Cardiac Catheterization Program
The Cardiovascular Institute's Cardiac Catheterization Program at UPMC is staffed with specialists in the management of patients needing elective and emergency catheterization, such as those with unstable angina pectoris, acute myocardial infarction (heart attack), and cardiogenic shock. Treatment involves the use of a catheter — a long tube that can be threaded into the arteries to bring miniature cameras and instruments to a disease site in the heart or blood vessels. Program doctors can diagnose blockages in the arteries that supply the heart. Often doctors can restore blood flow to threatened heart tissues without surgery, by using the catheter to reopen the blocked artery, and hold it open with a small, meshwork collar called a stent.
The Chest Pain Center at UPMC Presbyterian's Emergency Department is designed for the rapid evaluation of patients with suspected heart attack. A person who is diagnosed with a heart attack may be admitted immediately to a cardiac intensive care unit or intermediate care unit or transported directly to the cardiac catheterization laboratories.
The Cardiac Catheterization Program features the largest group practice in Pennsylvania and one of the largest in the country for catheter-based therapy. Annually, they perform more than 12,000 procedures to diagnose heart attack, and more than 4,000 interventional procedures to treat it. UPMC's cardiologists encounter an extraordinarily wide range of cardiovascular diseases, gaining intensive experience with those that are very common and those that are extremely rare that is uncommon among practicing cardiologists.
The program offers treatment for very common conditions such as angina (chest pain) and myocardial infarction (heart attack). Cardiovasular Institute cardiologists have superior experience in treating the most difficult of cases using stents, intravascular ultrasound, and distal embolic protection devices, among many others. UPMC physicians now are using radiation therapy for treating patients with coronary artery disease who have had renarrowing of arteries after interventions and were one of the first groups in the country to have the newest drug-coated stents. These stents release a drug into the blood-vessel wall that significantly decreases the likelihood of renarrowing.
The cardiac catheterization laboratories feature five state-of-the-art General Electric laboratories, providing cardiologists at the Cardiovascular Institute with the most modern technology in imaging to diagnose and treat patients. Program cardiologists also lead national efforts to develop new treatment techniques. For example, they have developed a method to totally support heart function in critically ill patients without the use of surgery.
Emergency and Critical Care Treatment
The Cardiovascular Institute's cardiac catheterization laboratories are staffed around the clock with specialists in emergency catheterization for life-threatening conditions such as unstable angina pectoris, acute myocardial infarction, and cardiogenic shock. These physicians have particular expertise in the care of acutely ill patients, many of whom arrive by helicopter from regional community hospitals.
To help speed the delivery of lifesaving angioplasty to heart attack patients, the Cardiovascular Institute has instituted a door-to-balloon-time protocol, which aims to assess patients before they arrive at the Emergency Department and streamline the triage process, so that -- if needed -- they are more quickly routed to the cardiac catheritization lab. CVI physicians have worked with local EMS providers to help train them on delivery of electrocardiogram (EKG) testing on the patient while en route to the hospital. The EKG results are sent via wireless technology to UPMC's Command Center, which notifies the ED. A patient's condition can be assessed before he or she arrives, and physicians and staff can prepare to treat the patient. UPMC Presbyterian's door-to-balloon time -- the time from when a patient enters the door to when they have angioplasty -- is typically less than 90 minutes.
Cardiologists at the Cardiovascular Institute are well equipped to treat the sickest cardiac patients. The program offers experience in treating patients with heart failure and severe valvular heart disease, as well as those with debilitating atherosclerosis. The Cardiovascular Institute offers the latest treatment of these conditions, including external counterpulsation therapy (EECP) and placement of cardiac support devices such as intra-aortic balloon pumps. UPMC is also one of the few institutions in the country to offer the TandemHeart, a percutaneous left ventricular assist device, to assist patients with severe heart disease.
Other Heart Conditions
The cardiac catheterization laboratories also provide evaluation and treatment of valvular heart disease, congestive heart failure, and life-threatening irregular heartbeats. Digital imaging technologies now promise to enhance accuracy and accessibility of data for physicians caring for UPMC patients.
Program cardiologists are active in percutaneous treatment of atrial septal defects (ASD) and patent foramen ovales (PFO), which offers patients an exciting new option to treat congenital heart disease without surgery. The Cardiovascular Institute is also a major center for the treatment of patients with cardiomyopathy and pericardial and myocardial diseases, diseases of the heart muscle and other structures around the heart. UPMC's invasive cardiologists routinely perform evaluation on these patients to assess the best treatment options. UPMC cardiologists offer catheter-based treatment of valvular heart disease with balloon valvuloplasty for selected patients with mitral or aortic stenosis. With UPMC’s cardiac transplant program, interventionalists routinely help in the treatment and evaluation of these patients.
UPMC's interventional cardiologists have also begun an active program in the treatment of peripheral arterial disease, including the treatment of carotid artery disease, renal artery disease, and lower extremity vascular disease. This is an area of rapid growth, and UPMC is committed to maintaining an active program to offer patients the full gamut of options in the treatment of vascular disease anywhere in the body.
The Cardiovascular Institute's interventional cardiologists are committed not only to the treatment of patients with cardiovascular disease, but are also at the forefront of innovation and research to develop newer and better techniques. Program cardiologists are conducting studies to determine the importance of pharmacogenomics – looking at a patient's specific genetic makeup and prescribing treatments precisely suited to be most effective.