Heart Attack Q & A with Guangqiang Gao, MD
Cardiothoracic Surgeon at Pomona Valley Hospital Medical Center
Q: Can people of normal weight and who have exercised regularly all their
lives have heart attacks?
A: There are multiple risk factors for coronary artery disease. They are
hypertension, high cholesterol, diabetes, overweight or obesity, smoking,
lack of physical activity, unhealthy diet and stress. These factors can
be controlled by taking appropriate medication, exercise and lifestyle
modifications to minimize the risk of getting coronary artery disease.
But there are other risk factors, like aging and genetic factors, such
as a strong family history of coronary artery disease or cardiovascular disease.
Q: Does family history outweigh the fact that you lack other risk factors?
A: Patients who have a strong family history of cardiovascular disease
should be aware that this is a signal they may develop it too and should
take steps to reduce or eliminate other risk factors. If they experience
chest pain, they need to see a cardiologist as soon as possible. A stress
test can determine whether they need additional tests, such as an angiogram,
to look for coronary artery disease.
Q: Can you describe the “beating heart” technique that is sometimes
used during open-heart surgery and who is a candidate for this?
A: Yes. Coronary artery bypass grafting surgery could be done without using
a heart-lung machine. We call these “off pump” or “beating
heart” coronary artery bypass grafting surgeries. We use medication
to slow down the heart and we use what looks like a rubber band to temporarily
block the blood flow to the blood vessel we are working on. The benefits
include less bleeding, no impact on the lungs, a shorter stay in the intensive
care unit, and a shorter stay in the Hospital overall. The best candidates
for this technique are people whose lungs are damaged and cannot tolerate
the heart-lung machine. For most patients, standard coronary artery bypass
grafting surgery with the heart-lung machine is a good approach; I believe
it is more accurate and controlled. Studies have shown that the long-term
outcome using both techniques is similar.
Q: What are the benefits of using blood vessels in the chest instead of
the leg during coronary bypass surgery?
A: The conduits used for bypass grafting surgery include the internal mammary
artery behind the chest bone, the greater saphenous vein in the leg and
the radial artery in the forearm. The mammary artery is the best; it lasts
longer than any other conduits. Here we use the mammary artery for every
patient who undergoes coronary artery bypass grafting surgery.
Q: Are there other treatments for heart attack besides open-heart surgery?
A: Yes, heart attacks can be treated by percutaneous coronary intervention
(PCI), which is performed by an interventional cardiologist in the cardiac
catheterization lab. The cardiologist places stents in the coronary artery
to open the blockage, thus resuming the blood flow. This is a minimally
invasive procedure compared to open-heart surgery. Unfortunately, not
all coronary artery disease is amenable to stent placement. When the stent
is not an option, coronary artery bypass grafting surgery is needed. Studies
show that patients with three-vessel coronary artery disease, diabetes,
and decreased ventricular systolic function have better long-term outcomes
with coronary artery bypass grafting surgery than with stent placement.
Q: Are there other advanced treatment options for heart attacks?
A: Patients with a heart attack are usually treated with either stent placement
or coronary artery bypass grafting surgery. Patients with a heart attack
may have severe complications; these patients are critically ill and require
an intra-aortic balloon pump, a left ventricular assisted device, or extracorporeal
membrane oxygenation support followed by open heart surgery. Heart transplant
is also an option for patients with end-stage heart failure and no optimal