Drs. Michael Twyman and Jeffrey Brown

According to the American Heart Association, more than 2,200 Americans die of cardiovascular disease every day. Through their new cardiology practice with Premier Medical Specialists on Des Peres Hospital’s campus, Drs. Michael Twyman and Jeffrey Brown are determined to do their part to reduce that number. “Our focus is on preventing people from developing coronary disease in the first place,” Twyman says. “But if they do develop the disease, we want to offer a less invasive approach to the diagnosis and appropriate treatment.”

Prevention is the first step, and it can mean the difference between life and death, Twyman explains. “Coronary artery disease can be silent, with a person developing blockages, and by the time they have symptoms, it results in sudden cardiac death.”

The cardiologists work with patients to evaluate their cardiac risk factors—mainly family history, smoking, high blood pressure, diabetes and high cholesterol— and determine a course of action. They then utilize several screening methods, including advanced lipid analysis with an NMR lipid profile, which helps better analyze cholesterol, and coronary calcium scoring tests, which can help determine the disease prognosis for those at intermediate risk.

Some patients need screening because a close relative suffered from coronary disease. Others may already be experiencing symptoms like chest pain. In that case, the doctors may call for a treadmill stress test with an echocardiogram to evaluate a patient’s functional capacity, as “the ability to exercise is one of the main prognostic indicators,” Twyman notes. Through referrals, Brown and Twyman also provide risk assessments for other hospital patients who are facing pre-op clearance or cardiovascular symptoms.

An abnormal stress test may indicate the potential of coronary artery disease, and the doctors will turn to cardiac catheterization for clarity. While the traditional approach to the procedure is through the femoral artery in the upper thigh, Twyman and Brown are bringing a newer method to Des Peres. The radial artery approach uses the artery in the wrist—a technique that allows the patient quicker recovery time, less pain and fewer possible complications. The femoral artery approach can lead to extremely rare, but potentially fatal bleeding complications, while the radial artery method eliminates that bleeding risk at the access site, Twyman says.

The cardiology practice also offers right-heart catheterization using a vein in the forearm to access the heart and evaluate for pulmonary hypertension. It is a technique that Twyman has rarely seen in use outside of Saint Louis University School of Medicine, where he and Brown completed their cardiology fellowships.

While 75 percent of the cardiac catheterizations are diagnostic only, showing no blockage, the other 25 percent will require treatment. If the results show minimal coronary artery disease, the cardiologists treat patients with medication and lifestyle modifications. But if the tests show severe blockage, patients are referred to specialists for stents or bypass surgery.

With breakthroughs in treatment continually surfacing in the world of cardiology, Twyman is excited about the possibilities for his and Brown’s new practice. “I want the patients to feel like we’re really collaborating with them to reduce their coronary disease risk, as well as offering the most cutting-edge, minimally invasive approaches we can.”