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1st Apr 2007

Heart Disease and Repairing the Damaged Heart


Dave Ansell

Chris Smith

This week we explore the science of Heart Disease. Dr Niall Campbell joins us to explain what heart attacks are and how they're treated, Dr Anthony Mathur discusses how stem cells might hold the key to mending a broken heart, and Ben Valsler visits Brian Callingham to investigate how arteries behave when you give them various drugs.

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Heart Disease and Repairing the Damaged Heart - More about this podcast

 

Straight to the Heart

Heart disease is responsible for for more deaths in the UK than any other single cause – every five minutes someone in the UK dies from a heart attack. This week on the Naked Scientist's Radio Show and Podcast we will have three experts from this field: Dr Niall Campbell who will tell us what heart attacks are and how they're treated, Dr Anthony Mathur who will discuss new treatments for heart attacks currently being trialled and Dr Michael Crawford who will explain the role of Omega 3 in a healthy heart. Sabina Michnowicz provides a flavour of what the experts will be covering ...  

The Bare Facts – What is a Heart Attack? 

I put this question to Dr Niall Campbell (from the Heart Attack Centre at the London Chest Hospital) and he explained that “The heart is a muscle which pumps blood around the body and it needs nutrients and oxygen to do this effectively. It receives this from its own plumbing system; the coronary arteries. If a coronary artery becomes significantly narrowed or blocked by a blood clot, the blood supply to an area of heart muscle stops and this results in that area dying. The larger the area of muscle supplied by a coronary artery, the larger the heart attack.” As mentioned in the opening, heart disease is the biggest killer in the UK, however, the treatments available are excellent – particularly if received early. Niall stresses that early treatment prevents more of the muscle dying and that anyone suffering chest pains shouldn't delay calling 999 (they certainly shouldn't wait longer than 15 minutes). Paramedics and doctors would rather see a false alarm than someone arriving too late because they didn't call for a ambulance sooner.

What are the current treatments? 

There are a few treatments which can be used in patients having heart attacks; one involves the blocked heart artery being opened with clot-busting drugs given via a vein in the arm – this is known as 'thrombolysis'. Another newer treatment has been developed where the blocked coronary artery can be opened with a minimally invasive operation called an 'angioplasty', which is the main treatment used in Niall's hospital. This is performed whilst the patient is awake and involves passing a balloon through the blood vessels in the leg or the wrist into the blocked heart artery and then inflating the balloon to relieve the blockage. The doctor treating the heart attack can position a permanent metal scaffold (called a 'stent') inside the artery, keeping it open and reducing the risk of it narrowing again. Niall told me about one patient (with the patient's permission!) who had a heart attack and received this type of treatment. This is his story...

The 83 year old man did not have a previous history of heart disease but he suddenly experienced severe central chest pain at 10:30am. He promptly telephoned for an ambulance and the paramedic crew performed a test to obtain an electrical trace of the heart (called an ECG). Abnormalities in his electrical traces demonstrated that he was having a heart attack. He was brought immediately to the Heart Attack Centre at the London Chest Hospital where he had an angioplasty operation to unblock the heart artery causing the problem. Tubes were passed from the blood vessel at the top of his leg to his heart and a special dye was injected which lights-up the heart arteries. This demonstrated that the two heart arteries on the left side of his heart did not have important narrowings (Figure 1) but that the artery on the right side of his heart (which also supplied blood to the underside of the heart) was blocked (Figure 2).

If he had not received any treatment, the heart muscle on the underside of the heart would have died, resulting in a large heart attack. He had an angioplasty operation, where a blocked artery is opened up by passing a wire through the narrowing. The wire is then used like a train track to place a metal scaffold – the stent – which keeps the artery open. After this was performed, he rapidly felt better. You can see how the blood flow had returned to almost normal at the end of the procedure (Figure 3). A heart scan performed before he went home showed that his heart was working well and because his artery was opened quickly, his heart attack had not been large, the scan also showed that no significant heart muscle damage could be seen. He was feeling well when he went home. He was advised to stop smoking to decrease his risk of having a future heart attack.

Angioplasty 1

Angioplasty 2

Angioplasty

Figure 1:Angioplasty: Catheter tube from leg can be seen in top left corner. Foreground: shows left heart arteries with no significant narrowings.©Barts & the London NHS Trust

Figure 2: Again catheter tube from leg can be seen in top centre of picture and below that the blocked right heart artery.©Barts & the London NHS Trust

Figure 3: The right heart artery has been opened and the stent has been positioned below the catheter tube.©Barts & the London NHS Trust

 What treatments are currently being trialled? 

Dr Anthony Mathur (Consultant Cardiologist, Barts and the London NHS Trust, Queen Mary University of London, Medical School) is currently running a clinical trial to test whether stem cells taken from patients suffering from heart disease can be used to repair the damage that has been caused. Adult stem cells have the potential to repair organs that have been damaged by disease; a type of therapy which has revolutionised medical practice. The patients enrolled in this study have all had damage to their hearts caused by a heart attack which leads to a condition called heart failure in which not enough blood can be pumped around the body by the heart. It is hoped that by injecting stem cells taken from the patients own bone marrow into the areas of weakness, their hearts will become stronger (through the production of new muscle or blood vessels) therefore leading to an improvement in their heart failure. Results from this trial will be expected in a years time and will help develop the use of adult stem cells, from a research question into a treatment for heart disease. It is hoped that lessons learnt from this work can also be applied to other organs affected by disease.

Prevention is better than cure

There are many ways to prevent heart disease including regular exercise, not getting too stressed and eating a balanced diet. A balanced diet should involve lipids and essential fatty acids including Omega 3. Dr Michael Crawford (Director of the Institute of Brain Chemistry and Human Nutrition at the London Metropolitan University) is a specialist in lipids and essential fatty acids. He is interested in the key interaction between nutrition affecting membrane lipids and gene expression. Lipid composition is influenced by diet and that in turn influences the membrane proteins which are the ion channels, receptors, signalling and protective enzymes. Michael will be on the show to talk about the importance of Omega 3 in the diet to ensure the healthy functioning of membranes which help the heart to work properly.

Has the excitement of reading this article got your pulse racing? Are you eager to learn more about how the heart works, what heart disease is, how it can be treated and how it can be prevented? Of course you do! You know what to do – tune in live on Sunday and download the podcast after the show to re-live it again and again.



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