The many faces of heart disease

From Bill Clinton's bypass surgery to the state of the stent, heart disease is in the news. But just as no two patients are alike, no single remedy is right for every patient. In a field that is changing rapidly, successful treatment often requires more than good medicine. At Lahey Clinic's Heart & Vascular Center, doctors from multiple specialties work together, combining clinical skill with diagnostic expertise and state-of-the-art technology. The result: treatment plans tailored to meet each patient's needs-and some of the best cardiac outcomes in the country.

Curing cardiac arrhythmias
An estimated two million Americans have atrial fibrillation, a disruption of the heart's electrical system that affects the contraction of the heart's two upper chambers. The American Heart Association reports that hospitalizations for this disorder have tripled since 1985.

People with atrial fibrillation are at risk of serious complications. Blood thinners help prevent the formation of blood clots, which can cause stroke, and beta blockers help maintain heart rate. For some patients, however, medication is not enough to keep atrial fibrillation under control. Cardiac electrophysiologists at Lahey specialize in diagnosing and treating patients with atrial fibrillation and other heart rhythm disorders. More than 1,000 procedures are done each year in Lahey's electrophysiology labs. They include minimally invasive techniques, such as catheter ablation, which can destroy misdirected electrical pathways, effectively "rewiring" a faulty electrical system in the heart. "Many arrhythmias can be treated so as to allow patients to have a normal quality of life. Treatment can improve the efficacy of medication or, hopefully, yield a cure," says Dr. David T. Martin, director of the Cardiac Arrhythmia Program.

Imaging on the leading edge
CAT scans, echocardiography, and angiography help doctors diagnose heart attack and coronary artery disease. At Lahey, physicians also use cardiac MRI (magnetic resonance imaging), the leading edge of heart imaging. Heart attack occurs when the blood supply to the heart muscle is severely reduced or stopped, usually as a result of a blood clot forming in the coronary arteries.

The need for surgery or an intervention such as angioplasty is determined by the extent of the problem.

Cardiac MRI is useful in determining where a blockage has occurred as well as the degree of damage done to the heart muscle and lining. Studies have found that it can detect small areas of heart cell death-called microinfarcts-that are not detected through traditional cardiac imaging techniques.

"Microinfarcts are often hidden beneath the surface of the heart and are very difficult to view using techniques other than MRI," says diagnostic radiologist Dr. George Holland. "Cardiac MRI allows us to better identify patients who would benefit from surgery or intervention, so we can avoid surgery when it's not necessary."

A comprehensive program
Lahey Clinic's Heart & Vascular Center treats the many faces of heart disease through clinical programs in lipid management, anticoagulation disorders, cardiac arrhythmias, heart failure, and cardiac rehabilitation. Medical, surgical, and interventional programs address areas such as peripheral vascular disease, coronary artery disease, and electrophysiology.

Each year, doctors at Lahey perform approximately 450 heart surgeries and more than 5,000 procedures in the cardiac catheterization labs. For more information about Lahey's leading outcomes and how to make an appointment, visit www.lahey.org.