For Our Cardiology Patients

Cut through the heart health confusion. Get tips from a cardiologist.

We welcome you, our cardiology patient, with a few thoughts to help you learn more about cardiology and cardiologists and tips for bettering your health.

President Clinton Health Update | February 2010

There have been some questions as to why our past President, Mr. Clinton, had two stents placed in his coronary artery last week. After all, just a few years ago he had bypass surgery. Contrary to popular belief bypass surgery does not necessarily cure the disease. Some patients go back to their pre-operation life styles including smoking, poor dietary habits, and sedentary practices. The issue here is that Mr. Clinton did exercise and changed his life style. Then, why did have another blockage?

The answer is simple. Once one is diagnosed with Coronary Artery Disease, he carries the diagnosis for the rest of his life. Bypass surgery does not get rid of the blockages. The patient's own diseased blood vessels are bypassed with a vein harvested from the leg. The bypass could also be arterial rather than venous. In this case an artery which is normally found attached to the inner chest is used. Studies have shown that in general the venous grafts have a patency rate of 50% in ten years; the arterial grafts have a patency rate of 90% in ten years. One of the main reasons for failure of the graft within the first year following the operation is secondary to technical issues such as poorly sutured grafts or kinked grafts. After the first year, progression of disease process can lead to occlusion of the vessel.
One of the experts on television mentioned that once stents are placed there is a possibility of movement that can be followed up with a chest X Ray. This is not true. Once the stent is placed it will not move. It will become part of the patient's body for ever. If the stent is not dilated optimally there is a chance it may collapse. If the patient is not given a proper blood thinner the stent may clot off acutely or even subacutely.

So why did Mr. Clinton get bypass surgery rather than stents in the first place? Based on multiple research, the American College of Cardiology and the American Heart Association have put together guidelines. It is clearly evident that if one has three vessel disease involving the main artery or the main frontal artery there is clear survival benefit for bypass surgery. It is even more beneficial if the patient is diabetic and has a weakened heart. The idea is to give the patient a chance for a complete revascularization. Last week, it was noted that Mr. Clinton had a complete occlusion of his vein graft to the side artery in his heart. He was also symptomatic. Given these factors, the cardiologists went ahead and opened his native artery as opposed to tackling the severely diseased venous bypass graft. The procedure is done this way because it is less likely that the native would close down again compared to the severely diseased venous graft.

The lesson learned here is that all patients with history of coronary artery disease are at risk for further blockages in the future. If one follows his cardiologist's advice and does everything right he is still vulnerable to new blockages. This further reinforces the importance of following up with a cardiologist for a close monitoring of one's heart condition to first try to prevent further progression of heart disease and if there is a chance for a blockage to develop, to get treated early and appropriately before it is too late.

On behalf of ACC California Chapter, I hope this article will answer all the website visitors' questions and concerns regarding this condition. Heart disease continues to lead all diseases in mortality in the United States. The good news is that with proper guidelines implemented by ACC and AHA , we have seen a 30 percent reduction of cardiac mortality within the last ten years.

Amin Manshadi, MD, FACC, FAHA, FACP, FSCAI

Chair, Media Relations American College of Cardiology, California Chapter; Associate Clinical Professor, UC Davis

What is a Cardiologist?

A cardiologist is a physician who deals with diseases of the heart (cardio=heart, logist = person who studies).

After medical school, to become a cardiologist a physician must finish three years (at least) of Internal Medicine - so all cardiologists are board certified in Internal Medicine and are therefore "Internists". After completing their training in Internal Medicine, they move to a part of their training called "fellowship" and they become "Fellows" or "Cardiology Fellows" in the training program to which they have been accepted. They are Fellows for between three and six years and then take the "Boards" or "Cardiology Boards" or the "Cardiology Board Exams". After passing the "Boards" they become "Board Certified in Cardiovascular Disease" or more commonly, "Board Certified in Cardiology".

Cardiologists evaluate and treat diseases of the cardiovascular system. Examples of this would include.
All of these diseases require very specialized tests and treatments, and this is the reason so much training is required before becoming a "Cardiologist".

One important thing to remember is that there is a difference between a "Cardiologist" and a "Cardiac Surgeon". A "Cardiac Surgeon" or "Cardiothoracic Surgeon" is someone who actually does surgery on the heart and the blood vessels. This means they open the chest of the patient, will often place the patient on a heart-lung machine and perform complex surgery to repair a problem". "Cardiac Surgeons" are all Board Certified in General Surgery, then go on to complete seven years of training in heart surgery. A Cardiologist will send a patient to a cardiac surgeon for complex surgical procedures.

What is the ACC?

  • ACC was chartered and incorporated as a teaching institution in 1949, and established its headquarters, called Heart House, in Bethesda, Maryland in 1977.

    In 2006, the College moved its headquarters to Heart House Washington, D.C., a state-of-the-art facility in the nation's capital. Heart House D.C. was designed to accommodate a bigger, better, bolder organization. It offers outstanding access to hotels, amenities, cultural attractions, health care partners and lawmakers. Visit the ACC at 2400 N Street NW, Washington, DC 20037.

    The mission of the American College of Cardiology is to advocate for quality cardiovascular care—through education, research promotion, development and application of standards and guidelines—and to influence health care policy. For more information on the ACC, please click below.
  • Read More

"A sad soul can kill you quicker than a germ."
John Steinbeck