By DeAnn Rossetti
Over 1 million Americans will have a heart attack this year, and 50 percent of them will die.
Heart disease is the No.1 killer of American women. One in three women will have a fatal heart attack, perishing of heart disease, according to the National Institute of Health and the U.S. Department of Health and Human Services.
As the nation’s leading cause of death, coronary artery disease can now be detected in its earliest stages with the Electron Beam Tomography (EBT) scan and treated or reversed with changes in diet, lifestyle and medication.
In 50 percent of men and 62 percent of women who died of coronary heart disease, there were no previous symptoms of the disease, according to the Department of Health.
“If you wait for symptoms, you’re too late,” said Islander Dr. Gary Oppenheim, the cardiologist who brought the only EBT machine in Washington to Swedish Heart Institute four years ago. “Two-thirds of the time, the first symptom is a heart attack or dying. We want to pick up the signs early and apply preventative strategies to those at risk of coronary disease.”
Oppenheim, a New York City native, graduated from medical school at the University of Pennsylvania. After residency at the Harvard Hospitals and a fellowship at the University of Chicago, he landed a staff position at Stanford.
“I decided this (the West Coast) was a lot nicer place to live,” he said. He and his wife have lived on the Island since 1990, and have two children, David, 11, and Brian, 7, who attend Lakeridge Elementary.
Oppenheim, 49, was a cardiologist with Minor and James Medical Center in Seattle, but has decided to “go independent” with all 10 cardiologists from Minor and James to start Seattle Cardiology on the 15th Floor of the Nordstrom Tower as of March 15.
“It allows us more freedom to provide better care for our patients,” said Oppenheim. “We’re going to paperless medical records, so if someone calls with a problem at anytime or anywhere, I can type up their name on my laptop and find their medical records and history generated on the computer.”
Oppenheim hopes that Swedish Hospital and Minor and James will still make use of his services as a cardiologist familiar with the EBT machine and what it can do, but he’s ready to move on to the new EBT C-300 machine established in Bellevue, across the street from Overlake Hospital.
“It’s one generation newer than the one at Swedish,” he said. “There are now only two EBT machines in the state, and this is the second one.”
There’s less radiation involved in getting an Electron Beam Tomography scan than mammograms or dental X-rays, said Oppenheim. The newest EBT scanner uses the same amount .
An EBT works by generating a powerful electron beam that is focused on one of four tungsten target rings positioned beneath the patient. A technologist applies three electrocardiogram leads to the chest of the patient and then they pass through the scanner. Radiation exposure is minimal and no intravenous injection of contrast dye is required, as it is with some other cardiac diagnostic tests.
The EBT scan sees the calcium that has built up around the soft plaque deposits in the walls of the arteries. Though most people develop some plaque in their lifetime, this calcification doesn’t generally occur in the arteries until one is in their 40s or 50s.
Though it looks like a CT scan machine, the EBT machine, invented in 1984, is five times faster than any other X-ray/scanner currently in use, with a shutter speed of 1/10 to 1/20 of a second. Three of these cutting edge machines are in use at the Mayo Clinic in Minnesota and 10 in Chicago.
“The detail you can see with an EBT scan is amazing,” said Oppenheim. “It has been used investigationally for detecting early lung cancer, and can be used for virtual colonoscopy.”
With the EBT scan, he noted, doctors now can do an angiogram in a non-invasive way. Instead of putting a catheter in through the groin, an IV is inserted into the arm, contrast injected and pictures are taken quickly with the EBT scanners.
“We get angiogram quality, plus we can see how much blockage there is,” he said. “Some people may not have to have the full test if this test looks okay.”
EBT scans can pick up a square millimeter or less of calcified plaque in the artery wall.
Another reason the EBT scan is important is because even cholesterol tests can’t predict heart attacks.
“We all know people with cholesterol of 300 (normal range for cholesterol is under 200) who live to be 90,” said Oppenheim. “We also know people with cholesterol under 200 who have a heart attack at 40. How each body handles it tells the tale.”
Oppenheim noted that former President Clinton passed a stress test every year with flying colors until he recently had to have bypass surgery.
“Even if all three of the arteries to the heart are 50 percent blocked, you’d have a negative stress test,” said Oppenheim. “Not until you’re 70 percent blocked would the president have had any symptoms, and by the time he needed angioplasty or bypass. By contrast, President Bush has had an EBT scan and his doctors have adjusted his medication accordingly.”
Oppenheim said that if Clinton had taken an EBT scan even 10 years ago, it would’ve shown his heart disease at an early stage and he might never have had to have bypass surgery.
For patients who have some blockage showing up on their EBT scans, Oppenheim recommends changes in diet and lifestyle that can dramatically improve the patients chances of preventing heart attack or death by heart attack.
“I recommend that they not smoke, exercise and eat the Mediterranean diet, which includes a lot of monounsaturated fats such as olive and canola oil, avocados and nuts. The diet also includes important Omega-3 fats, such as those found in fatty fish (salmon, mackerel, tuna) and walnuts. Exercise alone will cut your risk (of heart attack) by up to 50 percent.”
Oppenheim also uses cholesterol-lowering medications for his patients who have high cholesterol.
Oppenheim is also the head of the new EBT program at the Heart Health Center of Bellevue, where he will focus on the intermediate risk population — those who have one or two risk factors, such as having heart disease in their family, or high cholesterol.
“These are people who may or may not have heart disease, but are therefore the people who benefit most from this scan,” he said. “They can either be shifted to a higher risk group and be treated more aggressively for that, or can be shifted to the lower risk group.”
The Heart Health Center of Bellevue is located at 1632 116th Ave. N.E., suite D. Call 425-455-1788 for more information. EBT Heart scans cost $450 and are not covered by most insurance companies.