'Squeezing' Away Chronic Chest Pain - NewsChannel5.com | Nashville News, Weather & Sports

'Squeezing' Away Chronic Chest Pain

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ORLANDO, FLA. (Ivanhoe Newswire) - It's a pain in the chest nine-million Americans live with every day. Angina is treatable, but most of the time patients have to take medication for the rest of their lives to control it. Now, a simple therapy is helping patients kick it for good.

Connie Crews has a very important job, she's a full time mom to dogs Casey and Marty. But while working her part time job as a nurse she realized something wasn't right with her heart.

" I noticed what I thought was heart burn.," Connie Crews told Ivanhoe. "With the burning, I would have some radiation, I would feel it radiate to the left side of my chest."

It was micro vascular angina or MVA, an early form of coronary heart disease that occurs when arteries narrow and the heart doesn't get enough oxygen rich blood. Cardiologist Doctor Ken Kronhaus said people with it have few options.

"The vessels are too tiny to put a stent in, they're too tiny to even see to think of doing surgery and the medications work much less than half the time," Kenneth D. Kronhaus, M.D., a medical director and cardiologist at Lake Cardiology in Orlando, Florida said.

To treat it, he's using a non-invasive treatment for heart patients, enhanced external counterpulsation or EECP.

"It milks the blood in the arteries and veins in the legs and increases the blood flow to the heart," Dr. Kronhaus said,

For seven weeks, patients lie on a bed for 35 one hour sessions. Blood pressure cuffs inflated with air are wrapped around each leg. They contract and expand with each heart beat helping develop better circulation.

"You actually get a mechanical angiogenesis, new blood vessel development in the heart without any needles, cutting or added medication," Dr. Kronhaus said.

EECP has few side effects and there's no recovery time. It's been proven to work in 95%of MVA patients. Doctor Kronhaus says the therapy could one day replace life-long heart drugs. After 6 weeks of treatment, Connie's medication free.

"I continue to feel better, to have more stamina and just have a better sense of well being," Connie said.

Doctor Kronhaus says MVA is most commonly seen in women who are peri- menopausal but it can also affect men. Researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors. The treatment could cost up to six thousand dollars but it's usually covered by insurance.

RESEARCH SUMMARY

BACKGROUND:  Angina pectoris is a Latin phrase that means "strangling in the chest".  Patients often say that angina is like a squeezing, suffocating, or burning feeling in their chest, but an episode of angina is not a heart attack.  The pain often happens after exercise.  Unlike a heart attack, the muscle is not damaged forever, and usually goes away with rest.  Angina is usually caused by coronary artery disease, CAD.  The pain usually happens when a clogged or diseased vessel in the heart no longer delivers enough oxygen-rich blood to a part in the heart. Furthermore, Cardiac Syndrome X is related to microvascular angina. Cardiac Syndrome X is a condition where patients have the pain of angina, but they do not have CAD.  Cardiac Syndrome X is more common in women, especially women who have gone through menopause.  It is not life threatening and does not increase risk of CAD or heart attack.   (www.texasheartinstitute.com)

CAUSES:  The causes of microvascular angina are not fully known.  Some doctors think it has to do with how the patient feels pain, while others think it may be linked to low levels of the female hormone estrogen.  In microvascular angina, the small blood vessels in the heart, capillaries, tighten or constrict.  This tightening reduces the blood flow in the heart and causes the pain of angina.  However, since the capillaries are so tiny, they do not increase the risk of heart attack.  (www.texasheartinstitute.com)

TREATMENT: EECP, Enhanced External Counterpulsation, is a non-invasive treatment that uses timed, sequential inflation of pressure cuffs on the calves, thighs and buttocks to augment diastolic pressure, decrease left ventricular after load, and increase deoxygenated blood return. Augmenting diastolic pressure displaces a volume of blood backward into the coronary arteries during diastole, a period of time the heart fills with blood, when the heart is in a state of relaxation and the resistance in the coronary arteries is at a minimum. The resulting increase in coronary artery perfusion pressure may enhance coronary collateral developmental or increase flow through existing collaterals, vessels. In addition, when the left ventricle contracts, it faces a reduced aortic pressure to work against since the counterpulsation has somewhat emptied the aorta. EECP has been primarily investigated as a treatment for chronic stable angina. (www.ncdhhs.gov; American Medical Association)

APPLICATION: Intra-aortic balloon counterpulsation is a more familiar, invasive form of counterpulsation that is used as a method of temporary circulatory assistance for the ischemic heart, often after an acute myocardial infarction. In contrast, EECP is thought to provide a permanent effect on the heart by enhancing the development of coronary collateral development. A full course of therapy usually consists of 35 one-hour treatments, which may be offered once or twice daily, usually five days per week. The multiple components of the procedure include use of the device itself, finger
plethysmography to follow the blood flow, continuous electrocardiography to trigger inflation and deflation, and optimal use of pulse oximetry to measure oxygen saturation before and after treatment. (www.ncdhhs.gov; American Medical Association)

INTERVIEW

Dr. Kenneth Kronhaus, Cardiologist at Lake Cardiology, talks about a therapy that helps treat some types of heart disease without medication.

Can you talk about what we saw in the other room?

Dr. Kronhaus: The patient comes in and lies on a comfortable bed and we put three blood pressure cuffs on each leg. We put a calf a lower thigh and an upper thigh on each leg. And using air pumps the cuffs are blown up to contract and to release. But the magic of EECP is that the compression and release of the six blood pressure cuffs are timed to the cycle of the heart. The machine is a smart machine it knows when your heart relaxes and it knows when it contracts. And the heart gets its blood flow when the heart relaxes and when the heart goes in to its most extensive relaxation state these six blood pressure cuffs milk the blood in the arteries and the veins back to the heart. So you have an upper and a lower blood pressure number and the lower blood pressure number is increased briefly by the increased blood flow from the heart when it fully relaxes. You get increased blood flow to the heart. And then as the heart is about to beat, contract, and that's the higher number of your blood pressure that's when the rest of the body gets its blood flow. All six-blood pressure cuffs magically together release. So actually the heart has less of a force to have to pump against to cause unloading of the heart. And this goes on with each heartbeat and the machine is triggered by ones own heartbeat.

Do you see any side affects after using the machine?

Dr. Kronhaus: We rarely see any side affects, occasionally we'll see some skin irritation and if one takes very careful care of watching for that it can almost always be dealt with. I have been doing this treatment since 2000, I've treated hundreds of patients I've never hurt anybody.

Can you talk a little bit about Connie and her situation?

Dr. Kronhaus: Connie is a registered nurse, she's fifty-three and she came to see me complaining of chest pain, unexplained fatigue and palpitations. She as an intuitive nurse tried to diagnose herself and was so frustrated because she couldn't come up with a cause of her symptoms. And she had eliminated all of the obvious culprits and came to me and I was concerned that given her age and her sex, perimenopausal female that she was very suspicious with her symptoms that she had microvascular angina. What we did was we put her on the treadmill, we did an exercise stress echo she had a very small area of inadequate blood flow, we call it ischemia. And instead of doing a heart catheterization we did a CT angiogram of her coronaries and we were able to see the big coronaries giving the blood to her heart. The big coronaries, the epicardial coronaries were wide open and five, ten, fifteen, twenty years ago the heart doctors would have said, Connie you're fine no problems. And she would have gone from doctor to doctor and ultimately probably ended up at the physiatrist thinking that she was crazy. And I unfortunately have seen too many people like that before we even recognized microvascular angina as a real diagnoses because that's only occurred in the last five to ten years. And there are three million heart catheterizations each year in America and one million are normal and we've been telling those one million they have no heart disease and a significant fraction of that one million have microvascular angina. They ping pong from doctor specialist to doctor specialist, no one ever finds their diagnosis and they usually end up on the psychiatrist couch. And I've had so many, many women but some men come to me frustrated, we've diagnosed microvascular angina, we've treated them with EECP and it's even more effective for microvascular angina than it is for the big vessels. We see ninety to ninety five percent improved. Connie has had resolution of her chest pain, palpitations, fatigue. We then did a stress test after her EECP was completed and her stress test now normalized.

Treating microvascular angina, can you do surgery for that?

Dr. Kronhaus: For microvascular angina you have limited options for treatment. About forty percent are able to get some benefit from medications but unfortunately most of the medications lower blood pressure and that becomes a limiting factor. But most don't get any benefit from the medications or from exercise and the vessels are much too tiny to even see. You can't see them on a routine heart catheterization so you can't stint them and you can't do invasive bypass surgery. The only effective option for so many who have microvascular angina is the EECP.

You said pre-menopausal but is there something people should be looking at?

Dr. Kronhaus: I think if anybody has unexplained chest pain, shortness of breath, palpitations, unexplained fatigue, if you have any of those symptoms and the doctor can't diagnose the cause you have to think about microvascular angina. It's so common.

So Connie has had how many sessions?

Dr. Kronhaus: Connie two years ago, in the fall of 2009 had thirty-five one-hour treatments.

Why do you think a doctor is so quick to prescribe drugs instead of thinking of a therapy like EECP?

Dr. Kronhaus: I think doctors treat with what they're comfortable with and it's a reasonable first approach to try medications. We each have our own approach to the patients. I find being on medications for life, which will have adverse affects if you have a substitute, another option like EECP which will avoid any cutting, any needles, any medications it seems to me that that's just a wonderful option. And in the long run it's going to be cost effective you don't have the cost of lifelong drugs. And with microvascular angina there's only a small sub-group of people that even get any benefit.

You are a cardiologist, you see a lot of patients, is there anything you do differently in your life that you didn't do before?

Dr. Kronhaus: Well I like to walk the walk. Everybody teases me because I do eat healthy, I try to watch the blood pressure, the blood sugar, the blood cholesterol, I don't smoke. I try, it's a continuous effort to maintain ideal body weight and I try to walk the walk. And so I have tried to live a heart healthy life.

Is there something specific, do you run three miles, what do you do?

Dr. Kronhaus: I'm a great believe in where I am in life is train don't strain. So I try to get some aerobic exercise every day. But not to the point where it is actually no pain no gain, I'm a great believer in mid life to train don't strain. And also it's a good idea to do weights three times a week on alternative days.

Is there anything you don't eat?

Dr. Kronhaus: Well I'm not crazy and exclusive, I'm a great believer in moderation but obviously most of my diet is fruits, vegetables, whole grains, low fat dairy products, beans, seeds, nuts, fish, turkey, lean meats you know that's most of my diet.

 FOR MORE INFORMATION, PLEASE CONTACT:

Kenneth D. Kronhaus, MD
Cardiologist
kkronhaus@lakecardiology.com
www.drkenshow.com

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