Heart Attack Q & A with Guangqiang Gao, MD

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 bypass targets.