Health Resource Center has new partner

The mission of the Leon County Health Resource Center (LHRC) is to improve access to health care to the citizens of Leon County through coordination and collaboration. To accomplish this we have partnered with a number of agencies and professionals who have teamed with us to provide services unique to their respective specialties and expertise. One of our newest partners is Dr. Robert McFarlane, a noted cardiologist who has practiced in Anderson and Leon County for a number of years. We are extremely pleased to introduce him as the newest affiliate with the LHRC to provide cardiology services. Appointments may be made with Dr. McFarlane by calling 903- 322-4067.

From time to time we release articles through the local media to inform the public of what we are doing through the LHRC. Following is an article written by Dr. McFarlane as a part of our ongoing efforts in this regard:

HEART DISEASE IN THE 21ST CENTURY: WHY YOU NEED A DOCTOR, NOT JUST A PLUMBER, OR WHY YOU CAN SAFELY BE TREATED IN YOUR HOMETOWN

The prognosis for a patient with heart disease has changed, radically, in the past few years for the better: the mortality of coronary artery disease (CAD) has dropped by over 50% since 1980 which is especially good news, since by 1980 cardiac mortality had already dropped over 50% since 1960.

The reasons for this are multiple: the advent and improvement of invasive procedures like open heart surgery and angioplasty and stenting, but, in recent years, the biggest advances in cardiology have come from improvements in medicines and better understanding of the pathophysiology of CAD.

In view of the advances of medical treatment of CAD and the new knowledge that has come to the fore, the time is apt to review the role of medicine vs. invasive procedures for this entity.

First a conundrum: in the past few years, multiple studies have demonstrated that a patient who develops chest pain and gets a heart cath and is found to have an 80-90% blockage and who then refuses a recommended intervention – either surgery or an angioplasty – and then returns after more than a year with a heart attack, has greater than a 90% chance of the previously documented severely blocked artery not being the culprit artery or the cause of the heart attack.

Huh?

Doctors, especially in Texas, have a reputation of using frightening language in order to get a patient to submit to invasive procedures. Diagnostic information about blockages in the arteries of the heart have often been conveyed to the patient in extremely negative and frightening terms: “You have a widow maker;” “If you’d waited another day to come in, you wouldn’t have made it;” or “You have a time bomb in your chest,” to use a few common examples.

What is the explanation for the above mystery of severe blockages not usually causing heart attacks? It is this: blockages that cause chest pain (usually greater than 70%) are hard and calcified, i.e. stable. They seldom rupture, which is the proximate cause of a heart attack. It turns out that the lining of a coronary artery in someone who has CAD or diabetes, is covered with literally thousands of minimal blockages (20% or less) that are soft, filled with fat, and prone to rupture. When the surface of one of these blockages or plaques ruptures, a blood clot forms which will either cause a heart attack if the new clot/ blockage combo obstructs 100% of the artery, or severe chest pain (unstable angina) if it obstructs less.

This explains why stenting severe blockages which obstruct blood flow may relieve chest pain, but doesn’t prevent heart attacks because the procedure does not, cannot, deal with the gazillion minimal culprit blockages from which most heart attacks arise. Unfortunately, the public has unrealistic expectations concerning the results of angioplasty/stenting because in multiple surveys of heart patient’s beliefs about this procedure(s), patients falsely believe that getting it done will prevent heart attacks or prolong their life.

Because of its diffuse nature, CAD must be treated as a metabolic disorder, i.e. with medicines. And, in fact, the panoply of cholesterol medicines, chemicals which improve blood flow to the heart, blood thinners (primarily aspirin), and medicines that effect the neuro-hormonal balance of the body for the better (primarily beating back evil hormones that do damage, secreted by the most nefarious of organs, the kidney) have the enormously beneficial effect of stabilizing, if not causing regression of, those multitudinous minimal, but unstable, fatty blockages.

To illustrate, what follows is an all too common case history: I explained all of the above to one of my relatives who was distraught after finding out that her husband had a 90% blockage discovered as a result of a stress test. Though he was asymptomatic, his doctors in Houston recommended an angioplasty. I could not dissuade her from having him get it done because, even knowing the above, she said, “I would just feel better knowing his blockage was fixed.” At this point, I suggested that she consume a gallon of Blue Bell as that would make her feel better also but without any long term negative consequences.

Cardiology practiced best today, compared to when I went into practice over 25 years ago, is a preventative enterprise rather than one that deals with imminent disasters; having said that, if a patient is afflicted with unstable angina or is in the throes of a heart attack, then all of the procedures that should have remained in the background heretofore can be brought to bear with impressive results.

Oh, and regular exercise has been shown to be as salutary as any medicine.

So, if you have CAD, be sure you are on a proper preventative medical regimen, don’t smoke, exercise regularly, get your cancer screening done, check the brakes on your car, and get on with your long life.