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December 10, 2010
By Claudene Wharton
University of Nevada, Reno Orvis School of Nursing researcher Michele Pelter has been awarded $377,000 from the National Institutes of Health to study detection of ischemia, a condition that can lead to heart attacks.
Over the two-year course of the study, Pelter will work with two local cardiologists, Dr. Richard Ganchan and Dr. Anita Kedia, who will serve as consultants on the study. She wants to see if different monitoring of patients experiencing symptoms of possible ischemia could lead to better care.
Ischemia occurs when there is a plaque rupture, and the body responds by forming a clot in an effort to stop the bleeding. But, this causes blockage in the coronary artery, the heart starts to suffer from lack of blood flow, and if the clot doesn’t dissolve itself or isn’t cared for medically, it can lead to a heart attack.
“The rupture creates a local injury and sets in motion a series of physiological processes,” Pelter explains. “Sometimes the clot gets washed away, but then it does it again. It can come and go.”
Because of this phenomenon of “coming and going” and the various locations the clots can occur, Pelter wants to see if a different form of monitoring would provide more complete information on which the physicians could base their care, resulting in better care being received.
An EKG is used to monitor patients experiencing chest pain or other possible related symptoms. But, an EKG can utilize varied numbers of “leads” or electrodes attached to the body, ranging from two to 12. Currently, the prescribed standard of care calls for two leads, or points of monitoring.
“If the electrode isn’t where the blockage is, it can get missed,” Pelter said. “Sometimes a 12-lead EKG will be done once a day, or with symptoms, but since the blockages sometimes come and go, if the 12-lead monitor isn’t hooked up at the right time, detection of the blockage may be missed.”
In Pelter’s study, patients will be hooked to a “Holter,” a small device that straps on to the chest, which will record results from a 12-lead EKG that will monitor the patient continuously for 48 hours. She wants to see if physicians would possibly prescribe different care if this method of monitoring were used.
“Perhaps there will be ischemia detected with this form of monitoring that would have resulted in different care, such as medication being prescribed to dissolve the clots early, or possibly more invasive procedures, if needed,” she said.
Pelter explained that in medicine, “You don’t just change the current standard of care unless there is research that indicates there is a better one. Currently, patients are getting very good care, the best care that is known. But, maybe this type of monitoring would enable physicians to provide even better care. We will see.”
Pelter says that the 12-lead constant monitoring can be cumbersome to work around when trying to care for patients, as well as expensive. But, one benefit is that it is noninvasive. If there is research indicating that this form of monitoring results in better assessment of ischemia and identifies high-risk patients who might benefit from more aggressive treatment, it could change the current standard of care.
Pelter will meet with the cardiologists throughout the study and will have a Data Safety Monitoring Board, which will meet every few months to check on how the study is going and ensure patient safety. Pelter is grateful to those who have agreed to serve on the board and collaborate with her on the study.
“Having Dr. Richard Ganchan and Dr. Anita Kedia, two excellent cardiologists, agree to work with me on this was key to being able to do this important research and get the funding to do it,” she said.
Pelter, currently assistant professor of nursing at Nevada’s Orvis School of Nursing, is also an alum of the school and a native Nevadan. After earning her bachelor’s degree of nursing at Nevada, she went on to earn her master’s and doctorate degrees at the University of California, San Francisco, where she was part of a research team for 10 years before returning to Reno in 2004. She joined the University of Nevada, Reno in 2008, after serving as director of nursing research at Renown Regional Medical Center for four years.