Until recently, people diagnosed with congestive heart failure and other cardiac problems faced a grim reality: Aside from lifestyle changes and medication, surgery often was their only option. For those with severe symptoms, even that extreme measure provided little relief. The best they could hope for was a steadily declining quality of life. But that was then.

Today, technological breakthroughs and emerging drug therapies are giving new hope to patients whose optimism had long since vanished. From state-of-the-art pacing devices to robot surgeons, cardiology is advancing at a breakneck pace—and we’re all potential beneficiaries.

New diagnostic tools

What makes coronary artery disease so insidious is its stealthiness: It often takes years for debilitating symptoms to develop, and by then it can be too late for meaningful intervention. Now a new blood test can quickly and accurately diagnose a person’s risk of heart disease. “It’s an easy little blood test called CRP—C-reactive protein,” says Dr. Lance Sullenberger, director of the cardiology clinic at Walter Reed Army Medical Center in Washington, D.C. “The test measures inflammation in the body, which we now know can be an indicator of increased risk of heart disease and heart attacks. It’s another clue that we can use to determine whether someone has coronary artery disease.”

One method doctors long have used to diagnose heart conditions is the cardiac ultrasound procedure, which takes a two-dimensional picture of the heart using sound waves. Now there’s 3-D cardiac ultrasound that allows a physician to watch the heart beating in real time and rotate the image on a computer screen. Instead of a static photo of, say, a malfunctioning heart valve, the doctor can watch the valve as it opens and closes, pinpointing the exact problem and its location. The 3-D ultrasound is moving beyond its original diagnostic use and is helping surgeons guide catheters through the heart and plan complicated surgical procedures.

Help for unhealthy hearts

If you already have been diagnosed with a heart condition, new medical techniques can help in your treatment. For example, what if you’re suffering chest pain caused by blocked arteries or are in danger of having a heart attack? Since the mid-1980s, cardiologists have relied on a technique called balloon angioplasty to open clogged arteries. First, a balloon is inserted into a mesh tube called a stent; next, the balloon is blown up at the site of the blockage, expanding the stent against the artery’s walls to hold it open. “The problem,” says Sullenberger, “is that about one in five of those patients will be back within a year with scar tissue in that artery, have the chest pain again, and need additional work.”

Now, says Sullenberger, new stents coated with antibiotics are changing that. “The coatings prevent scar tissue from forming at the site of the stent; they keep the cells that form scar tissue from multiplying,” he explains. “We’ve seen the rates of scar tissue formation—a process called restenosis—fall off to somewhere between 0 [percent] and 10 percent. It’s a big leap forward.”

Keeping the beat

But coronary disease is just one of many things that can go wrong with the heart. It’s estimated up to 22 million people suffer from congestive heart failure (CHF), with an additional 2 million diagnosed each year. CHF is marked by uncoordinated heart contractions, making it impossible for the heart to supply the body with enough blood for normal operation. Regular pacemakers can’t help; they’re designed to prevent a too-slow heartbeat, not an unsynchronized one.

Enter Cardiac Resynchronization Therapy (CRT), comprised of an implanted electronic device designed to help both sides of the heart beat in proper rhythm. CRT isn’t for everyone, but in cases where nothing else has worked, it can provide a significant improvement for CHF patients. “To meet the criteria, you have to have a heart that doesn’t pump as well as it should,” explains Sullenberger. “You have to have an EKG that shows uncoordinated contractions of the left and right ventricles, and you must have been on the standard regimen of medication for CHF.”

If a patient meets those criteria and still can’t walk across a room without shortness of breath, Sullenberger suggests CRT. “The CRT device has an extra lead that goes through the left ventricle to make both sides of the heart beat simultaneously,” he says. “It’s not an easy procedure—you have to thread the lead through a vein called the coronary sinus, which is very difficult—but it’s amazing how well some patients respond to the procedure. They’re not suddenly going to be running a 10-K race, but they should be able to do more than before the device was placed.”

A shock to the system

Many patients with congestive heart failure also are susceptible to fibrillation, in which the heart’s chambers quiver instead of beating. Fibrillation of the upper chambers (atria) can lead to the release of blood clots, which can lodge in the brain and cause a stroke. Ventricular fibrillation, where the heart’s lower chambers (ventricles) flutter rather than beat, can cause sudden cardiac death. If you’ve ever watched a medical drama on TV, you’ve seen the large paddles used to electrically stimulate the heart back into a normal rhythm. Time is of the essence when the heart is fibrillating—death can come in mere minutes if the fibrillating heart is left untreated. But few of us live next to a hospital, and rural patients are at even more risk, with help often many miles away.

Now there’s a device called an implantable cardioverter defibrillator (ICD). “It’s about the size of a standard pacemaker, with a lead that goes into the right ventricle,” says Sullenberger. “The device monitors the heart rate, looking for evidence of an abnormal rhythm. If it finds one, it can either try to pace the heart out of it—send electrical signals very quickly to try to recapture and restore the rhythm— or it can deliver a shock to bring the heart back to normal operation.”

Sullenberger says anyone who has had a heart attack and whose heart function is below 30 percent is a prime candidate for an ICD. Even patients who haven’t had a cardiac event but who have low heart pumping volume can benefit. For patients who need both synchronization and defibrillation, a combination CRT/ICD device is available.

A brave new world

Despite all the technological advances, sometimes surgery still is necessary. However, cardiac surgeons might soon have a new high-tech tool at their disposal: a robot surgeon. The still-experimental da Vinci Surgical System has proven its effectiveness in recent ongoing trials, drastically reducing the size of surgical incisions and postoperative recovery periods for certain procedures. A surgeon operates da Vinci’s robotic arms using 3-D imaging; the surgeon’s hand movements translate seamlessly to the system’s surgical instruments inside the patient.

The rapid advance of technology ensures more advanced techniques, medications, and equipment soon will arrive to aid those with life-threatening cardiac ailments. The Medical Robotics Technology Center at Carnegie Mellon University in Pittsburgh currently is working on a tiny mobile robotic device that will crawl inside the heart to operate and administer medications. In the field of cardiology, it truly is a brave new world.