Cardiology at Shaare Zedek: 'A conceptual breakthrough'

Having all of cardiac services under one team creates a unified approach, and leads to better treatment.

By ALAN ROSENBAUM
INNOVATIVE APPROACHES to cardiac medicine define care at the Jesselson Integrated Heart Center at Shaare Zedek (photo credit: SHAARE TSEDEK)
INNOVATIVE APPROACHES to cardiac medicine define care at the Jesselson Integrated Heart Center at Shaare Zedek
(photo credit: SHAARE TSEDEK)
Israel’s largest cardiology department is located at Jerusalem’s Shaare Zedek Medical Center, but as Prof. Michael Glikson, director of the hospital’s Jesselson Integrated Heart Center explains, what makes it effective is not just its size – it’s the integration of its resources.
“Two years ago, when I came to Shaare Zedek, we decided to create one major heart center,” he explains, “including cardiology, cardiac surgery and cardiac rehabilitation, all with common management. This creates wonderful collaboration and transfer of information, because the patient is being treated by both teams at the same time.”
At many other hospitals, he explains, different cardiac-related services can be totally separate entities and may be located at different ends of the hospital. Having all of the cardiac services under one team creates a unified approach and ultimately leads to better treatment. Glikson terms Shaare Zedek’s integrated philosophy “a conceptual breakthrough” that is becoming prevalent in many places in the world.
Shaare Zedek’s size is also effective in ensuring first-rate treatment for cardiac disease. The hospital’s cardiology hospitalization facilities – with 60 beds, including the Intensive Care Unit, holding area and general cardiology department – has more beds than any other hospital in Israel.
Glikson says that the large number of spaces ensures that most patients entering the hospital via the emergency department with a severe cardiac condition will be admitted to the department of cardiology.
“In other hospitals, cardiac patients may be admitted to the internal medicine department. At Shaare Zedek, almost all cardiac patients that are admitted are sent to the cardiology department.”
This, he says, was due to the vision of those who built the hospital, who decided to build a large cardiology department, relative to the hospital’s overall size.
Shaare Zedek’s Integrated Heart Center focuses both on prevention and treatment of cardiac ailments.
“Genetics is very important,” he says. “There are healthy families without any heart disease, and there are young people who lead healthy lives, that have heart disease.”
He explains that there are modifiable as well as unmodifiable factors relating to heart disease. “If one is born into a family that has a genetic tendency for heart disease or atherosclerosis, there is nothing that you can modify. But almost all other factors are modifiable.”
Quitting smoking, treating hypertension, treating high lipid levels, exercise, and eating healthfully are all factors that can be modified, he adds.
Shaare Zedek has recently expanded its focus on preventative care with an all-new Cardiac Rehabilitation and Prevention Institute, which opened in the adjacent Yad Sarah building.
“We have two tracks in the Cardiac Rehabilitation Center,” says Glikson. “One is for patients with heart disease who have had a heart attack and come for rehabilitation. The other track is for people who are healthy but have risk factors. They receive treatment and engage in physical activity to prevent development of heart disease.”
Risk factors can range from obesity and high blood pressure to individuals who have an unhealthful diet or have a blood lipid disorder. Shaare Zedek also presents lectures and other educational activities for the community at large, to encourage a healthy lifestyle that can prevent heart disease.
While he agrees that prevention is important, the daily practice of cardiology at Shaare Zedek is focused on treatment of existing cardiac conditions.
A number of new developments in the cardiology department are dedicated to improving treatment, such as the new echocardiography laboratory.
Echocardiography is a test that uses sound waves to produce live images of the heart and allows doctors to evaluate functioning of the heart and its valves. Images from echocardiography can be used to diagnose blood clots, fluid around the heart, and issues with the aorta, the main artery that is connected to the heart.
“Our echocardiography lab is extremely active, and uses top-level, high-end echocardiography equipment that is operated by very skilled personnel,” says Glikson. The cardiac intensive care unit has also grown and now has room for nine patients. “The department has become much more active, and there is a huge flow of patients in and out.”
THE INTEGRATED Heart Center is deeply involved in diagnostic activities to better understand the workings of the heart. Two of these areas are cardiac electrophysiology and cardiac imaging.
Cardiac electrophysiology diagnoses and treats the electrical activities of the heart. Glikson, an accomplished electrophysiologist, explains that Shaare Zedek’s electrophysiology department has acquired new equipment for mapping heart arrhythmia, which allows for precise catheter ablation to target areas within the heart. Catheter ablation is a procedure in which doctors advance a flexible thin tube (catheter) through the blood vessels to the heart to stop abnormal electrical pathways within the heart tissue.
“We recently purchased new software that combines heart imaging with electrical mapping to improve results of ablation procedures, says Glikson.” Mapping, he explains, is the most important part of electrophysiology, in order to find the sources of arrhythmia and heart rhythm problems.
Another highly technical area of cardiac expertise within Shaare Zedek is removal and replacement of infected pacemaker leads. Over time, many heart pacemakers become infected or break.
“It is a difficult procedure that needs special equipment,” he says. “I myself remove the pacemaker leads.”
Cardiac imaging is noninvasive imaging of the heart using ultrasound, magnetic resonance imaging, computed tomography, or nuclear medicine imaging.
Shaare Zedek’s cardiac imaging department is regarded as one of the top centers in this country.
“People from around the country are referred for imaging in our center,” says Glikson. He adds that imaging is a growing and expanding area in cardiology, and Shaare Zedek will be adapting to meet these needs.
SHAARE ZEDEK’S cardiology department has made great strides in treating patients who have experienced heart failure.
“About one year ago, we opened a program to implant artificial hearts,” says Glikson. “We now have five patients with artificial hearts who are walking, and living almost normal lives, after having been implanted with artificial hearts at Shaare Zedek. So far, this program has been working very well.”
The artificial hearts are implanted in the chest or abdomen, with a cable that connects to an external power supply that the patient carries in a small bag.
“When the heart can no longer function, this is the modern, up-to-date solution that is becoming more and more useful,” says Glikson.
He says that Shaare Zedek plans on expanding its artificial heart program and hopes to one day establish an outpatient day-care center for heart failure patients, where patients would come in once or twice a week for treatment, without having to be admitted.
Looking to the future, Shaare Zedek is attempting to find more solutions to structural heart issues with interventional cardiology, the subspecialty that deals specifically with the catheter-based treatment of heart diseases. The field includes the diagnosis and treatment of coronary artery disease, vascular disease and acquired structural heart disease.
“Traditional interventional cardiology used to deal with coronary arteries,” he explains. “Today, the interest has shifted toward treatment of valves – the aortic valves, the mitral valves – which used to be treated by surgeons, but are now treated by interventional cardiologists.”
Shaare Zedek’s interventional cardiology department has also been developing new devices.
“Our interventional cardiology department has been very innovative and aggressive in developing new technologies,” Glikson reports, mentioning a device under development that will provide a constant measure of pressure within the heart.
The Integrated Heart Center plans to continue its innovative path in prevention and treatment of heart disease, using the latest technologies and integrated treatments in a setting designed to provide the very best for its patients.
This article was written in cooperation with Shaare Zedek Medical Center.