Wrist Assessment

A specialized, but not widely used procedure is helping heart attack victims at Mary Greeley Medical Center.

Bill Kruse is 66 and still puts in a lot of hard work at his farm just outside of Beaver in Boone County.

A good sweat is a typical part of Kruse’s day. But on April 24, 2012, there was something unusual about the perspiration pouring from his brow. Though the early spring weather could hardly be characterized as oppressive, he was sweating uncontrollably, simply driving a trailer load of hogs from his farm to a drop-off spot in Perry, about 20 miles away.

“I got to Perry, unloaded the hogs and just didn’t feel right,” Kruse says. "My only real symptom of anything going on was the fact that I was sweating so badly.”

“After I unloaded, I got back in the truck and came to a four-way stop. I was still not feeling right then, but figured it was just in my head,” he continues. “By the time I got home, I knew something was wrong and I decided I needed to get to the hospital.”

Kruse’s wife, Zelda, took the wheel, and they headed east to Mary Greeley Medical Center. “They told me as soon as I got there what was going on,” Kruse says. “They told me it was a heart attack. Before I could get to a seat, they were taking me back to a room.”

Kruse was rushed to the cath lab, where one of his hardworking arms played a crucial role in a specialized procedure to treat heart attack victims at Mary Greeley.

‘Time Is Muscle’

Cheryl Pietz, B.S.N.,R.N., supervisor of the Mary Greeley Medical Center Cardiac Catheterization Lab, says moving patients in the midst of a heart attack into the cath lab quickly is vital.

“The saying ‘Time is muscle’ is true when it comes to heart attacks,” Pietz says. “The quicker we can get a patient into the cath lab and open up a blocked vessel, the more heart muscle we can save. It is critical to get them in to the cath lab and restore blood flow to the heart within 90 minutes of their arrival at the emergency department.”

That 90-minute benchmark is commonly referred to as “door-to-balloon time.” The measure reflects hospital readiness—and speed in applying that readiness—to the provision of emergency interventional cardiac care for patients suffering heart attacks. (See sidebar for detailed information.)

Upon arrival in the Cardiac Cath Lab, Kruse was met by Imran Dotani, M.D., a cardiologist with McFarland Clinic and medical director of cardiology services at Mary Greeley.

“Dr. Dotani affirmed I was having a heart attack,” Kruse says. “He also told me we needed to fix it and that he was going to take care of it. The next thing I knew, I was recovering in the intensive care unit.”

Radial Access

Cardiac catheterization involves threading a thin tube through a patient’s artery toward the heart, using the body’s circulatory system to clear blockages, deliver medication and position stents. Since its acceptance in the 1950’s, the procedure has primarily been performed using a femoral artery in the patient’s groin.

This method is effective but often leaves patients in considerable pain, can lead to excessive bleeding, and can greatly limit activities of daily living such as driving and walking up stairs, for days after a procedure.

There are now a handful of physicians in Iowa, Dotani among them, who have taken the next step cardiac catheterization interventions. Instead of using an access point in the groin, Dotani often uses the wrist, a procedure referred to as radial artery catheterization. Dotani, who has performed the procedure thousands of times and used it to treat Kruse, says the radial approach offers patients a wealth of benefits.

“The data shows that both outcomes and the comfort of the patient are improved when performing the radial procedure,” says Dotani, who offers training for other physicians on the procedure. “Patients, on average, are discharged a day early, and complications, like pain at the access site and bleeding, are greatly reduced.”

Kruse says he was amazed when told the little scratch on his wrist was the only visible evidence of the procedure.

“It was just a little nick on my wrist,” Kruse says. “I had a bigger scratch on my other arm that I came in with. You could hardly see where they put the cath in.”

With the improved outcomes and decreased complications, why isn’t the procedure used more widely? Dotani says it is slowly gaining acceptance as the method of choice.

“It requires a high level of skill and a lot of procedures for a physician to get competent in performing it,” Dotani says. He estimates he has done 4,000 to 5,000 radial procedures in his eight years at Mary Greeley Medical Center. “It requires a great deal of time for physicians to become comfortable with this method, but it is being taught more now. It will become more common in the years to come.”

And physicians aren’t the only ones who require advanced training to perform the radial procedure.

“The whole cath lab at Mary Greeley has advanced training to do it,” Dotani adds.

Back to Normal

Cardiac Rehabilitation

Sue Tjelmeland, R.N.,
with Cardiac Rehab, checks on
Bill Kruse's progress.

Now months removed from the heart attack, Kruse says he is feeling better than ever. He attributes his recovery to the full support of Zelda, the skilled professionals who cared for him at the medical center, and the one-on-one coaching he received from the Mary Greeley Medical Center Cardiac Rehabilitation staff.

Kruse first met with the Cardiac Rehab nurses when he was in the intensive care unit. After discharge, he regularly attended rehab classes that helped him see the importance of eating better and exercising regularly.

“None of what they told me was a real surprise. I knew I needed to make some changes,” Kruse says of the cardiac rehab team of Sue Tjelmeland, R.N., and Patty Huisenga, B.S.N., R.N. “They did a really good job in explaining why I needed to begin to make changes."

“I am now much more mindful of what I eat,” Kruse continues. “I’m certainly not perfect, but I eat a lot more fruits and vegetables and drink tea now. None of that was part of my diet before, but this whole experience showed me it was important.”

Looking back, there is something else Kruse has a great appreciation for.

“It’s funny, because I didn’t have any fear or anxiety,” says Kruse, who had both of his knees replaced at the medical center in the year prior to his heart attack. “My past experience left me with a feeling that I was in the right place and in the right hands."