Implantable Device Provides Early Heart Attack Warning


Kristi L. Nelson | | Thursday, February 28, 2008

There were two minutes left in the Super Bowl. The Patriots had just scored a touchdown when Donald Beltz, a Giants fan, noticed his AngelMed Guardian device was telling him to call 911 and get himself to a hospital emergency room: He was having a heart attack.

Beltz, 65, didn't feel any heart attack symptoms. Then again, he'd had at least two heart attacks already, including one in 1999 so serious that the paddles had to be used twice to restart his heart.

In fact, that was why he had the Guardian in the first place. Beltz is participating in a national clinical trial to test the implantable device, which is particularly intended for folks who already have coronary artery disease but might not have traditional heart attack symptoms, such as chest pain and shortness of breath.

So it never occurred to Beltz to watch those last two minutes of the game. His wife, Kris, called the paramedics, who took him to Baptist Hospital of East Tennessee, where cardiologist Dr. Malcolm Foster of East Tennessee Heart Consultants, principal investigator for the trial, practices.

In the emergency room, an initial blood test didn't show the presence of enzymes that would indicate Beltz had had a heart attack, but a follow-up test eight hours later showed he'd had a mild attack. In fact, the main artery in Beltz's heart had two 90 percent blockages, so Foster put in a stent to open up the artery.

"The 'big one' (heart attack) was right around the corner," Beltz said. "The only symptom I would have had was that I would have been dead."

"We treated his (second, more serious) heart attack before it happened," said Foster, who said most of the time heart attack patients are in a crisis situation, and treating them is an emergency, with the main goal being to save their lives. "Treating the same blocked artery before the heart attack happened is an entirely new experience - and it was fantastic."

Late last year, Foster's practice became one of three facilities nationwide to participate in the now-closed "feasibility" trial, which involves 20 patients across the country. Ultimately, in the next phase of testing, 100 patients at multiple centers will be implanted with the Guardian system.

Patients have a pacemaker-size device surgically implanted under the skin. A lead attached to the heart wall using a very tiny screw registers the heart's electrical signal, and the device monitors that signal for anything unusual. The patient carries a pager-size portable external alarm device, which - using yellow or red flashing lights - can tell the patient either to see a doctor in the next day or two or to call 911 and go to the hospital immediately. If the device detects an abnormality, it begins vibrating under the skin, and it sends a signal to the external device, which begins beeping.

"We didn't necessarily think ... we'd have anybody in this brief period of time get alerted to a heart attack," Foster said. Beltz was the first.

Beltz was implanted with the device Jan. 3; he had called East Tennessee Heart Consultants after seeing a news segment on the trial. Kris, his wife of nearly 28 years, initially was opposed "to what I felt was totally unnecessary surgery" for her husband, given his shaky health history.

"I am so thankful that I was so wrong," Kris Beltz said. "This device is a miracle."

But it's not for everyone, Foster said. For example, the surgery involved would make the device inappropriate for someone who's at low risk for heart attack anyway.

Patients who really could benefit are those who might not recognize they're having a heart attack, either because they have mild or no symptoms or because other chronic conditions would prevent them from differentiating heart attack symptoms from the way they regularly feel.

"There are people who have heart attacks and don't even realize it," Foster said. "They attribute the symptoms to indigestion or feeling profoundly tired."

Beltz one night had a heart attack but simply took five nitroglycerin pills and "wouldn't wake anybody up, because my mother had to work the next day," said daughter Kimberly Fulmer, who lives next door to her parents. "We all wanted to kill him then!"

"I'm the type of person that I don't like to alarm people, so I'll ignore things that I probably shouldn't," Beltz admitted.

But he said he knows now not to ignore the vibration and flashing lights on his Guardian device.

Foster thinks the device will become an approved product and eventually may be added to pacemakers and implantable defibrillators.

"I think sometime in the future that this is going to change the way we treat high-risk patients," he said.

Maryville resident Donald Beltz shows the portable external alarm device that's part of the AngelMed Guardian device. Another component of the device is implanted in his chest. The device will alarm if it detects Beltz is having a heart attack - even if Beltz can feel no symptoms.

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Related Topics: Cardiac and Circulation

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