Patient Blood Management and Cardiology
An Interview with John Schindler, MD, FACC, FSCAI
Assistant Professor of Medicine at the UPMC Cardiovascular Institute
What is a cardiologist?
A cardiologist specializes in the prevention, diagnosis, and treatment of cardiovascular disease. Cardiovascular disease encompasses problems with the blood vessels (vascular supply), heart valves, heart muscle (cardiomyopathies), electrical conduction (arrhythmias), and blood pressure (hypertension). Heart disease is the leading killer of men and women in the United States, so it is essential for patients to be aware of the risk factors that increase the likelihood for developing vascular disease, and what measures they can take to reduce their risk of a vascular event (stroke or heart attack).
Resource: CardioSmart from the American College of Cardiology
What types of tests do cardiologists order?
There are many types of tests that look at different aspects of the anatomy, structure, and function of the heart. Some of the most common include:
- Echocardiogram — a painless test utilizing ultrasound to image the four heart valves and overall mechanical function of the heart.
- Cardiac MRI — a radiology study that provides detailed and clear images of the heart muscle and other structures in the chest.
- Exercise echocardiogram or exercise nuclear stress test — an in-depth analysis to search for cardiac reasons for chest pain or pressure or exercise-induced breathing abnormalities.
- Cardiac catheterization — an invasive test in which a catheter or long tube is placed into an artery in the groin or arm in order to evaluate for vascular disease (blockages). If blockages in the arteries are diagnosed, they can be treated with medications, angioplasty or stent placement, or open heart surgery, depending on the severity and location of the blockages.
If a catheterization is required, are there measures that can reduce the risk of bleeding with the procedure?
In general, I find that cardiac catheterizations are highly misunderstood procedures. They actually are quite well-tolerated, with minimal discomfort to the patient. They do require placement of a sheath, which is a special device similar to an IV, into an artery. The overall risk of bleeding related to the placement and removal of this device varies by patient but overall is quite low (less than 1 or 2 percent).
There are techniques that can reduce the risk of bleeding associated with the procedure, which involves a combination of using the smallest devices necessary and alternate vascular access points. For most patients in the United States, the femoral artery (groin region) is utilized for the sheath insertion. We know from many medical studies that the risk of bleeding associated with the procedure can be minimized by placing the sheath into the radial artery (wrist). Whenever possible, I like to utilize this approach; however, there are medical and anatomic factors which may preclude its use. Therefore, not everyone is a candidate for radial access, and this needs to be determined by the treating physician.
How do you feel about treating patients who refuse to receive blood products?
I am completely comfortable treating patients who wish to restrict the use of blood products. When treating bloodless medicine patients, I try to correct any misconceptions about the risks associated with the proposed diagnostic testing. When possible, I use the radial artery to gain access into the arterial system, which lessens the risk of blood loss associated with the procedure.
I am also extremely fortunate to work alongside a team of physicians, including cardiothoracic surgeons who are also comfortable with the bloodless medicine concept. My experience is that these patients receive an individualized treatment plan that respects their beliefs.
To contact The Center for Bloodless Medicine and Surgery at UPMC, call 877-674-7111.