What sparked your passion for interventional cardiology?
I was strongly influenced by the experience of my mother, who was born with an atrial septal defect. When she immigrated to the United States from China, she required surgical correction of her congenital heart defect at Minnesota in the mid 1950s with Dr. Walt Lillehei, who had pioneered the initial use of the heart lung machine. Ultimately, she did succumb to heart failure from her congenital heart disease; but her experience motivated me to consider cardiology as a career.
My first rotation during my general cardiology fellowship at the Cleveland Clinic was in interventional cardiology. From this initial experience as well as mentoring from my senior physicians and fellows, I decided to pursue interventional cardiology. I completed my interventional cardiology and peripheral interventional training also at the Cleveland Clinic prior to joining the medical staff at Vassar Brothers Medical Center. Interventional cardiology appeals to me because you have an immediate impact on the health and outcome of your patients.
What does your team do in the cardiac catheterization laboratory to treat a heart attack victim?
In the majority of cases, there is an occlusion or blockage in a coronary artery. We place a catheter through the wrist or leg to engage the coronary arteries and inject contrast to identify which vessel is blocked. We then thread a small wire which is about a width of a hair across the blockage. By inflating a balloon within the artery where the clot or blockage is, we can to restore flow to the artery. We often will then place a stent, which is a metal scaffold to keep the vessel open.
The most common heart attacks we see involve cholesterol plaques that rupture; the blockages range from partial to complete occlusion.
Other than ruptured plaques, what else can cause heart attacks?
Less commonly, we can see:
- An infection of the heart (myopericarditis) that mimics a heart attack. Treatment in that case may require special medicines or immunotherapy.
- Vasospasms due to severe stress or drug use that cause the artery to constrict and limit blood flow.
- Injuries to the aorta that tear the coronary artery, which require emergency surgery.
- Spontaneous coronary dissection, more common in woman that can lead to partial or complete closure of the vessel.
What’s a big challenge that cardiologists currently face?
I’ve worked at the Heart Center for 12 years, trying to promote early recognition of heart attacks. Once a heart attack victim is identified and reaches the catheterization lab, the ability to improve treatment strategies for the most part have reached a plateau. We can make more of an impact with earlier recognition in the community. We need to reach people earlier in the process.
Unfortunately, many people shrug off the earliest signs of a heart attack—for several hours or longer—and don’t get help until serious damage has been done. These signs can include not only chest pain, but also frequently shortness of breath, dizziness, neck pain, jaw pain, shoulder pain, weakness, nausea, and heartburn. The longer the artery is occluded, the greater the potential for irreversible damage and risk of mortality.
What can be done about this time delay?
Our team recently joined with the American Heart Association to promote a program to speed up reaction times by coordinating with Emergency Medical Services (EMS) in the field. When EMS encounters a patient with a suspected heart attack, the team transmits an electrocardiogram (EKG) to the emergency room. The EKG is reviewed by the emergency room physician and if the EKG indicates a heart attack, the physician activates the cardiac catheterization team. So, when the patient comes through the door of the hospital, our team is often already present in the hospital. We’ve analyzed the numbers for this program and seen a response time improvement of usually 15 to 20 minutes. That doesn’t sound like a lot of time, but it can mean the difference between life and death—or between full recovery and recovery with lifelong complications.
What else can be done to reduce heart attacks and save more lives?
Over the last few decades, mortality rates from heart attacks have gone down, due to better treatment strategies favoring coronary intervention, quicker recognition pathways, and cardiac intensive care unit. Obviously, it would be better however if we could prevent these events in the first place.
Ideally, we’d like to see people eat a more heart healthy diet, limiting excess sugar and fat, and pay more attention to lifestyle modifications such as daily exercise and quality of sleep. Seemingly small details can add up to have big effects. Sleep deficiency has been implicated in the development of hypertension, stroke, and diabetes.
Better assessment of risk factors would also help us identify patients at risk. One promising test is the Coronary Artery Calcium (CAC) score which can be used to screen asymptomatic patients who have several cardiac risk factors. A markedly elevated score would indicate that certain individual is at higher risk and should focus on lifestyle modifications and consider medications that would reduce their risk such as statins.
Michael Yen, MD, FACC
Vassar Brothers Medical Center
The Heart Center, a division of Hudson Valley Cardiovascular Practice, P.C.
1 Columbia St
Poughkeepsie, NY 12601
TTY /Accessibility: (800) 421-1220
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