Cardiovascular health: Technology, research and unsurpassed patient care combine for excellence
Posted Dec. 21, 2011
When Darlene Hamilton of Sacramento developed shortness of breath in the middle of the night at the age of 59, the possibility of a heart problem did not occur to her. Thinking she might be having a bad asthma attack, her husband insisted they go right away to UC Davis Medical Center’s emergency department.
Hamilton doesn’t remember much else until she woke up three days later, after undergoing repair of a severely leaking heart valve.
“Dr. Young saved my life,” she says of J. Nilas Young, chief of cardiothoracic surgery, who performed her surgery. “I love UC Davis!”
Focus on cardiovascular care
Heart disease, strokes and related cardiovascular problems remain the leading causes of death and illness in the United States. For this reason, UC Davis Health System’s 2011– 2016 Strategic Plan identifies cardiovascular care as one of four focus areas for which improvements would greatly benefit individual and population health.
Central to carrying out the goals of the strategic plan is UC Davis’ Vascular and Heart Program, a hub for research, teaching and patient care. The multidisciplinary center — staffed by physicians with expertise in every specialty and subspecialty in cardiology and vascular care — offers personalized, comprehensive treatment services.
Reginald Low, chief of cardiology, takes pride that UC Davis is a recognized national leader in advancing catheter-based innovations.
“New developments in techniques, devices and medications have revolutionized treatment options,” Low says.
Less-invasive technologies are now used to perform a wide variety of procedures, including viewing the interior chambers of the heart and treating leaking valves, irregular heartbeats, coronary artery disease and other conditions.
One technology is Stereotaxis, a system of ultra-slim, highly flexible, magnetically driven catheters used to diagnose and treat cardiac arrhythmias. Physicians use computer software to navigate the catheters through cardiac chambers and project a detailed, 3-D image onto a large monitor to determine the causes of irregular heartbeats. In many cases, the problem can be treated on the spot.
“New developments in techniques, devices and medications have revolutionized treatment options.”
— Reginald Low
UC Davis is the only medical facility in inland Northern California that offers this advanced technology, and is the only site in California utilizing the system for diagnosing and treating arrhythmias in children.
For patients requiring more extensive treatment, the UC Davis Vascular Center’s new, sophisticated hybrid operating room suite allows both endovascular procedures and open-vascular surgery to occur simultaneously.
The new operating room allows sharing of technological advances with the regional — and worldwide — medical community. Sophisticated telehealth capabilities enable remote viewing of procedures as a learning tool, as well as transmission of voice, live video and other visual medical information to physicians elsewhere over a secure Internet connection. UC Davis’ continuing medical and nursing education programs use telehealth technology to conduct video and online courses that enhance the access of health professionals to the latest developments in their areas of care.
At UC Davis, a highly collaborative research core of scientists and clinicians across many disciplines is tackling obstacles to the prevention and treatment of cardiovascular disease. Cardiologist and cell biologist Nipavan Chiamvimonvat, for instance, teamed with entomologist Bruce Hammock from the Department of Entomology in the College of Agricultural and Environmental Sciences to develop a potential new treatment for heart enlargement, one of the most common causes of rhythm disturbances and heart failure. Together, they found that an enzyme that plays an important role in how insects develop from larvae into adults is effective in preventing and reducing cardiac cell overgrowth and heart arrhythmias.
“The vascular center’s technology infrastructure for diagnosis and treatment is unparalleled in the region,” says John Laird, medical director of the UC Davis Vascular Center and an internationally renowned interventional cardiologist and vascular specialist. “Ours is also the only team in the region blending quality clinical care with basic and clinical investigations that are changing cardiovascular care worldwide.”
Advancing research — in the clinic, laboratory and community
Laird regards use of stem cells to generate new blood vessels among the most exciting areas of clinical research in cardiovascular medicine. One application of such research could lead to increased blood circulation in the lower leg with the hope of preventing amputation due to severe arterial disease or diabetes.
An estimated 85,000 leg amputations are performed each year in the U.S. due to advanced atherosclerosis, which occurs when buildup of fatty deposits, calcium and plaque in arteries greatly reduces blood flow to the legs. Current treatments for the condition include opening blockages with balloon angioplasty, bolstering weakened arteries with metal stents or bypassing damaged arteries with vein grafts. When the disease progresses, amputation is sometimes necessary.
“Many patients require limb amputation because angioplasty or surgery is either not successful or not possible,” Laird says. “Stem cell therapies could provide less-invasive options for these desperate patients, and may offer a more permanent way to restore circulation.”
Other cardiovascular research is being carried out at the Betty Irene Moore School of Nursing, where Holli DeVon, a nationally recognized expert in cardiovascular nursing research, recently joined the founding faculty team. She’s leading a $1.9 million National Institutes of Health study together with specialists from UC Davis Medical Center’s emergency department to determine the influence of gender on symptoms during acute coronary syndromes.
Many women, DeVon says, do not experience classic signs and symptoms of heart attack, such as crushing chest pain or shortness of breath. The more subtle nature of symptoms in women often contributes to delay in seeking medical attention, and may contribute to poorer outcomes following treatment.
“Learning directly from women what they experienced when they had a heart attack will be invaluable,” DeVon says. “Publicizing this information — to the public as well as to health-care professionals — will save lives.”
A high priority for the health system is to ensure the future of innovative and sophisticated research relevant to clinical care. The Howard Hughes Medical Institute (HHMI)-sponsored Translational Research Training Program introduces a select group of doctoral students in biomedical research and engineering to the world of clinical medicine. Current areas of study of the HHMI scholars include characterizing the role of inflammation in cardiac arrhythmias, developing novel anti-arrhythmic treatments to be used following myocardial infarction, and studying the role of estrogen loss in the development of atherosclerosis.
Collaboration is key to progress
Donald M. Bers, chair of the School of Medicine’s Department of Pharmacology, asserts that multidisciplinary and collaborative efforts are essential to innovative advancement. Bers, who holds the Silva Chair for Cardiovascular Research, has established a highly collaborative research core that consists of scientists and clinicians in many disciplines tackling obstacles to prevention and treatment of cardiovascular disease. The faculty members in the research core represent five colleges at UC Davis — School of Medicine, School of Veterinary Medicine, College of Engineering, College of Biological Sciences and College of Agricultural and Environmental Sciences — and nine departments ranging from cardiovascular to molecular bioscience to medicine to entomology.
“Our collaborative style greatly enhances scientific progress in he art disease,” says Bers. “It allows complex questions to be pursued from multiple angles simultaneously, to help build an integrative understanding of heart disease and therapeutics from molecules to patients.”
Darlene Hamilton, whose “asthma attack” turned out to be a serious underlying heart problem, has benefited from approaching her cardiovascular disease from many angles. With the help of the UC Davis cardiac rehabilitation clinic, she embarked on an exercise, diet and yoga program. She subsequently needed a further intervention to treat poor circulation in her legs. That procedure, an angioplasty with stent placements to unblock her abdominal aorta and major leg arteries, was a success. Since then, Hamilton has resumed her active lifestyle, traveling and enjoying life.
“I am so grateful for the excellent care I received from UC Davis medical professionals,” Hamilton says. “I feel certain that they have added many healthy years to my life.”