ABOUT THE EMORY CARDIAC TOOLBOX
Today the software to analyze cardiac images is used throughout the world, with it being used on about 4 to 5 million Americans every year. The cardiac imaging technique is either a SPECT or PET scan depending on the tracer and imaging device used. These scans use a small amount of radioactive material (tracer). The tracer is given through a vein (IV), most often on the inside of the elbow. The tracer travels through the blood and collects in organs and tissues, in cardiac imaging it is usually the heart muscle which pumps blood to the body. Then, the patient will lie on a narrow table that slides into a large scanner. The scanner detects signals from the tracer. A computer changes the signals into 3-D pictures and performs intricate measurements of blood flow and heart function. The images and measurements are displayed on a monitor for the doctor to read.
It answers the critical question: Does the patient have coronary heart disease? But the tool, which has become more sophisticated over the years, also analyzes blood flow and helps determine which treatments and medications will be most effective.
SOURCE: Emory University
Ernest Garcia sprinkled crushed garlic over a bowl of pasta, ate his dinner — and felt pain.
The Emory University professor of radiology assumed it was acid reflux. After all, he had suffered from the condition for years, and maybe he went a little overboard with the garlic.
But the pain felt different this time. While he usually feels the pain under his left rib cage, the pain was centered on his right side this time. He contemplated going to the emergency room, but he was alone; his wife was traveling and he didn’t want to bother his neighbor to give him a ride. So he took a Prilosec for the acid reflux, an aspirin “just in case” it was his heart, and went to bed. He woke up feeling better — but not 100 percent. His resting heart raced, with his pulse rate reaching the 90s.
He never could have imagined on this evening back in the spring of 2008 what was really happening: He was having a heart attack. He never would have guessed that what he needed was his invention: the Emory Cardiac Toolbox, a sophisticated software imaging program that analyzes the beating heart and helps doctors decide whether surgery, in many cases lifesaving surgery, is necessary. He and his colleagues developed the Emory Cardiac Toolbox back in the late 1980s. The tool has become more sophisticated over the years.
No one in Garcia’s family had heart disease. He was lean, didn’t eat red meat, and instead ate mostly fish for protein along with fruits and vegetables. The 59-year-old exercised regularly. He wasn’t worried about his heart. His wife, Terri, also thought it was nothing. He worried about being stricken with cancer since he lost family members, including his father, to the disease.
The months passed and spring warmed up to summer. Garcia traveled to China and Argentina for conferences and speaking engagements.
But still feeling minor chest discomfort, he finally went to his cardiologist, and they decided to use the Emory Cardiac Toolbox on him. The moment he saw the results — three-dimensional images of his beating heart — there was no question that he had indeed suffered a heart attack. He saw the black void showing inadequate blood flow and that cells had died. He eyed the bright doughnut-shaped image of blood flow to the heart muscle that didn’t make a complete circle, indicating blockage to an artery.
Every year, the Emory Cardiac Toolbox is used on about 4 to 5 million Americans. Garcia is now one of them.
Since experiencing a heart attack, he is also on a mission to encourage people to have a “heart attack plan.” Talk to your neighbor, he said, and agree to help each other in case of an emergency, even in the middle of the night. Be specific to paramedics about requesting a particular hospital where you want to go. And remember, he said, not all heart attack symptoms are the same.
“Be informed about your health care options because when a heart attack comes,” Garcia said, “you will have very little time and many treatment decisions to make.”
Back in 2008, while he knew what he was looking at was not good news, he also felt a sense of comfort, a special connection to the images on the screen.
“It was like an old, trusted friend telling me, ‘Believe me,’” he said.
Dr. Robert Guyton, chief of cardiothoracic surgery, Emory University Hospital, said Garcia’s technique and the analysis of what parts of the heart are not getting enough blood allowed for “a focused operation” and helped doctors be more certain an operation (and in the case of Garcia, quadruple bypass surgery) was needed.
Garcia talks about how he believes stress was a major contributing factor in his heart attack. Garcia, then 12, and his 13-year-old brother were part of the 1960 exodus of middle-class Cuban children after the Castro takeover the year before. He was allowed to take only one item of value — he chose his typewriter. His father hid cash in a bottle of talcum powder. For years, he had nightmares that authorities had discovered the money hidden in toiletries. Stress built up over time, first as a newcomer acclimating to his new country. And then as an adult, there was the everyday stress from a demanding career, raising two children, driving in traffic.
Garcia seems easygoing, but admits to “internalizing” stress.
Now 65, he practices meditation and continues to exercise to help ease stress.
For years, Garcia’s work has played a role in assessing heart disease.
In 1979, clinicians were amazed by the first images of blood flowing to the beating heart. Garcia, who has a Ph.D. in physics, created the software needed to interpret those dancing images. Early computers were too slow to handle the complexity, but they caught up over time.
At his first-floor office at Emory University, Garcia looks at the three-dimensional image of a beating heart rotating on the computer monitor. Color-coded virtual “slices” of the heart show the distribution of blood flow while the patient is at rest and also while exercising. Garcia continues to focus on evolving the Cardiac Toolbox into a vast set of software-imaging tools.
Earlier this year, Garcia underwent a follow-up Emory Cardiac Toolbox scan, which showed while some of his heart muscle cells had died during the heart attack, the bypass surgery had restored blood flow and improved the pumping action of his heart.
