NCMA Healthy Insights – NCMA Newsletter 2014

Dr. Patrick Coleman Plays Pivotal Role in Northern California Heart Healthcare

For over 20 years, NCMA cardiologist Patrick S. Coleman, MD, FACC, has tirelessly dedicated himself to improving the survival rate of cardiac arrest in Sonoma, Mendocino, and Lake Counties.

Dr. Coleman’s work has the additional benefit of reducing morbidity rates, meaning that
heart attack survivors are increasingly likely to maintain heart health and quality of life after major cardiac events. Dr. Coleman’s steadfast efforts include directing the Coastal Valleys STEMI Program, a two-countywide initiative to establish protocols between hospitals, EMS, and doctors to expedite cardiac response processes. He also serves as the local Medical Director for the Public Access Defibrillation (PAD) Program, and participates in cutting-edge research with organizations like Stanford, UC Davis, and Medtronic to develop new methods for saving the lives of heart attack victims and maintaining the health of patients living with heart problems.

In the event of a heart attack, even the smallest increment of time can drastically change a patient’s prognosis. One common and severe type of heart attack, known as an ST segment elevation myocardial infarction (STEMI), requires rapid intervention for the victim to have the best chance of survival. In a STEMI, the coronary artery is completely occluded by a blood clot. The clogged artery can no longer supply blood and oxygen to the heart muscle, and virtually all the heart muscle reliant on the affected artery starts to die.

To maximize chances of surviving, and with minimal heart muscle damage, patients need to get to a catheterization lab equipped with the necessary personnel and medical technology to remove the obstruction from the artery. These specially equipped hospitals are referred to as STEMI receiving centers. The STEMI receiving centers in Santa Rosa are Santa Rosa Memorial Hospital (SRMH) and Sutter Medical Center of Santa Rosa. Thanks to Dr. Coleman and the Coastal Valleys STEMI program, patients with heart attack symptoms such as chest pain are given EKG tests at the scene or in the ambulance on the way to the hospital. If the test shows that the heart attack is a STEMI, then the patient is taken directly to SRMH or Sutter where a cardiologist and staff prepare the cath lab, saving invaluable travel time.

“The amount of progress we have made with the STEMI program over the last 15 years is
remarkable,” Dr. Coleman says. He continues, “Everyone involved in the chain of events for treating a STEMI patient plays a vital role, and in the STEMI program we emphasize
how saving just two minutes in one part of treatment might save 20 minutes down the road. Unfortunately, it is impossible to diagnose every STEMI before patients arrive at the hospital since symptoms are not always definitive, and patients don’t always arrive at the hospital in an ambulance. The next step is to perfect the transition of these patients from a hospital to the nearest STEMI receiving center. Our current goal is 30 minutes or less at the sending hospital, and we get faster every day.”

In collaboration with Stanford and UC Davis, Dr. Coleman has also helped bring the one of the latest treatments for aortic valve stenosis to patients in Northern California. As we age, our aortic valves narrow, making it more difficult for blood to flow from the heart, resulting in aortic valve stenosis. Until recently, the only way to treat aortic stenosis was to replace the old valve through open-heart surgery. Transcatheter aortic valve replacement (TAVR), developed by local companies such as Medtronic and Direct Flow Medical, is a recently FDA-approved procedure that enables cardiologists to replace the aortic valve with a bioprosthetic substitute using a catheter, eliminating the need to open the chest cavity altogether.

Dr. Coleman explains, “TAVR offers a far less invasive approach than open-heart surgery, as we only need to make a small incision to enter the catheter into an artery. The replacement valve is contained at the end of the catheter, and is deployed once the catheter situates the valve in the aortic position. Soon after the procedure, patients experience the multitude of health benefits that come with increased blood flow,
and since the procedure is minimally invasive they also recover very quickly.” This procedure is currently only available to patients whom doctors have determined to be ineligible or at very high risk for open-heart surgery, but the procedure shows promise of becoming available to a wider demographic in the future.

Another challenge to today’s cardiologists is treating patients with congenital heart defects. Thanks to recent advancements in medical technology and specialty training, these patients can overcome the dangerous health issues that arise due to their congenital heart defects, but only with careful monitoring and regular visits to cardiologists with very specific advanced training. In fact, there are more people living each year with cardiac birth defects than are born each year with them. NCMA and Dr. Coleman work in collaboration with Dr. George Lui, the Medical Director of the Adult Congenital Heart Program at Stanford who holds a clinic for NCMA patients living with congenital heart defects in Sonoma County.

“The key to treating patients with congenital heart defects is communication,” Dr. Coleman says. “For decades now, we have had the technology to diagnose heart defects for patients in utero, so these patients have often had regular visits to cardiology specialists from birth. The continuity of care is essential for patients with congenital heart problems, so when these patients move, they can no longer see their specialists with the same regularity. By coordinating care with Dr. Lui at Stanford, several colleagues and myself have been able to maintain continuity of care and take on these cases. This requires thorough study of patients’ very detailed medical records, regular updates to the patients’ specialists, as well as holding video conferences via telemedicine between specialists and their patients.”

NCMA Cardiology is the largest center for carotid stenting between the Golden Gate
and Redding, CA. Dr. Coleman serves as the Medical Director of the Cardiac Catheterization Laboratories for both SRMH and Sutter Santa Rosa, as well as the Director of the Cardiology Section at NCMA. In addition to practicing cardiology in Santa Rosa and Ukiah, Dr. Coleman gives monthly lectures to paramedics to educate them on STEMI protocol, and he actively works with organizations such as American Medical Response, Stanford, Emergency Medical Services, Save Lives Sonoma, Medtronic and more to further advance cardiac health awareness and treatment in Sonoma, Mendocino, and Lake counties.

For all of Dr. Coleman’s hard work and concerted efforts, the Northern California Center of Well-Being named Dr. Coleman the “Physician Leader” for 2013. NCMA is proud to have his leadership on our elite team of cardiologists.