BME 301OutlineEarly Warning Signs of Heart AttackSlide 4Heart Attack VideoHeart AttacksDetection of AtherosclerosisSlide 8Slide 9Slide 10Slide 11How Do We Treat Atherosclerosis?Slide 13Slide 14Slide 15CABG ProcedureSlide 17Slide 18Heart-Lung MachineHeart Lung MachineSlide 21Slide 22CABG EffectivenessInnovationsSlide 25Slide 26Slide 27Slide 28Slide 29PTCA: EffectivenessSlide 31StentsSlide 33Drug Eluting StentsComparison of RX MethodsSlide 36What Would You Do?Cost-EffectivenessPrevention or Treatment?Progression of Heart DiseaseBME 301Lecture EighteenOutlineThe burden of heart diseaseThe cardiovascular systemHow do heart attacks happen?How do we treat atherosclerosis?Open heart surgeryAngioplasty StentsWhat is heart failure?How do we treat heart failure?Heart transplantLeft ventricular assist devicesArtificial heartEarly Warning Signs of Heart AttackMany heart attacks start slowly; symptoms may come and goChest discomfortMost heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or painDiscomfort in other areas of the upper bodyCan include pain or discomfort in one or both arms, the back, neck, jaw, or stomachShortness of breath Often comes along with chest discomfort. But it also can occur before chest discomfortOther symptomsMay include breaking out in a cold sweat, nausea, or light-headednessHeart Attack Videohttp://www.heart1.com/attack/guidant.cfmHeart AttacksDiagnosis of AtherosclerosisDetection of AtherosclerosisHeart Attacks Treatment of AtherosclerosisHow Do We Treat Atherosclerosis? CABGhttp://www.learnaboutbypass.com/images/illustrations/bodybypasses.gifCABG ProcedurePatient is prepped, general anesthesiaChest access is gained, through sternumGraft vessel is retrievedExpose heart through pericardiumDivert blood through heart lung machineStop heartInsert graftReturn circulation to heartClose incisionhttp://www.ctsnet.org/doc/3311Heart-Lung MachineThe heart-lung machine:Consists of a chamber that receives the blood from the bodyBlood is pumped by machine through an oxygenatorOxygenator removes CO2 and adds oxygenPump then pumps this newly oxygenated blood back to the bodyConnected to patient by a series of tubes that the surgical team placesHeart Lung Machinehttp://www.brucemindich.com/images/bypass1.gifHeart Lung Machinehttp://www.davidfary.com/hlm_small.jpgHeart Lung Machinehttp://engr.smu.edu/~cd/EE5340/lect31/sld011.gif http://engr.smu.edu/~cd/EE5340/lect31/sld014.gifCABG Effectiveness2001: 516,000 CABG procedures performedProcedure takes 4-6 hours, 5-7 day hospital stayGrafts remain open & functioning for 10-15 yrsRisks:Heart attack (5%) Stroke (5%) (risk greatest in those over 70 years old) Death (1-2%) Sternal wound infection (1-4%)“Post-pericardiotomy syndrome“ (30%)Occurs few days to 6 months after surgerySymptoms are fever and chest painSome people report memory loss and loss of mental clarity or "fuzzy thinking" following CABGInnovationsOff-pump CABG:http://www.surgery.usc.edu/divisions/ct/videos-mpeg-offpumpcoronaryarterybypassgrafting.html Closed chest CABG:http://www.hsforum.com/stories/storyReader$1537How Do We Treat Atherosclerosis? AngioplastyPTCA: EffectivenessCannot always successfully perform procedureDiffuse diseaseTotal occlusionCalcified diseaseRestenosisOccurs in 25-54% of patientsUsually occurs within 6 monthsHow Do We Treat Atherosclerosis? StentStentshttp://www2.cajun.net/~wpharo/stent.jpg http://www.insel.ch/kardio/kardiorehab/bilder/stent.jpg http://www.wbamc.amedd.army.mil/images/newsphotos/stent%20implantation.jpgStentshttp://www.priory.com/cmol/stent3.jpg http://www.hybridmedicalanimation.com/media/mdtrnc_stent.jpgDrug Eluting Stentshttp://www.npr.org/features/feature.php?wfId=1452217Comparison of RX MethodsHospital Stay:CABG – 4-7 daysAngioplasty – 1-2 daysStent – 1-2 daysRestenosis:CABG – 5-6%, usually after 5 yearsAngioplasty – 25-45%, usually within 6 monthsStent – 15-20%, usually within 6 monthsComparison of RX MethodsCostCABG $35,000Angioplasty $17,000Stent $19,000Cost-effectivenessAdditive procedures:Within 5 years, 20-40% of patients have second PTCA, 25% have CABGAdditive costs:0 years: per patient costs of PTCA 30-50% those of CABG1 year: 50-60%3 years: 60-80%>3 years: >80%Moving Target ProblemWhat Would You Do?AngioplastyStentCABGCost-EffectivenessTherapy Patient Group $ per yr life savedtPA Post MI high risk $3,600tPA Acute MI, large infarct, treatment started >2 hours post$24,200CounselingSmoking cessation $1300-$3900CABG Two vessel disease, severe angina$9,200-$42,500http://www.sciencedirect.com/science?_ob=ArticleURL&_aset=B-WA-A-A-A-MsSAYZA-UUA AUYWDCBYZYAUYUBBVZZYBWAUBWEUBAU&_rdoc=1&_fmt=full&_udi=B6T1048NJXK25&_coverDate=5%2F22%2F2003&_cdi=4876&_orig=search&_st=13&_sort=d&view=c&_acct=C000004378&_version 1&_urlVersion=0&_userid=108429&md5=5f493caa5f65762c23c0d90eaea8b92dPrevention or Treatment?http://www.nytimes.com/2004/03/21/health/21HEAR.htmlProgression of Heart DiseaseHigh Blood PressureHigh Cholesterol LevelsAtherosclerosisIschemiaHeart AttackHeart
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