LI heart specialist eyes blood-pressure cuff's benefits

A Long Island heart specialist is among a growing number of physicians worldwide investigating the lifesaving potential of a low-tech medical device: the blood pressure cuff.

And they're not examining its use in terms of measuring blood pressure. Instead, doctors are using the device to apply pressure to the arm as a way of momentarily depriving the body of oxygen before bypass surgery or receiving a stent, the meshlike tube that props open a blocked artery.

That deprivation, doctors say, appears to protect the heart for possibly months, even years, from the kind of injury the heart muscle can sustain following bypass and stent procedures. Many heart patients suffer from post-surgery reperfusion injury - heart damage - which can occur once the free-flow of blood is restored.

Stunningly, applying pressure before such operations, experts are now finding, appears to set off a cascade of beneficial biological mechanisms that have long-lasting protective effects.

"Blowing up a blood pressure cuff is so safe and so inexpensive and so universal," said Dr. Nathaniel Reichek, a research cardiologist at St. Francis Hospital, The Heart Center, in Roslyn. He is testing the concept in a small group of patients.

The treatment involves applying a blood pressure cuff to one arm, inflating it for five minutes and then deflating for five minutes. The process is done four times in a row.

The trouble at this point, Reichek and other medical scientists say, is they know using the cuff works, but they have to figure out why. They know it works because patients who have undergone it tend to leak very little of a key cardiac protein called troponin - a marker for heart injury.

"If we can figure out how it works, it may be a tremendously valuable approach," Reichek said.

Dr. Abhiram Prasad, a professor of medicine at the Mayo Clinic, is also probing how the blood pressure cuff - first developed in the late 1700s - might serve as a pre-emptive measure. "This is a concept that has been around for two or three decades," said Prasad, adding much of the research so far has been in animals.

Only now, he added, are doctors starting to see a benefit for humans. It's also possible cuffing a heart attack patient in an ambulance may be yet another lifesaving use of the device, he said.

Reichek said it may take a few more years of study before doctors can say the technique could be standard therapy. A race is on worldwide to document patients' progress over time.

Dr. Barry Finegan of Canada's University of Alberta is hoping to study the technique in several hundred patients, to try to definitively determine why the cuff works. He and his colleagues are cuffing patients' legs.

"This is a noninvasive, non-pharmaceutical way of helping patients," he said, noting the cuff actually forces the body to produce protective measures that, in effect, help heal the patient.

Helping heart patients

Doctors are trying to find out if a low-tech, noninvasive method will help heart attack and cardiac surgery patients live longer, healthier lives. Applying pressure with a blood pressure cuff deprives the body of oxygen, but apparently also helps it mount a protective response after a heart attack or major cardiac operation.

Post-heart attack and post-cardiac surgery heart problems are a major public health concern in the United States where:

SOURCE: American Heart Association