Selected Podcast
Cardiac Testing - What You Should Know
This episode will highlight the expertise of the team and technology at Duly's new Cardiac Evaluation Center in Lisle, Illinois. The Center is home to comprehensive heart care diagnostics, including the Midwest's first and only CardioGraphe CT in an outpatient center. This sophisticated cardiovascular CT that captures images of the whole heart by a single beat, in just .24 seconds. In many instances. it is a superior substitute for more invasive hospital-based angiography.
Featured Speaker:
Learn more about Evans Pappas, MD, FACC
Evans Pappas, MD, FACC
Evans Pappas, MD, FACC is Chair, Department of Cardiology at Duly Health and Care.Learn more about Evans Pappas, MD, FACC
Transcription:
Cardiac Testing - What You Should Know
Dr. Paul Merrick: Welcome, everybody, to another episode of Duly Noted, the official podcast of Duly Health and Care. I am Dr. Paul Merrick, the Chief Physician Executive at Duly. And today, I'm delighted to introduce to our listeners, Dr. Evans Pappas, the Chair of our Department of Cardiology. Evans is leading the implementation of a new innovative service line at Duly, the Cardiac Evaluation Center, home to the Midwest only cardiograph CT scanner. Here to tell us more about it is Dr. Evans Pappas. Welcome, Dr. Pappas.
Dr. Evans Pappas: Thank you, Paul. It's a pleasure to join you today.
Dr. Paul Merrick: So, Evans, tell me a little bit about yourself, how you found your way to Duly Health and Care.
Dr. Evans Pappas: Sure. I've been with originally DuPage Medical Group, and now Duly Health and Care for about 14 years now. So I came into practice in cardiology in a single specialty practice, and then came on board with our larger scale multispecialty practice around that. And in that time, I've just seen our practice grow by leaps and bounds. And it's just been very rewarding to see the growth and development, both from a practice footprint standpoint, but also looking at how we embrace technology and bring great care to our community.
Dr. Paul Merrick: Yeah, it's really a growing thriving department. So tell me, where did the idea for this cardiac outpatient imaging center come from?
Dr. Evans Pappas: Sure. You know, over the years as our practice has been, you know, reaching into more and more sophisticated fields of cardiovascular care, you know, there have been a lot of new technologies that have been part of developing a great cardiology service line. And one of them has to do with cardiac CT imaging. And historically, we've been using this to prepare for a lot of our procedures that we do in the hospital and to work with some of our more sophisticated resources. And what we found is we're using them so much that we've been sending so many patients to the hospital setting that it's become a bigger and bigger part of our practice.
But when we send our patients to the hospital setting, the scanners that they use in those environments treat a lot of different conditions. They look at brains and livers and kidneys and everything, as well as the heart. And to do really good heart imaging in these scanners, we need to use some medications and prepare our patients in an appropriate fashion. And we had the idea that we can probably take all of our patients out of the hospital environment and do a better job of preparing them and getting better quality image data by using the scanner of our own. So that's kind of the origin of this imaging center side of things.
Dr. Paul Merrick: Boy, it is really fascinating to see us use new technology in innovative ways in a non-hospital setting. I'm just very encouraged and excited about continuing to move services towards a safe, simple opportunity. So tell me, what's the difference between this and previous cardiac resources like angiography or echocardiogram? Who should be considering using this service?
Dr. Evans Pappas: Yeah. So, you know, historically, the way we've always done things is we've done tests in the outpatient setting to look from the outside of the body to try to figure out what's going on. And that's been using things like a stress test or, like you said, ultrasound test and the echocardiography techniques to look at the heart. What CAT scanning technology does, is it actually lets us directly visualize the heart arteries and look at exactly how they look and you get data about the arteries. So the way we used to do that most commonly was by doing a procedure called an angiogram. And an angiogram is this procedure where we introduce a catheter or a little tiny tube into one of the arteries in the body. And that catheter will pass through those arteries out to the heart and let us take pictures of the heart arteries. But to do that, it's an invasive procedure. It requires somebody coming into the hospital. It requires putting things inside the body, and there are certain risks that go along with that technique.
Now, fortunately, with the evolution of technology and this CAT scanning technology, we can gather very similar data looking directly at the heart arteries and capturing very similar images without putting anything inside the body, without hospitalization, without those same risks. So that's really where this technology is taking us. So it's a really nice step forward. And as these scanners keep getting more and more sophisticated and better, the image quality keeps getting better and better, and we get more and more data with them.
Dr. Paul Merrick: And my understanding, my personal understanding actually, is that it's very simple and very straightforward. So this morning, I started my day with you. I got up. The only significant preparation that I had for the test, which I went through this morning was I had to deprive myself of a cup of coffee. I had to take a little pill, a beta blocker last night and again this morning to sort of slow the heart rate. I didn't really notice anything material from ingesting those two medications really at all. And then I went and saw your delightful staff. I was greeted by Lisa, the nurse, and Linda, who sort of oversees the program. My technician was Susan. You assembled an incredible team. They are honored and privileged to work in this setting and be trailblazers. I think I understand this is only the third such imaging center in the country and the excitement and the enthusiasm over providing the service to our community, it was extraordinary. For me, the test was very, very simple. I came in, I got a little IV. They didn't even need to give me any additional medicine while I was there, because my heart rate was slowed from the oral medication that you had shared. I laid in the CAT scanner for literally, it felt like less than 10 minutes, and done. And then you and I, we walked over into the room next door and you showed me pictures of my heart. It was remarkable. And I can't overemphasize how simple and straightforward it was from being in the patient's journey. So, I found it to be a remarkable experience.
Dr. Evans Pappas: Yeah, it's really kind of neat technology when you think about all the information that we get from that single step. You know, there are just a couple of medications that we use to prepare our patients to get these great images. And I think that's one of the things that really differentiates us on how great of a job we do of preparing those heart rates in anticipation of our tests. That, believe it or not, makes all the difference in the world. These scans are acquired in under a second. It's literally a fraction of a second that lets us get all this information. So slowing down the heart rate lets us gather better information when we do these tests. But it's really easy on our patients. I'm not sure exactly from the time you walked in the door to the time you left, I doubt it was much more than an hour if even that amount, sound about right?
Dr. Paul Merrick: It was less than that, I think.
Dr. Evans Pappas: Yeah, it's pretty quick. And that was with some socializing along the way on our behalf and things like that. And if I'm not mistaken, we got you some coffee pretty quick too, to make it all work out okay in the end for you. So, you know, it's a nice, easy and nice environment. The staff like you said, we're very, very fortunate. They're just excited to be delivering this, you know, first of a kind technology. We are the first ones in the midwest to have this type of resource with us. And it's just they're really enthusiastic about delivering a great patient experience.
Dr. Paul Merrick: In addition to the simplicity of the actual test, at the end of the looking at the pictures, you gave me a result and you said I was a zero, which I think is good in this situation. Having zero calcium in your coronaries is the report you're hoping for, correct?
Dr. Evans Pappas: That is what you're hoping for. So yeah, it's just really great. These scans, if somebody has a scan that shows no calcium, no blockage, the prognostic data, the information that shows what their future is like from a heart health standpoint is just fantastic. The likelihood of a negative cardiac event, meaning things like a heart attack or fatality from a heart event is just remarkably low for a decade after a negative scan like this. So it was just really wonderful information to have for our patients and provides great reassurance for that concerned population that's worried about their heart health.
Dr. Paul Merrick: Yeah, the data you shared with me, I think you said 0.04% chance in the next 10 years of a very significant cardiac event, that's remarkable. But it's not a license for me to go out and have a bad, unhealthy lifestyle. I still have to watch my cholesterol and my blood pressure and do all those important simple things to make sure that my heart and the rest of my vascular organs are prepared for the decades to come.
Dr. Evans Pappas: Absolutely. That's always part of good healthy habits. And, you know, with these scanners, fortunately, there's a lot of people that have really good data that come through where everything is negative. But the beautiful thing about these types of scanners is they can tell if there's a really bad problem that requires us to start working on things in different ways to protect our patients, like talking about angiograms and angioplasties and procedures to help open up arteries, if there's bad enough of a problem.
But even more importantly, one of the great things behind these types of scanners is they help identify those patients that have some disease starting to form and lets us have a warning at an early point in their life to protect them for years and years to come. So we can start treating them with the right medications, to treat their cholesterol, to treat their blood pressure, to treat, you know, the things that lead to more blockage and protect them so that they don't have a problem down the road and it can really offset a lot of potential problems in the future.
Dr. Paul Merrick: So, final comment, and then I'll ask you one final question, Evans. So my comment, in addition to me getting wonderful news that my heart's in a nice shape. You had shared a story that you and the team last week saved a life. A person came in with some chest pain and some findings were discovered and intervention was deployed that were life-saving. So that's remarkable. And so remind clinicians, physicians and also patients who should consider being evaluated with this new resource and technologies. For our physician partners, who's an ideal candidate for referral? For the broader community, who might consider coming in and get screened?
Dr. Evans Pappas: Yeah. So it's pretty much one of the same for both populations. So in patients that have concerns about symptoms of chest pain or unusual shortness of breath that could be cardiac in origin. This is one of the tools that we can utilize now to evaluate for that. So our patients that are concerned about those things, they can come to us and we can talk about this type of testing versus other types of things that will help give answers along those lines and see as to whether there's a cardiac cause of those symptoms. Likewise, the same thing goes to our physician partners. You know, this is another tool to be utilized in addition to things like stress testing. You know, it's another mechanism of seeing how the heart and the heart arteries behave. And, you know, just to point out, the scan is part of this imaging center that we have here, but we've taken that imaging capabilities a step farther. Not only are we using this for imaging, our patients and all our outpatients for the entire practice, but we've linked this device to a center, what we're calling our Cardiac Evaluation Center, where we're having patients within Duly Health and Care referred into this environment for acute evaluation of those types of symptoms.
So, you know, if somebody is really thinking they're truly having a heart attack, well, they need to go to the emergency department where we can treat people that way. But sometimes people have concerns about some unusual symptoms where they really deep down don't think a heart attack is happening, but they're concerned enough that they would normally, you know, be headed to the doctor's office or the emergency department. In that type of population, we can bring them here to this center, have one of our board certified cardiologists evaluate them, do blood testing, EKGs, you know, place them on a monitor to check their heart rhythms, but also send them for one of these scans if appropriate or do a stress test or do an ultrasound test all in this center. So we're piggybacking that technology with an acute care model for patients that have lower intermediate risk for heart disease. So it's a really exciting format to take care of our population.
Dr. Paul Merrick: Evans, I can't thank you enough for joining me on our podcast and, importantly, taking care of me as well. I'm grateful for your clinical excellence, your leadership. I'm grateful for the entire team. They did a remarkable job. And I would encourage both clinicians and our community to stop by, visit the center, speak to the people, learn about this phenomenal new program. I think you share that up to 85% of people who show up in emergency room for evaluation of chest pain are discharged that same day. This would create a much more safe, efficient opportunity to be evaluated for those less acute individuals.
So evans, I can't thank you enough for your friendship, your leadership, your dedication to our community, and in our cardiac care. Honored and privileged to work with you. Have a wonderful day and thank you for all the good work you do. Look forward to the next podcast Thank you for listening. Thank you, Dr. Pappas, for being with us to share the exciting new information about the Cardiac Evaluation Center. If you're interested in learning more, you can go to dulyhealthandcare.com or call Duly Health and Care or visit the site at 430 Warrenville Road. We look forward to talking to you next time at Duly Health and Care.
Cardiac Testing - What You Should Know
Dr. Paul Merrick: Welcome, everybody, to another episode of Duly Noted, the official podcast of Duly Health and Care. I am Dr. Paul Merrick, the Chief Physician Executive at Duly. And today, I'm delighted to introduce to our listeners, Dr. Evans Pappas, the Chair of our Department of Cardiology. Evans is leading the implementation of a new innovative service line at Duly, the Cardiac Evaluation Center, home to the Midwest only cardiograph CT scanner. Here to tell us more about it is Dr. Evans Pappas. Welcome, Dr. Pappas.
Dr. Evans Pappas: Thank you, Paul. It's a pleasure to join you today.
Dr. Paul Merrick: So, Evans, tell me a little bit about yourself, how you found your way to Duly Health and Care.
Dr. Evans Pappas: Sure. I've been with originally DuPage Medical Group, and now Duly Health and Care for about 14 years now. So I came into practice in cardiology in a single specialty practice, and then came on board with our larger scale multispecialty practice around that. And in that time, I've just seen our practice grow by leaps and bounds. And it's just been very rewarding to see the growth and development, both from a practice footprint standpoint, but also looking at how we embrace technology and bring great care to our community.
Dr. Paul Merrick: Yeah, it's really a growing thriving department. So tell me, where did the idea for this cardiac outpatient imaging center come from?
Dr. Evans Pappas: Sure. You know, over the years as our practice has been, you know, reaching into more and more sophisticated fields of cardiovascular care, you know, there have been a lot of new technologies that have been part of developing a great cardiology service line. And one of them has to do with cardiac CT imaging. And historically, we've been using this to prepare for a lot of our procedures that we do in the hospital and to work with some of our more sophisticated resources. And what we found is we're using them so much that we've been sending so many patients to the hospital setting that it's become a bigger and bigger part of our practice.
But when we send our patients to the hospital setting, the scanners that they use in those environments treat a lot of different conditions. They look at brains and livers and kidneys and everything, as well as the heart. And to do really good heart imaging in these scanners, we need to use some medications and prepare our patients in an appropriate fashion. And we had the idea that we can probably take all of our patients out of the hospital environment and do a better job of preparing them and getting better quality image data by using the scanner of our own. So that's kind of the origin of this imaging center side of things.
Dr. Paul Merrick: Boy, it is really fascinating to see us use new technology in innovative ways in a non-hospital setting. I'm just very encouraged and excited about continuing to move services towards a safe, simple opportunity. So tell me, what's the difference between this and previous cardiac resources like angiography or echocardiogram? Who should be considering using this service?
Dr. Evans Pappas: Yeah. So, you know, historically, the way we've always done things is we've done tests in the outpatient setting to look from the outside of the body to try to figure out what's going on. And that's been using things like a stress test or, like you said, ultrasound test and the echocardiography techniques to look at the heart. What CAT scanning technology does, is it actually lets us directly visualize the heart arteries and look at exactly how they look and you get data about the arteries. So the way we used to do that most commonly was by doing a procedure called an angiogram. And an angiogram is this procedure where we introduce a catheter or a little tiny tube into one of the arteries in the body. And that catheter will pass through those arteries out to the heart and let us take pictures of the heart arteries. But to do that, it's an invasive procedure. It requires somebody coming into the hospital. It requires putting things inside the body, and there are certain risks that go along with that technique.
Now, fortunately, with the evolution of technology and this CAT scanning technology, we can gather very similar data looking directly at the heart arteries and capturing very similar images without putting anything inside the body, without hospitalization, without those same risks. So that's really where this technology is taking us. So it's a really nice step forward. And as these scanners keep getting more and more sophisticated and better, the image quality keeps getting better and better, and we get more and more data with them.
Dr. Paul Merrick: And my understanding, my personal understanding actually, is that it's very simple and very straightforward. So this morning, I started my day with you. I got up. The only significant preparation that I had for the test, which I went through this morning was I had to deprive myself of a cup of coffee. I had to take a little pill, a beta blocker last night and again this morning to sort of slow the heart rate. I didn't really notice anything material from ingesting those two medications really at all. And then I went and saw your delightful staff. I was greeted by Lisa, the nurse, and Linda, who sort of oversees the program. My technician was Susan. You assembled an incredible team. They are honored and privileged to work in this setting and be trailblazers. I think I understand this is only the third such imaging center in the country and the excitement and the enthusiasm over providing the service to our community, it was extraordinary. For me, the test was very, very simple. I came in, I got a little IV. They didn't even need to give me any additional medicine while I was there, because my heart rate was slowed from the oral medication that you had shared. I laid in the CAT scanner for literally, it felt like less than 10 minutes, and done. And then you and I, we walked over into the room next door and you showed me pictures of my heart. It was remarkable. And I can't overemphasize how simple and straightforward it was from being in the patient's journey. So, I found it to be a remarkable experience.
Dr. Evans Pappas: Yeah, it's really kind of neat technology when you think about all the information that we get from that single step. You know, there are just a couple of medications that we use to prepare our patients to get these great images. And I think that's one of the things that really differentiates us on how great of a job we do of preparing those heart rates in anticipation of our tests. That, believe it or not, makes all the difference in the world. These scans are acquired in under a second. It's literally a fraction of a second that lets us get all this information. So slowing down the heart rate lets us gather better information when we do these tests. But it's really easy on our patients. I'm not sure exactly from the time you walked in the door to the time you left, I doubt it was much more than an hour if even that amount, sound about right?
Dr. Paul Merrick: It was less than that, I think.
Dr. Evans Pappas: Yeah, it's pretty quick. And that was with some socializing along the way on our behalf and things like that. And if I'm not mistaken, we got you some coffee pretty quick too, to make it all work out okay in the end for you. So, you know, it's a nice, easy and nice environment. The staff like you said, we're very, very fortunate. They're just excited to be delivering this, you know, first of a kind technology. We are the first ones in the midwest to have this type of resource with us. And it's just they're really enthusiastic about delivering a great patient experience.
Dr. Paul Merrick: In addition to the simplicity of the actual test, at the end of the looking at the pictures, you gave me a result and you said I was a zero, which I think is good in this situation. Having zero calcium in your coronaries is the report you're hoping for, correct?
Dr. Evans Pappas: That is what you're hoping for. So yeah, it's just really great. These scans, if somebody has a scan that shows no calcium, no blockage, the prognostic data, the information that shows what their future is like from a heart health standpoint is just fantastic. The likelihood of a negative cardiac event, meaning things like a heart attack or fatality from a heart event is just remarkably low for a decade after a negative scan like this. So it was just really wonderful information to have for our patients and provides great reassurance for that concerned population that's worried about their heart health.
Dr. Paul Merrick: Yeah, the data you shared with me, I think you said 0.04% chance in the next 10 years of a very significant cardiac event, that's remarkable. But it's not a license for me to go out and have a bad, unhealthy lifestyle. I still have to watch my cholesterol and my blood pressure and do all those important simple things to make sure that my heart and the rest of my vascular organs are prepared for the decades to come.
Dr. Evans Pappas: Absolutely. That's always part of good healthy habits. And, you know, with these scanners, fortunately, there's a lot of people that have really good data that come through where everything is negative. But the beautiful thing about these types of scanners is they can tell if there's a really bad problem that requires us to start working on things in different ways to protect our patients, like talking about angiograms and angioplasties and procedures to help open up arteries, if there's bad enough of a problem.
But even more importantly, one of the great things behind these types of scanners is they help identify those patients that have some disease starting to form and lets us have a warning at an early point in their life to protect them for years and years to come. So we can start treating them with the right medications, to treat their cholesterol, to treat their blood pressure, to treat, you know, the things that lead to more blockage and protect them so that they don't have a problem down the road and it can really offset a lot of potential problems in the future.
Dr. Paul Merrick: So, final comment, and then I'll ask you one final question, Evans. So my comment, in addition to me getting wonderful news that my heart's in a nice shape. You had shared a story that you and the team last week saved a life. A person came in with some chest pain and some findings were discovered and intervention was deployed that were life-saving. So that's remarkable. And so remind clinicians, physicians and also patients who should consider being evaluated with this new resource and technologies. For our physician partners, who's an ideal candidate for referral? For the broader community, who might consider coming in and get screened?
Dr. Evans Pappas: Yeah. So it's pretty much one of the same for both populations. So in patients that have concerns about symptoms of chest pain or unusual shortness of breath that could be cardiac in origin. This is one of the tools that we can utilize now to evaluate for that. So our patients that are concerned about those things, they can come to us and we can talk about this type of testing versus other types of things that will help give answers along those lines and see as to whether there's a cardiac cause of those symptoms. Likewise, the same thing goes to our physician partners. You know, this is another tool to be utilized in addition to things like stress testing. You know, it's another mechanism of seeing how the heart and the heart arteries behave. And, you know, just to point out, the scan is part of this imaging center that we have here, but we've taken that imaging capabilities a step farther. Not only are we using this for imaging, our patients and all our outpatients for the entire practice, but we've linked this device to a center, what we're calling our Cardiac Evaluation Center, where we're having patients within Duly Health and Care referred into this environment for acute evaluation of those types of symptoms.
So, you know, if somebody is really thinking they're truly having a heart attack, well, they need to go to the emergency department where we can treat people that way. But sometimes people have concerns about some unusual symptoms where they really deep down don't think a heart attack is happening, but they're concerned enough that they would normally, you know, be headed to the doctor's office or the emergency department. In that type of population, we can bring them here to this center, have one of our board certified cardiologists evaluate them, do blood testing, EKGs, you know, place them on a monitor to check their heart rhythms, but also send them for one of these scans if appropriate or do a stress test or do an ultrasound test all in this center. So we're piggybacking that technology with an acute care model for patients that have lower intermediate risk for heart disease. So it's a really exciting format to take care of our population.
Dr. Paul Merrick: Evans, I can't thank you enough for joining me on our podcast and, importantly, taking care of me as well. I'm grateful for your clinical excellence, your leadership. I'm grateful for the entire team. They did a remarkable job. And I would encourage both clinicians and our community to stop by, visit the center, speak to the people, learn about this phenomenal new program. I think you share that up to 85% of people who show up in emergency room for evaluation of chest pain are discharged that same day. This would create a much more safe, efficient opportunity to be evaluated for those less acute individuals.
So evans, I can't thank you enough for your friendship, your leadership, your dedication to our community, and in our cardiac care. Honored and privileged to work with you. Have a wonderful day and thank you for all the good work you do. Look forward to the next podcast Thank you for listening. Thank you, Dr. Pappas, for being with us to share the exciting new information about the Cardiac Evaluation Center. If you're interested in learning more, you can go to dulyhealthandcare.com or call Duly Health and Care or visit the site at 430 Warrenville Road. We look forward to talking to you next time at Duly Health and Care.