Although heart disease remains the number one cause of death in the US, medical technology is advancing by leaps and bounds to counter current statistics. In the San Joaquin area, we are especially blessed with a wealth of advanced cardiac care. The following are just a few areas that have seen improvement in both the prevention and treatment of heart disease:

Cardiac Surgery

While minimally invasive cardiac surgeries have been performed for years, the precision with which these procedures are performed and the conditions that can be managed with it have changed considerably. Cutting and splitting the chest wall wide open in order to perform heart surgery is no longer necessary. Instead, a small incision is made under the breast area and damaged heart valves and arteries are fixed with the assistance of cameras and precision instruments.

At St. Joseph's Medical Center, the first minimally invasive cardiac surgery was performed in 1998. They improved and expanded on the minimally invasive program in 2007 with the modification of coronary artery bypass (CAB) surgery, a favorable alternative to traditional CAB surgery for select patients (those who have an easy-to-reach blockage at the front or side of the heart). In 2010, minimally invasive valve surgery was established for the repair and replacement of aortic and mitral valves.

a surgeon with the Stockton Cardiothoracic Surgical Group, describes the benefits of such surgeries as going far beyond reduced scarring. There's less post surgery pain, a lower risk of infection and bleeding, and far less recovery time. In other words, people can have this surgery and get back to their regular lives much quicker. Hal Lurtsema of Stockton was one of the first patients to have the minimally invasive CAB surgery at St. Joseph's. With an 85 percent blockage in his left anterior descending coronary artery (LAD, fancifully termed "the widow's artery," since a blockage is usually fatal), Lurtsema was considered a prime candidate due to his otherwise good physical health and the location of the blocked artery.

Dr. McDonald performed the surgery on the morning of April 1, 2008. That night, Lurtsema was up and walking around. The next day he was out of the ICU, and the third day he went home. He was back to work in a week. Not a bad recovery time for open heart surgery. Since then, Lurtsema has had no recurring heart problems. According to him, after the minimally invasive CAD, his life returned to normal, 100 percent.

Cardiac Catheterization/Electrophysiology

Before open heart surgery is indicated, cardiac issues are often well-managed by the Cath Lab team. It is in the Cath Lab that arterial blockages are cleared via angioplasty, and where the Electrophysiology (EP) team can find and regulate electrical disruptions (arrhythmias) of the heart and place pacemakers.

With the latest equipment, Cath Labs and EP departments can perform these procedures Photos: Matthew James Photographer; Courtesy St. joseph's Hospital Courtesy St. Joseph's Hospital Jerome McDonald, M.D., FACS Hal Lurtsema www.sanjoaquinmagazine.com SAN JOAQUIN MAGAZINE 47 faster and easier than ever before. At Dameron Hospital, such processes have been greatly assisted by the addition of state-of-the-art equipment, like the St. Jude Medical Version Four Recording System with Clear Wave Signal Acquisition Technology, which assists with EP diagnostics, and an intravascular ultrasound machine from Boston Scientifi c that makes it easier to see the interior anatomy of cardiac arteries. However, Cardiac Cath Lab Director Sandy Peterson, R.N., fi nds that it is her staff that really makes their lab function quickly and effi ciently. There are members of the Dameron Cath Lab team with twenty-plus years of hands-on experience. St. Jude is also working with St. Joseph's Medical Center. As of January, St. Joseph's has partnered with St. Jude to become the fi rst cardiac catheterization teaching center on the west coast, teaching health care professionals the latest techniques of rhythm management and pacemaker implantation.

Preventative Medication

Recent studies have shown that certain groupings of heart medications have had marked preventative effects. Kaiser Permanente's ALL/PHASE program has taken notable advantage of this research. The ALL initiative (consisting of aspirin, Lisinopril, and lipid-lowering medications) was implemented to reduce the incidents of heart attack and stroke in certain high-risk patients. In most cases it Even if you aren't a doctor or paramedic, you can still help save the life of someone in cardiac distress. The following San Joaquin area organizations conduct CPR classes that will teach you how: Central California Safety Council 6004 N. El Dorado St., Stockton californiasafety.org Certify U 2040 W Benjamin Holt Dr., Stockton (209) 952-5234 is also supplemented by the PHASE program (Preventing Heart Attacks and Strokes Everyday), which adds a beta blocker and lifestyle recommendations to the mix.

According to Michael Zhu, M.D., the Chief of Cardiology for the Kaiser Permanente Central Valley area, since 2000 this program has helped Kaiser effectively reduce the incidents of heart attacks in Northern California by 24 percent, and those resulting in permanent damage by 62 percent.

STEMI & D2B

When someone has a STEMI, or ST Segment Elevated Myocardial Infarction, time is of the essence. "Time is muscle," as the saying goes. The maximum allowable time span for getting someone with a STEMI from the "door to balloon" (D2B), or from the hospital entrance to blockage removal in the Cath Lab, is currently ninety minutes. Technology now exists that has reduced that time signifi cantly.

Under the direction of George Charos, M.D., St. Joseph's Medical Center implemented their STEMI/12- Lead EKG program in 2009. As outlined by Joann Marks, R.N., St. Joseph's Cardiac Vascular Thoracic Service Line Leader, the procedure works as follows:

Paramedics and/or EMTs in the fi eld attach EKG leads to a heart attack victim and send the signal electronically to the ER doctor. A positive diagnosis of STEMI and assemblage of the Cath Lab team begins before the patient even reaches the hospital door. So once the patient arrives, treatment can begin immediately. (Dameron Hospital also has the same program in place, using what they call LifeLine Technology.)

The current record holder for this time-saving technology is Chris Ranuilo of Stockton. On May 5, 2010, after having to carry his misbehaving golden retriever from the groomer's to his truck, Ranuilo began to feel pain in his chest. At fi rst he thought he'd just pulled something, until a crushing pain told him otherwise. He drove to his son's house, the pain getting progressively worse. His son called 911.

The paramedics gave Ranuilo nitroglycerin and attached the EKG leads. A STEMI was detected and the paramedics rushed him to St. Joseph's. An angioplasty was immediately performed to open his LAD, which was completely blocked. The D2B was twenty-eight minutes. Amazingly, this time proved so fast that no damage to the heart has been detected.

There was a casualty, however. Ranuilo had been wearing a brand new Harley Davidson T-shirt that the paramedics had to cut off. Although no longer wearable, Ranuilo kept the shirt and hung it up to remind himself of how lucky he was.