by Dr. Christopher Leet
According to the Centers for Disease Control and Prevention (CDC) heart disease is the foremost cause of death for both men and women in the United States. Nearly 25% of deaths are caused by heart disease every year. Fortunately, heart disease is often preventable. February is American Heart Month, making it the perfect time to seek out cardiovascular services for prevention or treatment.
There are three major Cardiology practices within the county, varying from 4-13 doctors, with multiple offices. All of these can be confusing for the lay public to sort out. Keeping in mind that since group size or number of offices is mainly a business decision, and no guarantee of quality, some clarity is needed.
Hospitals: Two major hospitals, at each end of Prince William (in early spring, Novant Health’s newest facility will open in Haymarket, giving us three local hospitals). Each is able to treat all of the common cardiac conditions quite well. Both have cardiac labs with EKG, Echocardiogram, Holter monitoring, Stress testing, and CT imaging. They each are able to offer emergency cardiac catheterization and stenting to treat acute MI(heart attack), as well as basic electrical problems such as pacemakers and defibrillators. Neither hospital at this time is able to offer open heart surgery, coronary bypass, heart failure/transplant services, or the more complicated arrhythmia problems. The closest facilities for these services are Inova Fairfax and Mary Washington in Fredericksburg.
- Clarient (formerly Virginia Cardiovascular Associates) is the largest group in the area with thirteen board-certified cardiologists. They have three offices within PWC, with others elsewhere. They offer all services mentioned above. There are several members performing cardiac catheterization/stenting, as well as two electrophysiologists (arrhythmia specialists). Clarient also offers in-office sleep study.
- Prince William Cardiology Associates is the smallest group with four Board certified Cardiologists, but is the longest continually established Cardiology practice in Northern Virginia They have been in existence for over 35 years. All of the standard services mentioned are available, although they favor referral to arrhythmia groups at Inova Fairfax for complicated arrhythmia studies. Two offices in PWC, one in Warrenton and one in Manassas.
- Mount Vernon Cardiology employs six Board-certified Cardiologists. Their main office is located in Alexandria, with a satellite office in Woodbridge. They are also a long established practice in Northern Va. All standard services mentioned above are available.
With all of these practices, there is not a great deal to choose, other than personal decisions about a particular physician. All three practices offer outstanding Board-certified physicians. Likewise, there is little difference in hospital services.
Cardiac Tests (Note that NONE of these replaces a well-performed history and physical exam.):
- EKG(ECG): Basic screen for heart problems. Electrodes measure electrical heart activity. Can be performed anywhere. Inexpensive, but least diagnostic. No risk.
- STRESS TEST: Exercise on a treadmill, or occasionally at rest with drug administration. May be monitored with EKG (least accurate), Echocardiogram (more accurate), or nuclear scan (most accurate). Used mostly to diagnose presence of coronary disease (likelihood for heart attack), but may have other uses as well. Can be performed in hospital or office setting. Generally very safe.
- HOLTER MONITOR: 24-hour heart monitor designed to show arrhythmias ,erratic heartbeats or palpitations, that may occur at odd times. Modifications of this may allow for longer monitoring-days or months. Can be performed in office or hospital. Very safe.
- ECHOCARDIOGRAM: Ultrasound exam of the heart (office or hospital setting) which gives a real-time image of the heart contraction. Generally looking for structural problems or the function of the heart muscle. Very safe.
- CARDIAC CATHETERIZATION: Performed only in hospital, most commonly looking for artery blockages in the heart, but also occasionally for structural abnormalities. Requires sedation and insertion of a small plastic catheter through a vessel into the heart. Low risk, but not entirely risk-free.
- ANGIOPLASTY/STENTING: Performed in conjunction with catheterization. Uses a balloon-tipped catheter to expand a blocked artery and restore flow. A mesh stent is usually attached to this and left in place to maintain the unblocked artery. Risk varies significantly, based on the condition being treated. Highest risk is in attempting to open an artery during a heart attack(acute MI).
- PACEMAKER: Performed only in hospital. Most commonly done for those whose pulse rate is slow or erratic, and not controllable with medication. May be a temporary or permanent device, based on the situation. Both involve the insertion of one or more wires through a vein into the heart. These are connected to either an outside (temporary) or implanted (permanent) battery device. Risk varies with the condition, but generally is low.
- DEFIBRILLATOR: An extension of pacemaker therapy, designed to treat very unstable heart rhythms where the risk of cardiac arrest is high. Higher strength battery designed to shock the heart if necessary. A modification of this is sometimes used to allow for more effective overall heart function. Procedure has acceptably low risk, although used mainly in those people at high risk for cardiac events.
All of these listed procedures are available throughout the county, either in the hospitals or the individual Cardiologists offices, as may be indicated. Invasive procedures such as, cardiac catheterization, angioplasty, and pacemaker surgery have to be performed in a hospital setting. There are many other procedures, including open heart surgery, coronary bypass, more advanced arrhythmia evaluation, heart failure/heart transplant services, which require more elaborate facilities, and are too elaborate to include in this discussion.
Manassas resident Dr. Christopher Leet, now retired, practiced medicine for nearly 40 years, specializing in cardiology and internal medicine.