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Cardiologist speaks to Rotary Club

April 27, 2011

A doctor from the Amarillo Heart Group was the special guest speaker for the Rotary Club meeting Tuesday afternoon.
Dr. Alan Chu of the Amarillo Heart Group shared about some of the work he does with the Amarillo Heart Group, along with some particulars about peripheral artery disease (PAD).
He said the Amarillo Heart Group focuses on various types of heart conditions, which includes coronary artery disease, which centers around patients with heart attacks or angina; PAD, which has symptoms of leg pain and ulcers and sores on the legs that lead to negative outcomes if they persist; venous disease, heart failure and valve disease, neurovascular disease, and blockages in the kidney arteries.
Also treated by the AHG are conditions containing to heart rhythm, and the center has a strong focus on preventive therapy, which Dr. Chu can have a profound effect on the health of a patient, particularly one with a history of heart attacks.
“There are many ways medical advancement has allowed us to treat patients with a lot of good effective medications that will reduce the need for that,” he said. “A lot of times, if we could prevent the first heart attack, that would be our goal. If we cannot prevent the first heart attack, at least we could prevent the second one, or at least slow down the growth of the cholesterol plaques that are developing bad outcomes.”
Dr. Chu said the Amarillo Heart Group works with physicians in the Borger community to reduce the cholesterol of patients and keep checks on their blood pressure when it comes to these types of issues.
He said the AHG is very interested in clinical research and is participating in a lot of trials to bring in cutting-edge technologies and therapies for patients with the different vascular diseases.
There are many procedures that can be done in the office of the Amarillo Heart Group, which he said is much easier for patients. Such procedures include cardionuclear testings, echocardiograms, CAT scans, and peripheral blockage interventions. He said patients can come in, have such a procedure done, and go home in about three to four hours without the need for hospitalization.
For patients with multiple blockages, Dr. Chu said they try to work an efficient plan to solve the problem and insure less risk in the process.
Other treatments include venous treatments, a pacemaker clinic, and a coumadin clinic.
“All in all, we try to use a multi-faceted approach in delivering comprehensive state-of-the art, contemporary treatment and preventive care in patients with cardiovascular diseases in the Texas Panhandle Region,” Dr. Chu said.
He said most of the illnesses treated by the Amarillo Heart Group stem from a condition known as atherosclerosis. He said this is the building of plaque inside the artery that plugs it up and reduces blood flow and damage to the tissue the artery supplies.
He said the lining of the artery can be damaged by such things as smoking, high blood pressure, or high cholesterol. The white blood cells will start sticking to the walls of the artery, causing a chemical and inflammatory reaction underneath the wall of the artery. It then begins to build up as cholesterol plaque.
“At this stage it is still a very minor plaque, but a lot of chemistry is already going on in there,” Dr. Chu said.
As the plaque continues to build up, the middle part begins to digest its own enzymes and becomes a pool of a pus-like substance. The substance will rupture through the plaque and a blood clot will then form inside the artery during the rupture. The rupture can happen in a short period of time. When it ruptures, the body will try to form a clot to stop the rupture.
“In the process, the clot will clog up the whole artery and cause the whole artery to stop blood flow to the tissue it is supplying,” Dr. Chu said.
He said if this happens in a person’s heart, it will result in a heart attack. If the process happens in the neck, a person will have a stroke. If it happens in a person’s leg, they will experience extreme pain or sores that will not heal well.
He said arterial disease is caused by a blockage that is greater than 70 percent, resulting in reduced blood flow to a person’s tissue. PAD is anything that is not coronary. Blockages can take place in the upper and lower extremities, carotid arteries, kidney arteries, or ones within the bowels.
Dr. Chu said PAD is a disease that is underestimated and underappreciated. It afflicts eight to 12 million Americans and about 75 percent of cases remain undiagnosed. According to a study done in the 2000s, he said 29 percent of patients 70 years and older have PAD, and in those who are smoking and are older than 50 years of age, they also have the disease, with diabetes being a contributing factor.
Less than 10 percent suffer from tightness or cramps in the legs, but most patients still may not have any idea that they have it, Dr. Chu said. Those who suffer from it are six times more likely to die within the next 10 years compared to the general public.
“The annual risk for heart attack, stroke, or death is greater than five percent, and that is very significant,” Dr. Chu said.
Ways to test for PAD are the ankle-brachial index, ultrasounds, CAT scans, MRIs, and arteriograms. He said the ankle-brachial index is very simple and is a procedure he uses twice a year with patients he is treating.
In order to treat PAD, Dr. Chu said a strong emphasis needs to be put on smoking cessation, hyperintensive treatment, diabetes treatment, and exercise. There are medications to treat the condition, such as folic acid. Lipids must be properly treated, and patients with PAD need to have a cholesterol level that is below 70. The same is true for patients with diabetes or suffering from renal failure.
Surgical options are available, but Dr. Chu said these are not trivial surgeries and can pose risks to the patient involved. However, if the surgeon is able to use a patient’s own vein, it can greatly increase their chance of long-term survival. He said chances of long-term survival are not as good with patients already suffering from sores on their legs.
He said heart attacks and infections can happen around the time of surgery, and there are some patients that do not report much significant improvement.
Dr. Chu said there are new techniques now available that allow doctors to perform these procedures without having to do an open surgery, more of a catheter-based procedure and devices that work similar to a Roto-Rooter. He said they are highly successful, and more than 80 percent reported improvement in their symptoms. There are also some procedures that can be performed in the AHG office.
He then showed some examples of different procedures he has performed for patients in the past through these new types of surgeries.

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