]

Hmmmm.....I’ve had IT problems in my right hip for over 10 years (mostly night pain)......that might help me! In fact, now I’m getting left hip problems....so, I better get with it. Thanks.

[jwalsh07]

I personally know of three runners who died running. They were all young. Two were women.

Almost happened to me about 11 years ago when I was 44. After a 6 mile run I decided to sprint the last 220. Heart rate exceeded max, split a plaque in my circ and on to the Cardiac Cath Lab.

Stented, two months later the stent occluded and back to the Cath Lab.

In stent rotoblation, which gets your attention since the ground up tissue has to go somewhere and that somewhere initially is the micro vasculature, and here we are 11 years later.

I don't run anymore because my Doctor won't drain my knees any more. I do carry my clubs up and down the hills of New England and ride the reclining stationary bike for cardio. Much easier on the joints and it has the advantage of killing a couple of birds with one stone.

About two months ago I was stress tested by a young cardiologist who had herself been stress tested as part of a physical a week before that. She stopped the test after I had exceeded her time and ramp elevation by a good bit. Evidently my bare metal stent has worked out pretty well for me. I thank both God and science for that.

My advice to guys and gals like me who like to push it on the exercise thing is to always work out while wearing a heart monitor and knowing your max heart rate.

It might save some heartache and money. :-}

[jwalsh07]

BTW, cardiac cath lab visits are down across the board up here in New England. The cardiologists and techs I know attribute it more to the decline in smoking and increased use of statins than anything else.

[Myrddin]

IMHO, a cardiothoracic surgeon would still get a cardiology consultation before doing anything.

I agree. My oldest son has been through 4 open heart surgeries. There was plenty of diagnostic work with echo cardiograms and cardiac catheterization to characterize the problems before embarking on the surgical solution. His sub aortic stenosis was so bad at age 5 that each heart beat sounded like a squirt gun against a window. The pressure of the stream was damaging the aortic valve. The surgeries at age 5 and 10 were complicated exercises in trimming the excess tissue below the valve. The surgery at age 15 required replacing the mitral valve damaged by high ventricular back pressure and installation of a pacemaker. The artificial mitral valve put pressure on the bundle of His and impaired the coordination of auricle/ventricle. It was a dual lead unit, but only the ventricular lead was successfully placed. At age 17 (when he was pretty much full grown), the artificial aortic valve was installed. The auricular pacemaker leads had damaged the tricuspid valve. It was necessary to put a band around it to bring the edges of the valve close enough to stop the regurgitation. Ten years later he only needs to go for a month "pro time" measurement and takes a daily dose of Coumedin to keep his blood sufficiently thin for the artificial valves. Moving to Idaho added a seasonal variation to his blood viscosity. He gets a bit more viscous during the winter.

[neverdem]

I'm sorry to read about you and your son's "adventure" in cardiology. Your son hopefully knows about the various food interactions with coumadin. The other recommendations on the link appear solid. I was unaware of "Large amounts of Vitamins A, and E have been shown to interfere with Warfarin therapy." Adios

[humblegunner]

Doc said I was healthy

And you didn't have to threaten him or anything?

[Myrddin]

We are well aware of the vitamin K foods to avoid. My mom was just put on warfarin last week. The doctor advised her to avoid cranberries. She apparently had a heart attack (undiagnosed) prior to 2003 that did some damage to her heart.

Vitamin E certainly acts as a natural thinner. When I go for my annual flight physical, the blood sample comes zipping right out into the Vacutainer. It takes about 10 minutes to get the needle stick to quit bleeding as well. My hematocrit was running about 38.5 last March. Satisfactory for flight.

[Squantos]

5th of Jack .......answers are always favorable.

Glad ya beat the bug Brother !!

[VOA]

“Bet there is no one like him in socialized medicine utopias like
the UK or Canada...”

It would be nice to know what percentage of his patients are subjects/citizens
of Canada, UK, and other points about the globe.

BUT, not to be a total chauvanist...
IIRC heart stents got their start in Italy, well before they were
approved for use in the USA.

[Yossarian]

My advice to guys and gals like me who like to push it on the exercise thing is to always work out while wearing a heart monitor and knowing your max heart rate. It might save some heartache and money. :-}

Yes, megadittos on that point, FRiend. I wear a Polar Heart Rate monitor for all exercises, setting up the alarms to go off it I go too high or too low.

My only gripe is that the transmission system that Polar uses can get screwed up by external interference like old phone lines, high tension power lines, etc. I hit these a lot on hikes. I need to find a better transmission system, or get a HRM that is hard wired.

[Monitor]

I’ve been biking 100+ miles per week for the last three years. Beginning in June, during several rides in a row, I experienced what I thought was heartburn, which didn’t respond to antacids, so I called my doctor.

It was angina. I had four blockages - 20, 30, 80, and 90 percent. I was a small blood clot away from a heart attack.

Two stents later...

Went through cardiac rehab, where the nurses really didn’t want me doing any vigorous exercise outside of their supervision.

I got a completely different story about exercise during recovery from my cardiologist and his assistants, whom I talked to about this on several occasions. According to them, exercise won't cause heart problems, it will only highlight existing heart problems, as long as you wait until enough scar tissue has grown to hold the stent in place, and you're keeping your heart rate below the limit for your age.

I'm 43, so my max heart rate is 220 - 43, or 177. My max target cardio-exercise rate is then 177 * 85%, or 150. I have my polar heart monitor set to complain about anything above 150 beats per minute.

[trisham]

I take shark cartilage, chicken collagen, hyaluronic acid, and six aspirin a day. Seven years ago I was using crutches or a cane. I've gradually learned how to manage my knee pain and "locking up" issues. It's an old skiing injury. I ran for many years afterward, however.

I can now stay on the treadmill for over an hour with very little, if any, pain. I also have a universal weight machine. I recently started golf lessons.