Peggy Tippin is quite matter-of-fact when she talks about the day her heart stopped, or, as she puts it, “the day I died.” And, it’s no tall tale she tells. She doesn’t embellish the facts, and you won’t hear over-the-top dramatics. She just tells it like it is.
There’s the part where she collapses in the hallway at work. The part where paramedics struggle to resuscitate her. The story of doctors shocking her heart, unable to get blood pumping to her brain for about 45 minutes.
And, finally, the almost unbelievable part. “They froze me for a few hours, and I woke myself up, asking: ‘Why am I here?’” says the 53-year-old from Louisville, Ky.
Tippin was diagnosed with a heart arrhythmia, which had stopped her heart. Thanks to a new technology called therapeutic hypothermia that helped reduce the risk of brain damage, her cardiologist had time to implant an internal defibrillator to prevent it from happening again. After a week, she walked out of the hospital, and was back at work in three weeks.
“I have a whole different outlook,” she says.
Heart disease is the leading killer of Americans, and that’s why doctors and researchers are exploring new ideas—even ones that sound like science fiction—to treat the heart.
From new surgical techniques to smarter, more targeted diet choices, experts say there’s a long list of new ways to diagnose, treat and even prevent heart disease. Read on to learn about the procedures that can keep your heart strong, and patch them up when they run into trouble.
Out in the cold: Therapeutic hypothermia
After all the standard treatments failed to restart her heart, Tippin’s doctors at Baptist Health Paducah in Paducah, Ky., turned to one of the latest techniques in heart health: therapeutic hypothermia. Also called targeted temperature management, this cooling treatment is recommended by the American Heart Association to treat cardiac arrest.
Doctors injected iced saline into Tippin’s veins, to bring her body temperature down to 91 degrees Fahrenheit. By keeping the body cooler than the typical 98.6 degrees, oxygen can circulate better, decreasing the risk of permanent brain damage. In some cases, doctors also wrap patients in a special blanket that has cool water circulating inside.
The AHA has praised the procedure since 2010, but it’s just now spreading from highend treatment centers to hospitals across the country, says Dr. Benjamin Abella, clinical research director at the University of Pennsylvania’s Center for Resuscitation Science.
Therapeutic hypothermia is one of many new advances dramatically changing outcomes for people who suffer cardiac arrest, Abella says.
“It’s a wondrous thing, being able to see this person who was technically dead for a period of time actually wake up and ask for their family,” he says. “And the people who wake up tend to do very well, and can go back to normal lives.”
Life renewal: Left ventricular assistive devices
Surgeons have been implanting mechanical pumps in patients with serious heart trouble for more than a decade. Former Vice President Dick Cheney even had one for a while, before receiving a heart transplant in 2012.
But until fairly recently, implanting LVADs wasn’t exactly a common procedure. Now, as more doctors have seen how invaluable they can be, LVADs have become more durable and accessible to a greater number of patients.
Dr. Edward Geltman is medical director of the heart failure program at Barnes- Jewish Hospital in St. Louis. He says the growing use of LVADs has created a ripple effect, with more companies producing them, giving people more options. The heart pumps are used in people who may be too old or sick to be good candidates for a successful heart transplant, he says.
“For people who don’t qualify for heart transplants but have a very sick heart, we can put the LVAD in and give them a boost,” Geltman says. “And they can have really very acceptable lifestyles.”
It’s nowhere near a cure, but it can allow a person a renewed chance at life. One of Geltman’s star LVAD patients is a 68-year-old man who got well enough to check some items off his bucket list.
“He went pheasant hunting, and we have pictures of him on a cruise looking at glaciers outside of Alaska,” he says.
Cell mates: Bone marrow stem cells and cardiac stem cells
The body has an amazing capacity for healing, and now researchers are finding the heart may be able to repair itself with help from bone marrow, or its own cardiac cells.
A 2013 breakthrough study of European heart failure patients, led by the Mayo Clinic and published in the Journal of the American College of Cardiology, tested how stem cells could repair damaged heart tissue.
Researchers injected ischemic heart failure patients with their own bone marrow stem cells, treated with specialized proteins. They discovered the bone marrow cells helped the heart cells regenerate and reversed the effects of damage. And it’s not relatively all that tough, Geltman says.
“The stem cells that come from bone marrow are not that hard to harvest, select and grow,” he says. “They take a sample, grow it in a laboratory for a couple of weeks, and then go back and get them into the heart.”
And if that doesn’t wow you, you’ll be amazed at what researchers at King’s College London discovered. The heart’s own stem cells may repair and regenerate muscle tissue damaged by a heart attack.
The study, published in August 2013, found that when a particular group of stem cells that reside in the heart are removed and then re-injected, they naturally resettle into the heart, finding and repairing damage. This can lead to total cellular and functional heart recovery, getting the heart pumping normally again.
Geltman says it’s still up in the air as to which type of stem cells—those from the heart itself or from bone marrow—is best suited to treat heart failure. Some studies, he says, have shown significant benefits for heart pump functions, while others result in neutral effects. Researchers are still sorting out how it all works. This is why these treatments haven’t reached community hospitals. They’re being tested in clinical trails at academic medical centers.
“All of this is still considered investigational,” Geltman says.
No studying needed: Coronary artery disease tests
Just because you look and feel healthy doesn’t mean your heart is off the hook.
Many doctors are recommending coronary artery disease tests, more commonly known as CAD tests, for all adults, not just those who have a history of cardiac problems.
Since 2010, the AHA has been recommending coronary artery calcium scans, a type of CAD test, for people with a family history of heart disease and other risk factors. The test detects plaque buildup in the arteries, dangerous if it impedes blood flow, or ruptures and breaks away, causing a potentially deadly clot.
Dr. Emil deGoma, director of the Preventive Cardiovascular Program at the University of Pennsylvania’s Perelman Center for Advanced Medicine, says the test requires a quick CAT scan, providing a picture that can help doctors get a glimpse into your future.
“That is probably the single best test we have,” deGoma says, because it can spot potential problems in people who have no other symptoms and have never had a heart attack.
CardioDX, a cardiovascular genomic diagnostics company based in California, is one leading the charge in innovative CAD tests. This company has created one of the first sex-specific CAD tests, taking into account key biological differences between men and women. Called the Corus CAD, it assesses specific genes in the blood to measure the extent of a person’s coronary artery disease. This test is performed through a quick routine blood draw at the doctor’s office.
Patients can get results within 72 hours, and doctors combine the results with other tests to offer a more complete picture of a person’s current heart condition.
Out of your control: Lp-PLA 2 tests
Another way for doctors to size up your risk of a heart attack is to take a close look at lipids—the fatty molecules—in your blood. More specifically, they want to examine a lipid known as LPA.
“The higher the LPA, the higher the risk of having a heart attack—that’s very clear,” Geltman says.
This test can be helpful to understand your risk, because, unlike other heart disease predictors, LPAs aren’t affected by your diet or exercise routine. And your lipid levels can be high, even while your cholesterol is relatively low.
That’s where the Lp-PLA2 comes into play. A lipoprotein-associated phospholipase A test is a cholesterol and blood test that assesses your risk of coronary heart disease, cardiovascular disease and stroke. The PLAC test is the new brand-name go-to version.
Geltman says the test can help doctors determine how soon a high-risk patient should start cholesterol-lowering medication based on their results and other risk factors, including family history.
“It is inherited, so you might have someone who says, ‘I don’t smoke. I’m fit.’ But your dad had a heart attack (at a young age), which means you’ve got to do all the good things,” he says.
Fighting the causes: Cholesterol medications
You’ve probably heard the big names in cholesterol drugs: Lipitor, Crestor, Zocor and a handful of others. These all fall into a category of drugs called statins, which help lower cholesterol by slowing production of a particular enzyme. Now, a newer type of drug is getting a lot of hype for its ability to dramatically drop “bad” cholesterol levels in a different way.
ALN-PCS, also known as PCSK9 inhibitors, may be able to drop cholesterol levels by about 60%, deGoma says. It works by stopping the body’s production of a protein known as PCSK9, helping to reduce cholesterol. And having a healthy cholesterol level reduces your chances of getting heart disease and having a stroke.
So far, the drugs are still in clinical trials. But deGoma says they could be ready for use within the next couple of years.
“It could be used above and beyond existing medications,” he says. “Or alternatively, for people who may have had side effects to existing therapies.”
Effective, but expensive: Transcatheter aortic valve replacement
In the not-so-distant past, many older people in need of a heart valve replacement were given bad news by their doctors: “Sorry, it’s too risky.”
Now, those higher-risk patients have a less risky option. A transcatheter aortic valve replacement—sometimes shortened to TAVR or TAVI—lets doctors replace a heart valve without traditional open-chest surgery.
Dr. Marc Gillinov is a heart surgeon at the Cleveland Clinic and author of Heart 411: The Only Guide to Heart Health You’ll Ever Need. He says this new FDA-approved process is great for patients at too high of a risk for standard surgery.
“We can take (the replacement valve), fold it closed like an umbrella, thread it up the artery, and then deploy it,” he says.
This procedure requires a 3- to 4-inch incision in the leg or left chest wall. It takes about three to four hours to complete, which is about two hours less than an average heart surgery. Most patients leave the hospital within four to six days, and usually return to their normal routine within 10 days of the procedure.
For now, the procedure is primarily available only in larger medical centers. But Gillinov says that’s likely to change in the next few years. He says the technique is widely accepted, but it’s expensive, which makes some hospitals reticent to use it.
“It’s a new technology that can save a lot of lives,” he says. “But can we afford it?”
Mediterranean diet
You don’t have to turn your kitchen into a fat-free zone to protect your heart. Research increasingly shows we need some fats to keep the heart running, Gillinov says.
“The idea that fat is bad is incorrect. (That notion is) too simple,” he says.
The Mediterranean diet is at the top of many doctors’ lists for heart health. It features fruits, vegetables, nuts and fish, a good mix of healthy fat and a small amount of meat.
“Many diets have been studied, but only one has been in a gold standard clinical trial,” Gillinov says. “There was a large European study showing that people who follow a Mediterranean diet live longer, have fewer heart attacks and fewer strokes than people who follow a reduced-fat diet.”
Gillinov says the trick is to avoid foods high in saturated fat, such as red meat and dairy. Eat foods with mono and polyunsaturated fats, which you can find in fish and olive oil.
