Throwback Thursday: 'C-arm speeds up heart diagnosis,' January 1979
By Kristy Bleizeffer Jan 30, 2020
In January 1979, the Casper Star-Tribune featured the hospital's new C-arm, a state-of-the-art imaging device able to diagnose heart blockages in real time.
Next month, we are preparing to open our new Interventional Radiology Suite that will revolutionize care for stroke, cancer and trauma patients. It will also allow us to offer Transcatheter Aortic Valve Replacement (TAVR), making us the first and only hospital in Wyoming to offer this life-saving procedure. TAVR is a minimally invasive treatment of severe aortic stenosis, a serious narrowing of the aortic valve that can be fatal if not treated. That aortic valve is replaced through a catherization procedure rather than an open-heart procedure. We'll have more on TAVR and the Interventional Radiology Suite in the coming weeks.
The C-arm was a percurser to our Cardiac Cath Lab.The 1979 article described a procedure performed by cardiologist Dr. Wesley Hiser, who first came to Casper in 1976 and was credited with creating the model for outreach clinics used by specialty doctors across the state.
"The procedure has permitted the diagnosis of blockages and allowed coronary bypass operations, where a vein is taken from the leg and positioned around the blocked part," Dr. Hiser told told the Star-Tribune. "Until this was available, nobody could do it because nobody could see what was wrong."
Later-generation C-arms are still used in our Cardiac Cath Lab. In 1979, we used the C-arm for diagnostic purposes only, sending most patients who needed surgery to Denver. Today, doctors perform a wide array of heart procedures in our Cath Lab, providing among the best heart attack treatment in the country.
We've transcribed the entire article below for easier reading.
By JILL STEWART, Staff Writer
CASPER -- The doctor fixed his eyes upon a small television screen, watching the ghostly palpitations of an unhealthy heart caught on film with the help of X-ray. He immediately noticed the bottom wall of the heart was not contracting, and the dye which was fed into the organ for visual aid moved out sluggishly.
The physician, Dr. Wesley Hiser of Memorial Hospital, views his patient's heart hours after patient went home, on film taken by a sophisticated device called the "C-arm."
The floor-to-ceiling structure gets its name from a C-shaped arm located at the end of an examinging table. The arm, equipped with movie and video cameras, an image amplifier and an X-ray tube, rotates around the prone patient.
The C-arm moves laterally and vertically, photographing the heart from every desired angle. Video tapes show instant replay, assuring the doctor he has shot everything.
In fact, the control room which monitors the equipment looks something like a television studio, complete with video sreens and button panels arranged behind a glass window. The similarity ends there.
The doctor and his three assitants wear lead aprons to shield against harmful X-rays. The control room window is made of thinck leaded glass. What the doctor discovers from the photographs taken by the C-arm will enable him to make a heart dignosis in a matter of hours that was not possible a few years ago.
"The procedure has permitted the diagnosis of blockages and allowed coronary bypass operations, where a vein is taken from the leg and positioned around the blocked part," Dr. Hiser said.
"Until this was available, nobody could do it because nobody could see what was wrong."
The dye, which shows up on X-ray, is injected in the heart using a technique called cardiac catheterization. First, a tube about three feet long and roughly the diameter of a matchstick is inserted in the body near the groin, where an artery to the heart is easily acessible.
Iodine-based dye is then squirted through the tube -- called a catheter -- into the heart. The colored dye is caught on film, allowing the dcotr to watch it move through the heart and surrounding arteries. Dr. Hiser said although patients are sedated during the procedure, "they are wide awake."
He said what little pain they feel comes from the pucture for the catheter.
The hospital uses the C-arm for diagnostic purposes only, Hiser said, and refers most surgical candidates to Denver.
Memoiral Hospital purchased the C-arm for about $260,000 this year with the help of the Natrona County Hospital Foundation, Hiser said. It has been in use in the cardiology wing of the hospital since Oct. 1.
Hiser said the procedure, which costs from $450 to $500, lasts about an hour. Generally, he said, dye is injected several times to get a variety of detailed views of the heart and arteries. He said an average of 5 or 6 clients, most of them men, are tested on the C-arm at Memorial Hospital each week.
Cholesterol plaque deposited in the heart and arteries is the most common heart problem Hiser encounters.
"We inject the dye into the bloodstream of the heart to look for clots," he said. "We can see them because the dye doesn't fill the are of the clot, and we can see the outline."
The catheter can also help measure the pressure it takes to force blood through the heart. The tube is filled with water, which transmits the blood pressure in the heart.
"If they have a narrowed valve, it takes more pressure to push the blood through the heart," Hiser said. "So if the pressure is high, it would indicate if surgery is needed."
An electrocardiograph hanging above the patient measures heartbeat, while another device records pressure. Pressure statistics are printed out on a machine in the control room. Hiser said the C-arm has made numerous medical innovations possible in the 1970s, including pacemakers.
Throwback Thursday is a series celebrating Wyoming Medical Center’s long and rich history in Natrona County. Special thanks to the Casper College Western History Center which archives the vast Wyoming Medical Center collection of newspaper articles, photographs and other memorabilia.