Many people are familiar with the two most common treatments for severely clogged heart arteries: angioplasty (with or without stents) and bypass surgery. During an angioplasty, an interventional cardiologist uses a catheter to inflate a tiny balloon that opens blocked arteries. The physician typically inserts stents in this minimally invasive procedure to try to prevent arteries from reclogging.
During bypass surgery, a cardiothoracic surgeon uses a patient's own blood vessels to create new arteries that go around (or bypass) areas of blockage. Both approaches improve blood flow and increase the amount of oxygen that nourishes the patient's heart.
Less well known is that, in some instances, a patient requires an angioplasty followed by surgery in a short period of time. Gorgonio Martinez was one of those cases.
Mending an injured heart
Last September, just a few weeks before his 65th birthday, Gorgonio came to the Gottlieb Emergency Department (ED) with pain in his chest and left arm. His blood test indicated that he suffered a heart attack. And worse yet, imaging revealed that he had blockages in four coronary arteries. Although he required open-heart bypass surgery, the Gottlieb team was concerned about Gorgonio's ability to have a good outcome from the operation.
"Bypass surgery is relatively safe when it is elective surgery. Mortality is less than 2 percent,” said Michael Bresticker, MD, cardiovascular thoracic surgeon. "An emergency bypass operation doubles or triples the risk. For cases like Gorgonio's, an interventional cardiologist first clears the blockages with an angioplasty. We allow the patient to recover so that he or she better tolerates surgery a few days later. Research shows the patient is more likely to have better outcomes than if we took him or her to surgery immediately."
Gorgonio had been feeling pain in his chest for about two weeks before he arrived at the ED. Had he come to the hospital immediately, he might have avoided a heart attack.
"Gorgonio ignored his symptoms for some time, but fortunately he suffered only minimal heart damage," said Ajanta De, MD, interventional cardiologist. Dr. De performed the angioplasty with stents about a week before Gorgonio underwent open-heart surgery.
Strengthening heart and mind
After surgery or an angioplasty, cardiologists and surgeons often refer their patients to a formal, medically supervised, cardiac rehabilitation program, typically one hour a day, three days a week for 12 weeks. In addition to closely monitored exercise, participants learn about nutrition, medications, stress management, smoking cessation and other ways to lower their risk of a future cardiac event.
"I recommend cardiac rehab to all of my patients," Dr. De said. People who complete the entire program tend to feel better about themselves and their capabilities. They better understand their contion, and how to increase their physical fitness safely and reduce their heart-disease risk."
Gottlieb's cardiac rehab program is so well respected that about half of its patients are referred by physicians outside the health system. Loyola also offers cardiac rehab at its Burr Ridge location. Gottlieb's program offers many choices for aerobic and strength-based exercises with continual monitoring by nurses who specialize in heart care.
“We make this as individualized as possible,” said Kim Haukland, RN, manager, Cardiac Rehabilitation. “We want our rehab session to be the least stressful part of a person’s day. Reducing anxiety is important because many patients – even those who exercised regularly before – are worried about increasing their exercise intensity. We help them get better.”
During Gorgonio’s 12th session, one of the rehab nurses noticed an irregular heartbeat. They immediately called Dr. De, who soon after saw Gorgonio in her office and helped him manage the issue.
“My job is to keep my patients out of the hospital,” Kim said. “We are always conversing with them, and checking their heart rate, blood pressure and exertion levels during each class. If we detect an irregularity, we’re prepared to intervene quickly to prevent another incident.”
Keeping up with child’s play
Gorgonio has four children, three grandchildren and has been married for 44 years. He is grateful for the care he received at Gottlieb and how Drs. De and Bresticker made him feel calm before the procedures.
“Dr. De explained what I need to do to stay healthy, and I enjoyed the cardiac rehab program,” Gorgonio said. “I feel strong and now I’m eating healthier meals. I’m following their advice so I can keep up with my grandchildren.”
To find a Gottlieb physician, call (708) 450-DOCS (708-450-3627).