Last year while on vacation, RG Carver was using a trimmer to cut weeds in his garden when he walked into a cactus and got a few needles stuck in his leg. After a few days, her legs were swelling.
He traveled from his home in Double Horn near Spicewood to Baylor Scott & White Hospital in Marble Falls.
There, they found that his pulse was quickening. He had an ECG done on his heart for the first time. It wasn’t the cactus that made the leg swell at all. It was his heart.
Carver spent five days in the hospital to remove the fluid from his heart and the rest of his body.
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Last January, he underwent surgery to get his heart back on track. And he took medication to regulate his heart, but he needed regular monitoring, which meant a trip every few days to Marble Falls to check in with his cardiologist, Dr Justin Coyle.
Then Coyle recommended Carver get CardioMEMS. The device from Abbott, part of its cardiac devices business based in Austin, measures pressure in the pulmonary artery in people with chronic heart failure. It is the size of a paper clip and is inserted through a catheter from the femoral leg vein to the pulmonary artery.
The procedure takes about 45 minutes. Patients cannot feel the MEMS in their body. Typically, they may just have pain in the groin where the catheter went in for a few days.
Until February, CardioMEMS was only approved for people with chronic heart failure who have been hospitalized for it and have symptoms such as shortness of breath when moving but not when sitting. These patients have class III chronic heart failure.
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After a study of 1,000 people who did not meet these criteria, had never been hospitalized, did not have such severe symptoms, or had more severe symptoms, the U.S. Food and Drug Administration extended the use of CardioMEMS to less serious patients. , Class II and people who have high levels of natriuretic peptides, indicating that their heart disease is getting worse.
MEMS stands for micro electromechanical system. Once the device is inserted, that person rests once a day on a mat that picks up radio signals from an antenna in the CardioMEMS. Using a hand-held device, the person then sends the pressure readings to the doctor.
The patient just has to make sure that there is no interference between the MEMS and the transmitter. Sometimes the beds with a lot of metal or the WIFI router can cause interference. A patient only has to find another location.
These daily pressure readings allow the person’s cardiologist to determine if medication needs to be adjusted before the person becomes sick enough to experience an increase in symptoms and require hospitalization. Fluid buildup that causes symptoms can take weeks to develop.
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In patients Coyle fitted CardioMEMS, he was able to see trends in their pressure levels and adjust medications. If there is a concerning reading, Coyle or a nurse will ask about symptoms and blood pressure to determine what is causing the change in pressure.
“The people I’m trying to target are the ones that are very symptomatic; they have a lot of fluctuation in their fluid status, they’re constantly walking the fine line of needing high doses or constantly needing a change of doses,” Coyle said. “It takes the guesswork out. There’s more continuous feedback. We have a better sense of where the volume (fluid) is.”
It won’t work for people who aren’t compatible with their care, Coyle said. If they don’t take their medications regularly, if they miss doctor’s appointments, CardioMEMS is not for them.
“It takes a very motivated person,” Coyle said. “It has to be part of their daily routine. I step on the scale and check my weight. I check my blood pressure. I do my CardioMEMS.”
Now every morning, Carver lies on the mat, which he describes as a pillow with a hard frame and a cushion on it. He presses the button and remains motionless on the mat for 10 seconds. Then he leaves it plugged in while he sends his reading to Coyle’s office in Marble Falls. He prepares his breakfast then unplugs it.
“If there’s a problem, someone will call me,” he said.
Most of the time no one calls him, but when he drove to Colorado and brought the rug with him, he got a call. The high altitude had affected his heart and the pressure in his pulmonary artery.
“They read them every morning,” he said. “I am impressed.”
If the readings change, Coyle can adjust Carver’s medication before it becomes a situation where Carver would need to be hospitalized.
Now that Carver is well regulated by medication, he realizes how sick he was before. The former coach and baseball player said he felt tired and irritable.
“I felt exhausted and felt like something was wrong,” he said. “When I started exercising, I noticed I couldn’t breathe. The more I exercised, the worse it got. I couldn’t put my finger on it.”
He now knows his heart wasn’t keeping up with all the fluids and he had to work overtime to keep up.
Now Carver is able to walk two miles every morning. He mows his own lawn, he stains his patio.
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