New diagnostic laboratory at CCGH aids cardiac care Catheterization yields a picture of blood flow


The man was 64 years old, and he suffered a heart attack in the emergency room at Carroll County General Hospital one Saturday.

The medical staff stopped the attack with injections that dissolved a blood clot blocking the flow of blood to the man's heart.

A few days later, the patient was on a table in the hospital's new cardiac catheterization laboratory. Above, a video monitor produced a black-and-white tracery of blood vessels stretched over the heart that radiology technologist Carlon Carson describes as "like trees in the winter."

Cardiologist Dr. Robert Ricketts was using dye injected through a long, thin tube into the branches of the blood vessel "trees" to show whether blood was flowing freely.

Ricketts found an artery blocked by fatty deposits on the top wall of the man's heart. The patient went to Sinai Hospital in Baltimore for a balloon angioplasty, a procedure in which a balloon is inflated inside an artery to widen the channel for blood to pass through.

Ricketts says the patient is doing well.

"There's a 65 percent chance that this guy is fixed for good without having his chest cut open," the cardiologist says.

Cardiac catheterization is not an inexpensive diagnostic tool. The lab at Carroll County General cost $1.3 million to build and equip, and each catheterization requires a staff of four or five -- a physician, nurse and two or three radiology technologists.

Physicians' fees for an average cardiac catheterization procedure can run from about $800 to $1,000. For outpatient services, hospital charges average $2,000, including laboratory tests. But the unit has been busier than expected since it opened in February.

Hospital officials' initial projections varied from three to 10 patients a week. The lab has been averaging three a day.

"I think it will average out to 500 [a year]," said cardiologist Dr. Dinesh Kalaria, co-director of the lab with Ricketts. Use of the lab may have been high in the first three months because some patients asked their physicians to delay the procedure until the hospital unit opened rather than go to Baltimore, Kalaria says.

Ricketts says he worried initially that patients might shy away from having cardiac catheterization at CCGH, "because a lot of people are conditioned to think if it's not in a 600-bed hospital, it's not good." But he says he hasn't seen that attitude.

Kalaria agrees. "Most of my patients, if they know they can have it done here, they don't want to go to Baltimore."

Five physicians have been accepted to perform the procedure at Carroll County General, and hospital officials say they expect to add two more in July.

In cardiac catheterization, a needle is inserted into an artery or vein in the groin or arm. Through the needle goes a flexible tube -- the catheter -- and inside the tube, a flexible wire. An X-ray camera shows the heart, so the physician can use the wire to guide the catheter into place inside a coronary artery.

When it is in place, the doctor withdraws the wire and begins injecting dye. The dye follows the blood's path, illuminating points where deposits of fat have narrowed the arteries.

It doesn't hurt, said Barbara Musotto. The 54-year-old Westminster woman, who had a heart attack in February, entered the hospital one week ago with pains in her chest and jaws and a feeling of heaviness in her chest.

She agreed with Kalaria's recommendation for cardiac catheterization.

"We were to the point that Dr. Kalaria and I both wanted to get to the bottom of what was going on," she said.

The catheterization revealed reduced blood flow to the heart, which means Musotto faces a balloon angioplasty, but she has only praise for the staff in the cardiac catheterization lab.

"You're very nervous [before the procedure], but they did all they could to make me feel at ease," she said.

The procedure carries the risk of stimulating a heart attack by irritating the heart, Ricketts says. But the risk is minimal -- fewer than 1 in 1,000 patients -- compared with the risk of heart attack among the general population, which is 100 per 1,000 people.

Ricketts has found it more than just a driving-time convenience to have the catheterization lab available at the hospital. He tells of one patient, a woman in her 60s, who complained of chest pains. He performed a catheterization on a Monday morning and found blockages on both sides of her heart. By 2 p.m., the woman was at St. Joseph's Hospital in Baltimore for double bypass surgery.

"It was sort of neat that we made the diagnosis at Carroll County General and they scheduled the surgery on our recommendation," he says.

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