Coronary Artery Disease (also called CAD) is the most common type of heart disease. Despite advances is diagnosis and treatment, it remains the leading cause of death in the United States for both men and women, according to the National Institutes of Health/US Library of Medicine.
CAD occurs when cholesterol or plaque build up on the inner walls of the arteries that supply blood to the heart. This causes the arteries to harden and become narrow, which means less blood flow and oxygen to the heart. This can cause chest pain or a heart attack.
"When a cardiac emergency occurs, it literally strikes the heart of a family and not just the heart itself," says Dave Varma, MD, MPH, the Medical Director of Augusta Health Cardiology. "There is significant impact to both the patient and his or her family."
One type of cardiac emergency is a heart attack called a STEMI, which means the ST segment is elevated on the patient's EKG. A patient may also have an NSTEMI, which means there is no ST segment elevation, but there is a significant lack of blood flow to the heart muscle and some of that muscle has died. Coronary artery disease may also present with Unstable Angina, or chest pain, or even sudden cardiac death due to cardiac arrhythmias, when the heart beats with an irregular rhythm.
"Fortunately, the cardiology community has made significant strides in helping patients survive these cardiac emergencies, and to help prevent further life-threatening cardiac events" explains Dr. Varma. "We evolved from providing almost no care, to bedrest, to medications to Acute Percutaneous Coronary Intervention, which most people know as 'balloon surgery' or 'stents'."
The evolution of cardiac care includes 'picking up the pace' of the care. "We have learned the important concept of 'time is muscle' and get patients with a STEMI heart attack to the cardiac catheterization laboratory as quickly as possible," adds Dr. Varma. "This means we can save heart muscle." The time it takes for a patient to get from the door of the Emergency Department to the cath lab and have the blocked artery opened is called Door-to-Balloon time. The national standard for this measurement is that our door-to-balloon should be 90 minutes or less.
"At Augusta Health, we are proud to exceed this standard for our community. We are thankful for our interventional cardiology physicians and cardiac catheterization staff, who while establishing an outstanding door to balloon time of about 42 minutes, continue to strive for better and faster care to open the artery," said Dr. Varma.
Dr. Varma also notes that research has given additional insight into the kind of medications to use for heart patients. Beta blockers, cholesterol lowering agents, antiplatelet therapy and angiotensin converting enzyme inhibitors, and stent coating have made an impact on cardiovascular deaths.
What can the average person do to help prevent CAD? Changing lifestyle habits—exercising more, eating a healthy diet, eliminating tobacco—all help lower the risk of CAD. Dr. Varma also believes being aware of the early symptoms—such as chest pain, tightness and pressure—and discussing these with a physician so testing such as an echocardiogram and diagnosis can occur before a serious emergency is also important.
"But perhaps most important," concludes Dr. Varma, "Tests and systems and advances cardiac care need to be delivered by a group of caring, compassionate and competent team of doctors, nurses and health care workers. I'm very proud of the effort that Augusta Health has made to put together a great team that delivers such high quality cardiac care to this community."
Dave Varma, MD, MPH, is a cardiologist and Medical Director at Augusta Health Cardiology. He completed his undergraduate studies at Howard University and received his Master's in Public Health from Johns Hopkins University. He graduated from the University of Maryland School of Medicine and completed residency and fellowship at the University of Virginia. He is Board-Certified in Internal Medicine, Cardiology, Echocardiography, Nuclear Cardiology, Endovascular Medicine and Vascular Medicine. Dr. Varma is married with two sons, and enjoys playing tennis and watching college sports and movies.
Originally published in the Staunton News Leader's Heart Healthy Section on February 12, 2017.