Dr. Ashesh Buch, an interventional cardiologist at Chesapeake Regional Medical Center, led the development of introducing a coronary microvascular dysfunction testing program to the region. Chesapeake Regional Healthcare is the first non-academic health system to offer the diagnostic service in Virginia or North Carolina, according to its Healthcare Heroes nomination.
Patients with chest pain were undergoing traditional cardiac testing that focused on major coronary arteries and missed the heart’s microscopic blood vessels. Predominantly women patients were sent home or had repeated procedures to determine a cause. Before Buch and the Chesapeake Regional team introduced CMD testing regionally, the closest facility was at the University of Virginia in Charlottesville.
Now, thanks to Buch and his team, the CMD testing program provides “answers where none existed before,” according to the nomination. It makes this cardiac care accessible to the Hampton Roads community, and creates opportunities for research and new therapies as they develop.
Buch shared more with Inside Business:
Q: What were key steps to creating the CMD testing program?
A: First, we chose a protocol for spasm testing; there are several with small variations. Then we discussed the steps for preparation of acetylcholine (a neurotransmitter) used for spasm testing with the pharmacy, and had this and the testing protocol approved by our hospital committees. Second, we familiarized ourselves with the cardiac catheterization lab equipment to use for these studies. We already use the Abbott Pressure Wire X and have the CoroFlow system to do standard pressure wire studies, which are used to determine if a narrowing in a vessel is truly bad enough to potentially cause angina (chest pain). It was a matter of understanding the extra functions available, how to use it and how to do the flow studies that use the temperature sensor on the wire. Third, we had patients we knew who required diagnostic testing and didn’t wish to travel for it. Fourth, we set a date and, with the aid of a clinical specialist from Abbott, did the first few cases in a setting of a less busy list to allow time to iron out any workflow issues.
Q: What keeps you motivated?
A: Knowing that doing this work is meeting a need that has been sorely unmet for some years.
Q: How do you approach challenges?
A: Calmly, logically and with a positive, problem-solving mindset.
Q: What are you most proud of?
A: Diagnosing patients who have had symptoms for years and been told their symptoms were not cardiac after several prior cycles of stress tests and heart catheterization.
Q: How do you measure success?
A: Improvement in the patient’s quality of life that comes with using the tests’ data to inform us how to treat.
Q: What lessons have you learned?
A: It’s worth persisting in wanting to set up a service despite the many challenges that arise before being able to do so.