HealthNews
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Teaching: The Heart
of the Matter
tcn actor means teacher, not healer," asserts
Waldemar Wajszczuk, M.D., performs cardiac catheterization along with Stacy Rannazzisi, R.N.
Heart and Goal
he goal of Sinai's
emergency treat-
ment of heart at-
tack is not
merely to save
lives. Sinai uses
the most modern
technology and
well honed skills to im-
prove the quality of pa-
tients' lives and reduce
their risk of future heart
attacks.
'When a patient comes
to the Emergency Room
with chest pain, and a
finding of acute myocar-
dial infarction (heart at-
tack) is made," says Dr.
Waldemar J. Wajszczuk,
"we can catheterize and
open 95 percent of the pa-
tient's blocked arteries
within a few minutes af-
ter the patient has been
prepped."
Dr. Wajszczuk, director
of the Catheterization Lab
and director of Interven-
tional Cardiology at Sinai,
uses what research re-
veals is the most effective
technique: balloon angio-
plasty. Results have
proven that emergency
catheterization and an-
gioplasty during a heart
attack is the treatment of
choice, he reports.
Catheterization pro-
duces images of vessels
that immediately tell him
and his Sinai team which
artery is blocked. The
artery is then opened with
the balloon, inflated at the
end of the catheter's tip,
squashing both the clot
and obstructing plaque.
This method leaves a
wider and more persistent
pathway for blood flow
than can be accomplished
with anti-clotting (throm-
bolytic) drug therapy alone.
"From the moment the
patient enters the hospi-
tal, we follow a treatment
plan. And the pictures
from the catheterization
permit us to make an in-
telligent plan. It is not a
guessing game," Dr. Wa-
jszczuk. says. "Using these
very low-risk and power-
ful angioplasty tools at the
outset reduces risk to pa-
tients and ultimately
saves money."
Sinai is one of only 18
percent of U.S. hospitals
that offers the service. "In
my opinion," Dr. Wa-
jszczuk says, "Patients
who have had an acute
heart attack should have
the artery fully opened
with the balloon within 90
minutes or less from the
onset of chest pain."
Emergency angioplas-
ty is 'the best way to avoid
permanent damage to the
heart muscle or death," he
points out. Furthermore,
when a catheterization is
done for diagnostic pur-
poses, it is wise, he says,
to choose a hospital like
Sinai, where a cardiac
surgical team is standing
by in case coronary bypass
surgery is needed.
And any time there is
suspicious non-emergency
chest pain, having the car-
diac cath at a comprehen-
sive facility like Sinai with
surgical or other inter-
vention capability mini-
mizes the delay, risk and
costs of transporting pa-
tients to another hospital
for treatment. V
LI Dr. Stephen Gunther, director of Sinai's
Cardiology Fellowship program.
Dr. Gunther believes that all patients would
benefit from more compassionate doctors who
have adopted the role of teacher. As a teacher,
doctors would interact with patients and their
families by helping them to understand their
medical care and choices.
Sinai cardiology patients will notice a dif-
ferent attitude and approach with Sinai's car-
diology staff: "We involve patients from the
very beginning as full-time members of the
healthcare team. They're encouraged to ask
questions and will find the staff spending
much more time in their rooms," explains Dr.
Gunther.
"Patients who are actively involved in their
care help us to provide better care and spend
fewer dollars doing it,"he simply states. This
goal includes "efficiently delivered, quality
care with a better outcome and a prompt dis-
charge."
Dr. Gunther, however, does not limit his
teaching to Sinai patients alone. Formerly on
the faculty of Harvard Medical School and cur-
rently a Professor at Wayne State Universi-
ty's School of Medicine, he directs the training
of cardiology fellows at Sinai.
Under his instruction, trainees are learn-
ing about the new order of medical delivery
aimed at improving care while reducing costs.
"We reaffirm the clinical skills of better his-
tory-taking and physical examinations. We
use more judgment and fewer tests along with
a different set of skills, including communi-
cation and partnership-forming skills," Dr.
Gunther explains. "We get the patient involved
in preventive medicine. We are changing the
way patients and physicians think about med-
ical care. I'm teaching health care reform to
both."
In order to accomplish his goals, Dr. Gun-
ther asserts, "an ethic is needed — a culture
— from housekeeper to ambulance driver to
surgeon — for the delivery of the best possi-
ble service with a smile. One of the reasons I
came to Sinai was because of the strong sense
of family; a sense of cooperation that exists at
the hospital. Everyone is focused on the same
set of goals and treats others respectfully."
Through educating patients and physicians,
Dr. Gunther has been able to establish Sinai
as a beacon of excellence in quality care.