ANGIOGENESIS
By:  Ellen L. DeBacker, R.N.

Although there have been significant improvements in cardiac care over the past years such as "clot busters," bypass surgery and angioplasty, there are a number of patients who have coronary artery disease and angina for whom, besides transplant surgery, nothing can be done.  There is hope, however, through an exciting field known as angiogenesis.

Angiogenesis is the term used to describe the formation or growth of new blood vessels in areas that are not getting enough blood.  These vessels (arteries) are called "collateral arteries."  Angiogenesis typically occurs during fetal development, wound healing and some other physiological stresses.  A current area of heart RESEARCH involves finding ways for the heart to grow a new blood supply once the coronary arteries have become blocked with plaque.

The heart is actually very good at growing collaterals.  These collaterals can act as nature's own bypasses.  If one of the heart arteries is completely blocked, other heart arteries will grow small blood vessels over to the plugged artery.  Unfortunately, this is a very slow process and these small arteries are often unable to grow large enough to supply an adequate blood supply to prevent chest pains.  Interestingly, daily exercise is one of the best ways to encourage the growth of these collaterals.

There are two new techniques under investigation that, in theory, may promote angiogenesis in the heart.  The first uses gene therapy in an attempt to promote the formation of blood vessels within the heart.  It is hoped that these new vessels will form "detours" (collaterals) around arteries that are severely narrowed.  Injection of Vascular Endothelial Growth Factor (VEGF) directly into the coronary artery, which is done through a catheter similar to a heart catheterization or angioplasty procedure, can cause hundreds of small new vessels to form very rapidly in just days.  The first injection is followed by a series of injections.  Limitations are the short half-lives of the preparations, limited retention of the growth factor and limited blood supply to the new vessels.

The second technique is called Transmyocardial Revascularization (TMR), in which microscopic holes armade into the heart muscle using a laser.  This is a major operation similar to open heart surgery.  Some speculate that the laser holes cause hormones to produce the new blood vessels.  Some patients have reported total relief of their chest pain after this procedure.  Improvement of this technique is the Percutaneous Transmyocardial Laser Revascularization (PTMR) which is done with a catheter inserted into the heart and multiple channels are created from inside the heart to improve blood flow to the heart muscles and stimulate growth of new blood vessels.

It is to be noted that we are focusing on angiogenesis for the heart, but it is also being investigated for circulation problems to the feet and legs.  Pain and sensory problems occur when the blood circulation in the individual's extremity has become obstructed by atherosclerosis, the same disease process that created the fat-filled plaques that clog coronary arteries.  Inflammation of the blood vessels of the legs, which usually strikes young men and patients with acute loss of feeling in the feet (sensory neuropathy), has benefited from the gene therapy (VEGF).

The opposite area of angiogenesis research is in the pathogenesis of various diseases collectively referred to as angiogenic disease.  Restricting the formation of the blood flow or the growth of new vessels is promising for the treatment of some cancer tumors that require blood vessels in order to grow.  This area is also being investigated in studies of chronic inflammation such as rheumatoid arthritis and psoriasis; debilitating eye disorders such as diabetic retinopathy and macular degeneration and solid tumors, both benign and malignant.  Anti-angiogenesis drugs exert their anti-tumor effects by interfacing with molecular events required only for blood vessel formation and thus restricting blood flow to tumors and other areas.

These areas of research will continue to be investigated.  At least for now, you are much better off PREVENTING blockages from forming in the first place by eating a low fat diet, exercising regularly, not smoking and by keeping your blood pressure, cholesterol and sugar under control.

HELENA CARDIOLOGY CLINIC NURSING RESPONSIBILITIES
By:  Lisa R. Cummings, L.P. N.

The nurses here at the Helena Cardiology Clinic have a wide variety of duties and responsibilities to Dr. Paustian and his patients.  The following is a brief rundown of  what we do at the Clinic to keep information as accurate and up-to-date as possible for Dr. Paustian and his patients.

Dr. Paustian has three nurses on staff.  Ellen DeBacker is a Registered Nurse whom many 

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