Friday, January 16, 2009

An unusual place for an aneurysm

Steve Leonard is treated by Dr. Nandita Scott at the Heart Center.

Many people experience excruciating pain just at the thought of a root canal, but Steve Leonard is different. A tough guy, Leonard and his whole family have a high threshold for pain.

So something was very wrong when Leonard complained of intense jaw pain during a root canal. Concerned, his dentist, Dr. Robert Gauthier, recommended a routine stress test to rule out heart disease. Although widely unknown, for many people jaw pain is a common symptom of heart disease.

Discovering an Aneurysm

In the following days the pain worsened for Leonard. His wife grew increasingly worried, and the couple decided to go through with a stress test. But the test itself proved to be very difficult. A pulled hamstring and an underlying heart condition made it impossible for Leonard to finish.

"Between having the injury and answering questions while on the treadmill, I was getting short of breath, and my blood pressure went up so high that they stopped the test," says Leonard.

Clinical staff turned to a stress test to evaluate Leonard's condition. This test was abnormal, and he was scheduled for a cardiac catheterization. The results demonstrated an aneurysm of his left main coronary artery, which is an unusual finding.

A typical aneurysm occurs when there is a breakdown in the structural proteins that make up the wall of the aorta. For Leonard, there was a breakdown in the wall of the left main coronary artery. This could have been caused by a number of factors, most notably a buildup of plaque.

"No one had seen it before," says Leonard, "and I wasn’t getting conclusive answers as far as what it is and what I should do."

Managing a Rare Condition

This nine millimeter aneurysm is now managed by Nandita Scott, MD, cardiologist at the Massachusetts General Hospital Heart Center. The most significant risk associated with an aneurysm is rupture (bursting) and clot formation. But Leonard’s aneurysm is located in his coronary artery, allowing normal blood flow to reach his heart. Ironically enough, his risk of rupture is actually quite low.

"With some conditions in medicine, there are no guidelines for management, especially for rare findings," explains Dr. Scott. "In a place like this [Mass General], we see rare and unique conditions and can figure out how to treat them."

Dr. Scott first scheduled a CAT scan to understand the scope of the aneurysm. When she determined its size and unusual location, she brought together a team of physicians to discuss the appropriate line of treatment.

"We have the ability to pick at the brains of the senior cardiologists, and it's so easy because their offices are right next door," says Dr. Scott.

Leonard's current treatment plan involves a mix of risk reduction strategies and medications. Dr. Scott will only revisit the idea of surgery if the aneurysm enlarges or changes at all. Right now surgery is not necessary, but he does need careful management. This means taking the appropriate steps to manage risk factors.

"I think the biggest measurement right now is my weight," laughs Leonard.

He plans to attend cardiac rehabilitation to reduce his blood pressure, cholesterol levels and weight. Luckily Leonard is ahead of the game - he already quit smoking and carefully manages his nutrition. In fact, he jokes that he had an easy time quitting smoking. Before he could date his wife, she made sure he had quit.

"She stays on top of my health...the reason I’m here today, no doubt," says Leonard.

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