Advancing heart health through interventional cardiology

This piece was originally published in the Medical Professionals Triad Magazine August 2022.

"Our main goal with each patient is to provide them the best care and guide them toward the best options possible.”

Novant Health uses technology, multidisciplinary approach to offer patients next-level care. There are two scenarios in which a patient meets an interventional cardiologist.

Scenario No. 1: A stable patient comes in for an elective outpatient cardiac catheterization or a peripheral angiogram or venogram procedure. These patients may have ongoing symptoms like chest pain, shortness of breath, a stress test that showed abnormalities or leg swelling that has been evaluated with other testing as an outpatient. They come to an interventional cardiologist for a confirmatory/ therapeutic procedure.

Scenario No. 2: A patient is in a 911 situation, experiencing severe chest pain and is experiencing a real-time heart attack or any other cardiac event that requires emergent diagnosis or treatment.

In both scenarios, said Bhalaghuru Chokkalingam Mani, MD, “Our main goal with each patient is to provide them the best care and guide them toward the best options possible.”

Dr. Mani is one of three interventional cardiologists at Novant Health Heart & Vascular Institute - Matthews, a department of Novant Health Presbyterian Medical Center. All are also endovascular fellowship-trained and endovascular board-certified.

The team partners with referring physicians and other specialists to provide patients with world-class care that gets them on the road to recovery.

Innovative nonsurgical options improve recovery

The Matthews team is trained to use the Impella device via catheterization to temporarily restore blood flow to organs while a patient receives care in appropriate patients. The Impella is used in both emergent settings and elective settings.

Novant Health Matthews Medical Center is the first and only nontertiary care hospital in the Novant Health system to successfully deploy and incorporate the Impella program, which requires intensive training across different care teams.

“When the heart cannot pump normally and is badly impaired from a massive cardiac event, requiring medications to keep up their blood pressure, patients are said to be in cardiogenic shock,” Dr. Mani said. “During this time, a support device can help improve the efficiency of the heart’s pumping capacity and reduce the demand on the heart to allow the heart to recover while we’re fixing the arteries. In patients like that, after we fix the arteries, it may take two to three days before the heart gets out of that stunned phase. So the Impella stays inserted while the heart recovers and then can be removed when it is no longer necessary.”

The Impella can also be used in nonemergent settings. “If the patient has reduced heart muscle pumping function or heart failure and is known to have severe heart artery blockages that need to be addressed, they’re at a higher risk of having cardiac events while we’re trying to fix the heart arteries by angioplasty or stent placement,” Dr. Mani said. “To protect the heart and thereby all the vital organs, the Impella device comes into play where it is helping the heart support blood flow.”

Matthews Medical Center has approval to use the Impella device in urgent or emergent situations.

Multidisciplinary approach for advanced vascular care

Thrombectomy devices and thrombolytic therapies are also implemented by the team to treat deep vein thrombosis and pulmonary embolism.

“For example, if we have someone with a massive amount of deep vein thrombosis and their entire leg is swollen, clot-busting medicine in addition to clot removal devices can be used by way of catheters to clean that out,” said Dr. Mani. “We have to be careful in our patient selection and device selection so as to ensure safety and excellent outcomes.”

With the right thrombectomy devices and catheterization approach, the team is able to support patients with large, symptomatic blood clots in their lungs or legs.

The team offers multidisciplinary care across a full vascular service line that encompasses cardiac catheterizations, coronary angiography, critical limb ischemia and limb salvage treatment, pulmonary embolism treatment and deep vein thrombosis treatment.

“All invasive procedures with respect to these scenarios require careful multidisciplinary care,” Dr. Mani said. “For example, if you have somebody with critical limb ischemia, meaning someone who has poorly healing ulcers in the legs for a long time, you need the vascular cardiologist or a vascular medicine specialist, a podiatrist or an orthopedic physician, internal medicine team, infectious diseases specialist and wound care specialist to properly evaluate and then address the underlying problem. We need many different disciplines to make one such service line a success. So the collaborative team approach is necessary for good patient outcomes.”

That complete support team can be found at Matthews Medical Center.

“That’s what’s really exciting,” Dr. Mani said. “With the technology and capabilities we have at Novant Health Matthews Medical Center, we can see incredible change in patients day-to-day. We’re able to provide this incredible, stateof-the-art care with the resources we have.”