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'Snuff Box' Used to Treat Heart Attack Patient

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Photo of Dan Spahn in his workshop

Dan Spahn, 69, of Cedar Rapids, was lucky he didn’t fall off his roof. That’s where he was when he started having chest discomfort in early October 2021. He climbed down the ladder and rested for a while. When the pain went away, he started working again, but the pain returned.

“I decided to go inside, take a shower and lay down, and I felt better,” Spahn recalled. “But the pain came back a third time, and I couldn’t breathe very well, so I put on my CPAP machine (continuous positive airway pressure device typically used for sleep apnea). That didn’t help either, so finally I told my wife something wasn’t right.”

Spahn had his wife take him to St. Luke’s Emergency Room (ER), where they immediately performed an EKG (electrocardiogram, which checks for signs of heart trouble) and it registered a heart attack. The ER team worked quickly to take Spahn to the catheterization (cath) lab, where Subhi Halawa, MD, St. Luke’s interventional cardiologist, performed a heart cath with a new technique, called the “snuff box.” Dr. Halawa found one of Spahn’s arteries nearly 100-percent blocked, cleared it and placed a stent.

A heart cath is a procedure in which a cardiologist guides a thin, flexible tube (catheter) through a blood vessel to diagnose and/or treat heart problems such as blocked arteries. There are many entry points where a catheter can be inserted, including the wrist, groin, inner elbow or neck, but a newer approach is through a triangular indentation of the wrist, at the base of the thumb. Formally called the radial fossa, this indentation is nicknamed “snuff box” because of its historical use to hold powdered tobacco (snuff) for inhaling through the nose.

More Comfortable, Less Risk of Complications

“We started using the ‘snuff box’ technique about a year or so ago,” said Dr. Halawa. “I became aware of it in 2017, after reading about it from a doctor in Europe. I researched and implemented it in our practice, and several of us are now using the approach almost exclusively.”

“The radial artery rests on top of a bone in the snuff box area, so it’s faster and easier to control bleeding,” added Hisham Wagdy, MD, St. Luke’s interventional cardiologist, who also uses the technique. “That’s particularly important for patients on blood thinners who have a higher risk of hematoma (bleeding). Simple pressure from a finger will stop the bleeding; we use a special compression band to control it.”

Dr. Halawa said the procedure doesn’t require general anesthesia, and the snuff box is more convenient for the physician to access, which means patients are treated sooner. It’s also more comfortable for patients, and they’re less likely to develop swelling and blockage at the entry site, which means a lower risk of stroke as well. With a planned procedure, Dr. Halawa said patients generally go home the same day, and those who require an emergency procedure typically spend one night in the hospital.

“Recovery is very fast,” stated Dr. Halawa. “People can bend their wrists and use their hands immediately afterward. Traditional methods often require a patient to remain on their back for several hours or use a stabilizing device to keep their arm or leg still.”

Spahn was amazed at how quickly he was in and out of the ER and the hospital. “It all moved so fast,” he said. “I didn’t know you could have a heart attack and be home the next day. Everyone knew exactly what to do. I feel like I owe them my life.”

Following his treatment, Spahn participated in St. Luke’s Cardiac Rehab. He had no activity restrictions and was able to return to his hobbies right away. “I love to work in the yard and fix things in my workshop. I just finished refurbishing a few small wooden benches. I’m so thankful for everyone at St. Luke’s. They were just fantastic. I couldn’t have asked for better care.”

To learn more about the advanced procedures only available at St. Luke’s, visit unitypoint.org/factsmatter or contact St. Luke’s Heart Care Clinic at (319) 364-7101.


Tools You Can Use to Prevent Heart Disease

Heart disease is the leading cause of death for both men and women in the United States. Each year, more than a million people lose their lives from some form of heart disease, some of which may be genetic, while others are the result of lifestyle choices. 

St. Luke's offers several resources to help assess the risk for heart problems and improve heart health:

It’s also important to keep up with annual visits to a primary care provider, who can help individuals know their numbers for blood pressure, cholesterol, heart rate and more.

Need a doctor? Visit unitypoint.org/find-a-doctor or call our Find-A-Doctor line at (319) 558-4858.