H E A RT & VA S C U L A R NEWS Fa l l 2 0 1 2
f r o m t h e Up s tat e H e a rt a n d Va s c u l a r C e n t e r , Up s tat e Un i v e r s i t y H o s p i ta l
impella device aSSiStS patientS with Severe heart diSeaSe ardiologists at Upstate are using a new pumping device to extend the lives of patients with severe forms of heart disease. Patients suffering heart failure, and those whose hearts are too weak to tolerate angioplasty are candidates for the device called Impella®.
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One Of new YOrk State’S tOp heart SurgeOn practiceS at upState or the last two years Upstate University Hospital’s Gregory Fink MD was ranked as one of the top performing cardiac surgeons in New York State. According to the NYS Department of Health cardiac services report, he and his team have lead Upstate’s Cardiac Surgery Service to continue outperforming other hospitals in New York State.
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From 2006 t0 2008, Dr. Fink, Chief of Cardiac Surgery, operated on 252 patients. He was one of four surgeons in the state with a significantly lower than average mortality rate. The latest report published in February of this year states that he operated on 274 patients in 2007-2009. Once again he was ranked among the top surgeons in the state. ♥
Heart & Vascular Center
“It’s for the really, really sick patients, for whom there is no alternative,” says Kozman, director of the Cardiac Catheterization Laboratory at Upstate.
David Grugan was just such a patient earlier this year. The 62-year-old Auburn man said he had come close to death twice. He Doctors insert the pump A catheter in the aorta was grateful to Dr. is used to insert a pump. through a catheter that Kozman and the enters the heart through its main Impella. After a heart attack in artery, the aorta. The pump is 2009, Grugan had four stents about the size of a triple A placed to prevent blockages in battery. It spins rapidly, like a his coronary arteries. Later, Luna corkscrew, propelling blood Bhatta MD, director of the backward from the left ventricle Electrophysiology Laboratory, out to the body to maintain implanted a defibrillator that circulation. would automatically restart his heart if it stopped beating. Hani Kozman MD says some patients require the Impella Months later, he began having during a medical crisis such as a very limiting chest pain and severe heart attack. Other trouble breathing. He was found patients are considered high-risk to have additional blockages for repairs to their coronary forming in his coronary arteries, arteries, and the Impella is however with his weak heart placed before the patients function, these would be risky. undergo their procedure. The Kozman spoke with Grugan disposable pumps, which may about his options, and Grugan said he appreciated the doctor’s remain for a few hours up to Continued on page 4 several days, connect to monitors that provide the Syracuse New York electrical source.
Up s tat e E x p ert s Heart & Vascular Center
tYpe a aOrtic diSSectiOn: rare But deadlY frOm the editOrS ongratulations to the Strong Women, Strong Hearts committee on a great February day of education, health screenings and heart healthy food provided for the community. Through lectures and health screenings, 350 women increased their awareness of heart disease. Knowing that many women have subtle symptoms of coronary artery disease that can go unrecognized by their physicians and themselves, the committee provided education along with fun and camaraderie.
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This issue of Heart and Vascular News highlights risk factors that can lead to heart, kidney and vascular disease. We describe state-of-the-art technology that can diagnosis and treat heart disease. There are articles about patients who have undergone life-threatening surgeries and are now leading active lives. We offer exercise, nutritional and pharmacological information. Our mission is to keep you informed, and hopefully to improve the quality of life for you and your family. Enjoy this issue of Heart and Vascular News!
Karen Gibbs RNC Nurse Practitioner, Cardiopulmonary Surgery
Amy Tetrault RN BSN Associate Director, Heart and Vascular Center
he aorta is the largest blood vessel in the body. It starts in the heart and runs through the chest into the abdomen. The part of the aorta that goes through the chest is called the thoracic aorta. Aortic dissection occurs when the inner layer of the aorta begins to tear. Type A Dissection, in the first part of the aorta, is considered a medical emergency. Delay in diagnosis can make a huge diffence in the outcome. Left untreated, tears may eventually burst causing severe bleeding. This can rapidly lead to shock or death.
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Symptoms are similar to a heart attack. Pain is sudden. The patient complains of chest, back or abdomen pain. Some experience nausea, vomiting and lightheadedness. Such was the case of actor John Ritter, the 54-year-old star of “Three’s Company” and “Eight Simple Rules…for Dating My Daughter.” He was rushed to the emergency department at a Burbank hospital, complaining of nausea, vomiting and chest pain. He died later that evening from a Type A aortic dissection. US special envoy to Afghanistan and Pakistan Richard Holbrooke fell ill during a meeting at the State Department with Secretary of State Hillary Clinton. He was rushed to George Washington University Hospital, taken immediately to surgery, but died two days later of complications from a Type A aortic dissection.
John Sardella and his wife, Cherie
As stated earlier, diagnosis may be difficult as symptoms can be mistaken for other disorders. Most dissections require surgery to repair the tear. When treated promptly, surgical outcomes are relatively good. Risk Factors Include: Marfan’s Syndrome ● Syphilis ● Obesity ● High Cholesterol ● High Blood Pressure ● Smoking ● Crack Cocaine Use ● Family history ●
To prevent aortic dissection, healthy diet, exercise, blood pressure control and stress reduction are recommended. If there is a family history, a full cardiac work up should be considered. John Sardella is well aware of how critical his condition was. The 60-year-old Native American musician woke at 1 a.m. on May 15 with sharp chest, back and abdominal pain. He began sweating profusely. He told his wife he felt like he was having a heart attack. Continued on page 3
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Up s tat e He a rt & Vas c ul a r Ne w s
Fall 2012
Up s tat e E x p ert s Heart & Vascular Center
cOmplex heart aBnOrmalitieS cOme intO fOcuS with cardiac mri ita Fischer’s doctor heard a heart murmur and sent the 78-year-old Cleveland woman to have an echocardiogram (echo), which provided pictures of her heart in motion. The echo, along with other cardiac exams, revealed a spot on her heart. Her physician sent her to Ali Salah MD at Upstate University Hospital for a cardiac MRI. Dr. Salah is an expert in the field of cardiac imaging. In Syracuse, the cardiac magnetic resonance imaging (MRI) is only available at the Upstate Heart and Vascular Center.
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“You know how you dread it? Well, I’ve got to say, it was a breeze,” Fischer recalls. “Dr. Salah is the sweetest man.” The cardiac MRI showed that Fischer had a large cyst pressing
on her heart. The cyst was drained, relieving her symptoms. A cardiac MRI is just like a regular MRI from a patient’s point of view. It is a minimally invasive procedure that does not involve radiation and delivers unparalleled image quality. It is used to evaluate a wide variety of heart disease including causes for heart failure, evaluate for myocardial disease, myocardial scar imaging, myocardial viability, heart masses, valvular heart disease and complex congenital heart diseases.
Cardiologist Ali Salah MD at Upstate’s cardiac MRI lab.
“This service is not widely available due to a lack of experts in the field of cardiovascular imaging,” states Dr. Salah, director of the Cardiac Imaging program at the Upstate Heart and Vascular Center.
After completing a cardiology fellowship, Salah did an advanced cardiovascular imaging fellowship at SUNY Stony Brook and Georgetown University. To reach him for consultations, call 315-464-4536. ♥
written prayers and pictures. “I can’t explain it,” says Kristen Iglesias, a cardiac critical care nurse. “I truly believe the family’s Native American spiritual practices helped his recovery."
Culbertson, who manages Upstate’s Department of Spiritual Care. “There is a lot of amazing research out there. A regular, active worship life extends life expectancy. Ask any hospitalized patient what keeps them going, and almost every one mentions some form of prayer."
Aortic Dissection — continued from page 2
“I wanted him to have the best hospital,” said Mrs. Sardella, “so I insisted he go to Upstate.” He arrived at the emergency department where a CT of the chest was obtained. The diagnosis was made and Dr. Fink and his team were notified. They immediately took him to the operating room. He returned to the intensive care unit in critical condition. Dr. Fink and the nurses encouraged the family to stay with him during this critical time. His wife covered him with a red prayer blanket, attaching hand
“Dr. Fink kept me very well informed,” states Cherie, Mr. Sardella’s wife. “He met with me every day and would go over his progress.” “The family was very involved,” says Dr. Fink. “Chanting, prayers and other non-tangibles are so real to many of us,” says the Rev. Terry
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Mr. Sardella is back at home with his wife performing in their band, Gypsy Red. He sees Dr. Fink every six months with a CT scan of the chest to monitor his repair. He is doing well and grateful for the care Dr. Fink and his team provided. ♥
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Center News Heart & Vascular Center
heart failure gOld pluS award
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The guidelines are designed to improve outcomes, prevent future hospitalizations and save lives.
To get gold plus status, a hospital must “Get with the Guidelines,” the association’s quality improvement initiative, which provides hospital staff with evidence-based guidelines for caring for patients with heart failure, stroke and other cardiovascular problems.
To be gold plus in heart failure, a hospital must achieve 85 percent or higher adherence to all of the association’s “Get With The Guidelines” measures for two or more consecutive 12-month intervals and achieve 75 percent or higher compliance with four of nine additional quality measures. Following the guidelines, heart failure patients are started on aggressive riskreduction therapies which may include beta-blockers, ACE inhibitors, or anticoagulants during their hospital stay.
pstate University Hospital attained a Gold Plus Quality Achievement Award from the American Heart Association for excellence in the treatment of patients with heart failure. Upstate University Hospital also has a Gold Plus award for excellence in the treatment of patients with strokes.
wOmenheart SuppOrt grOup
Impella — continued from page 1
The free WomenHeart Monthly Support Group is held on the last Friday of the month.
honesty. His heart would need help pumping during the procedure. Grugan would be on the Impella pump while additional Hani Kozman MD stents were inserted into his heart arteries. Grugan agreed.
Support group topics include: Heart failure – Oct. 29 Stress management – Nov. 26 Holiday celebration – Dec. 17 WomenHeart is the only national organization dedicated to advancing women’s heart health through advocacy, community education and patient support. As the leading voice for the 41 million American women living with or at risk of heart disease, WomenHeart advocates for equal access to quality care and provides information and resources to help women take charge of their heart health.
Strong Women, Strong Heart committee members.
To register for the free support group, or for more information, contact Leisha Doherty MSW at herheartbeatcny@gmail.com or 315-663-1712. ♥ Save the Dates WomenHeart Monthly meetings though December 17 6 to 7:30 p.m. HealthLink/OASIS Center 6333 Route 298, East Syracuse (next to the DoubleTree Hotel, off Carrier Circle)
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Upstate is also fully accredited by the Society of Chest Pain Centers, an international nonprofit that is focused on helping hospitals improve quality, cost and patient satisfaction in cardiovascular care. Upstate is an accredited Chest Pain Center, with “PCI,” or percutaneous coronary intervention, which is emergency treatment that reduces the amount of heart muscle permanently damaged by heart attack. For more information, contact Lorrie Langdon, heart failure program coordinator, 315-464-5399.♥
Up s tat e He a rt & Vas c ul a r Ne w s
“I thought I was going to be there for the weekend, because I had this done on a Thursday, he recalls. But the day after the procedure, Kozman said Grugan could go home. Gurgan has recovered well. His symptoms have improved significantly and he is able to continue with life as usual. ♥
Fall 2012
Center News Heart & Vascular Center
exerciSe any people who have been diagnosed with heart failure believe that they can no longer exercise. However, if done properly, exercise can help you feel better, make it easier for you to complete daily tasks, and may even improve your heart’s function.
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If you are not used to exercising, it is very important to begin slowly. Adding just 5 or 10 minutes of exercise to your day will help you move toward better health. Most people with heart failure should aim to accumulate 30 minutes of physical activity on most days. However, if you are not exercising now, it may take you a few months to reach this level. If you cannot exercise for 30 minutes continuously, you can spread several 5-10 minute blocks of activity throughout your day. There are many different ways to exercise. The best type of exercise for you is one that you
enjoy, because you will be more likely to stick with it. Exercising with a family member or friend can also help motivate you to exercise and make it more fun. Walking is the easiest activity for most people, because it doesn’t require any equipment and can be done almost anywhere. Biking and swimming are also good choices. Muscle strengthening exercises using weights, resistance bands, or just resistance from gravity can help you improve strength and balance and reduce joint pain. Even enjoyable activities like golf, gardening, shopping, or taking your grandchildren to the zoo can be considered exercise when they involve continuous movement. It is important to do gentle stretches or walk at an easy pace for a few minutes to warm up before and cool down after each session. You don’t need expensive shoes to exercise, but you should make sure you have
well-fitting, supportive footwear to decrease the risk of injury. You should never exercise to the point of complete exhaustion. You should be able to comfortably carry on a conversation while exercising. If you are breathing so hard that it is difficult to speak, you should stop and rest. Make sure you continue to monitor yourself as your doctor has instructed you, including taking your pulse and weighing yourself daily. Be sure to talk to your doctor before beginning a new exercise program, or if you have new symptoms while exercising, such as dizziness, feeling like your heart is racing, or becoming very short of breath with only light activity. A physical therapist can also help design a safe and effective exercise program for you. The most important thing is to just start moving a little more each day, and to have fun! ♥ By Kerry Walsh, PT, DPT, GCS, CEEAA
StrOng wOmen StrOng heartS event: feBruarY 2, 2013 pstate’s coronary care nurses would like to bring awareness to our patients of an educational event that is close to your heart. Strong Women Strong Hearts was established last year to increase awareness for women and heart disease. This event is similar to the national campaign, Heart Truths, and the American Heart Association’s Go Red initiative. We, the nurses of the Coronary Care Unit at Upstate, created this event over a year ago and
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through our efforts we were able to educate over 350 women. This day, that we have dedicated to the women of our community, is free and provides educational opportunities and pampering for all.
Save the Date Strong Women Strong Hearts Saturday, February 2, 2013 10 a.m. to 4 p.m. HealthLink/OASIS Center
Join us in February for nutritional information, heart-healthy tasting, health screenings, exercise, Reiki therapy, massage, yoga and meditation, and vendors with jewelry, food and more. ♥
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6333 Route 298, East Syracuse (next to the DoubleTree Hotel, off Carrier Circle)
Above right: The youngest “strong woman” at last year’s event.
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Did you know? Heart & Vascular Center
minimallY invaSive prOcedureS treat varicOSe veinS tOdaY aricose veins are enlarged blood vessels that are often raised above the skin on the legs. They can be blue, red, or flesh colored, and they appear as twisted, bulging chords. More than 30 million men and women have varicose veins. For most people, varicose veins are not just a cosmetic problem but the cause of pain, swelling, restlessness and leg fatigue.
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what causes varicose veins? When valves in the leg veins no longer function, this can cause blood to pool in the legs and create varicose veins. The condition is often hereditary and can affect many people in the same family. Other risk factors include older age, female gender, current or previous pregnancy, and lifestyles that require standing for long periods of time.
are there any treatments to remove varicose veins? Several minimally invasive procedures can completely eliminate varicose veins. Unlike vein stripping surgery in the past, these new procedures do not require large leg incisions and do not leave any noticeable scars. Patients go home the same day and usually recover completely and return to usual activities and work within one week.
are varicose veins dangerous? They do not pose a risk to life or limb. They do not cause deep vein clots that can be dangerous if they break off and travel to the heart or lungs.
can varicose veins be prevented? Usually not, however some symptoms of varicose veins can be controlled with several lifestyle changes including:
what could happen if i completely ignore my varicose veins? In severe cases, varicose veins may progress to chronic venous insufficiency, which can cause permanent skin damage and non-healing ulcers. Some patients with large varicose veins have problems with bleeding from the veins or painful blood clots that form in the veins under the skin.
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avoiding prolonged standing;
what are spider veins?
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elevating the feet above the thighs when sitting, and above the heart when lying down;
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avoiding clothes that are tight around the waist, thighs or legs;
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strengthening calf muscles through an appropriate exercise plan.
These are damaged veins that appear in the form of red or blue branches or “spider webs” close to the surface of the skin. They are similar to varicose veins, however they are thinner and usually do not bulge out from the skin. Spider veins can be treated with laser treatment or sclerotherapy which involves using very small needles to inject the veins with scar-forming liquid or foam.
how can i get evaluated for varicose veins? Physicians with an expertise in varicose veins and venous disease can evaluate your condition and go over the various treatment options. Vascular surgeons at the Upstate Heart and Vascular Center have wide experience treating patients with varicose veins and can perform minimally invasive procedures. To schedule an appointment, call 315-464-8668. ♥
By Michael Costanza MD, associate professor of surgery and director of endovascular services at Upstate University Hospital. Pictured at left.
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Good to know Heart & Vascular Center
dietarY SOdium: fact Or fictiOn? HEART MEDICATIONS EXPLAINED
By Danielle Stegman, registered dietitian
less sodium means less flavor. Fiction. Plenty of flavorful alternatives to salt exist. Use small amounts of these herbs — about ¼ teaspoon dry and 1 ½ teaspoons fresh — for every four servings of food, and experiment with these seasoning suggestions: Beef —
Rice —
basil, onion or sage
Chicken — rosemary, tarragon or thyme Fish —
turmeric, cumin, allspice, honey or onion
Drug class
How it works
Medication examples
Diuretics
Help the body excrete sodium (salt) and water. They are often used in combination with other types of antihypertensive meds.
Lasix® (furosemide) Hydrodiuril® (hydrochlorothiazide) Aldactone® (spironolactone)
ACE Inhibitors
Help the body produce less angiotensin (a chemical that causes the arteries to narrow, often referred to as ACE). When there is less angiotensin, the blood vessels can relax and open up, in turn, lowering blood pressure.
Lotensin® (benazepril) Vasotec® (enalapril maleate) Zestril® (lisinopril)
Angiotension II Receptor Blocker (ARBs)
ARBs block the receptor that angiotensin binds to, inhibiting it from constricting the blood vessel. The blood vessel stays open and blood pressure is reduced.
Diovan® (valsartan) Atacand® (candesartan) Avapro® (irbesartan)
Broccoli — vinegar, basil, oregano or garlic
lemon juice, dry mustard or cumin
Carrots — cinnamon, allspice or ginger
String Beans — nutmeg, dill seed or sage
Potatoes — chives, rosemary, garlic or paprika
Corn —
green pepper, onion, curry or paprika
Sea salt is better than regular table salt. Fiction. While sea salt has slightly less sodium per gram than regular table salt, it does not make a big difference in your overall sodium consumption and, as with table salt, should be limited.
processed foods are usually higher in sodium. Fact. Sodium lengthens product shelf time by preserving foods. It can also enhance the flavor and color of foods, and food manufacturers take advantage of this to make their products appealing.
Beta-Blockers Reduce the heart rate, the amount of blood the heart pumps out, and the workload of the heart which lowers blood pressure.
Tenormin® (atenolol) Lopressor® (metoprolol tartrate) Toprol-XL® (metopolol succinate) Inderal® (propranolol hydrochloride)
Calcium Channel Blockers
Prevent calcium from entering the smooth muscle cells of the heart and arteries. This decreases the force of the heart’s contraction, thus reducing blood pressure and lowering heart rate.
Norvasc® (amlodipine besylate) Cardizem CD®, SR® (Diltiazem hydrochloride) Calan SR® (Verapamil)
Alpha Blockers
Reduce the arteries’ resistance to blood flow by relaxing the muscle tone of vascular walls.
Cardura® (Doxazosin mesylate) Minipress® (prazosin hydrochloride) Hytrin® (terazosin hydrochloride)
the american heart association recommends daily sodium intake of less than 1,500 milligrams per day. Fact. This is the current recommendation.
a food labeled “reduced sodium” is okay to have on a sodium restricted diet. Fiction. Regardless of the claim, you need to read the food label to find out how much sodium the food actually has per serving. The definition of “reduced/less sodium” is that the product has at least 25 percent less sodium than the original product, making for a very wide variation from product to product. “Low sodium” means that a product has fewer than 140 milligrams of sodium per serving. ♥
Combined Originated for use as an IV drip Coreg® (carvedilol) Alpha and in patients with hypertensive crisis. Normodyne®, Beta blockers *See mechanisms above Trandate® (labetolol hydrochloride) Central Agonists
Decrease the blood vessels’ ability to contract.
Catapres® (clonidine hydrochloride) Tenex® (guanfacine hydrochloride)
Blood Vessel Dilators (Vasodilators)
Causes relaxation of the muscle in the walls of the blood vessels, allowing the vessel to dilate. This allows blood to flow through with greater ease.
Apresoline® (Hydralazine Hydrochloride) Loniten® (Minoxidil)
High Blood Pressure — Continued from page 8
suggest lifestyle modifications to help bring your blood pressure under control. These include eating a diet low in salt, exercising regularly, and avoiding alcohol and cigarettes.
Coupling these changes with medication can help to decrease your risk of heart attack, heart disease, stroke and kidney damage.
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Lifestyle modifications are important not only for those with hypertension, but also for those with risk factors who want to prevent hypertension from developing. ♥
800-464-8668
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Heart-healthy recipe Heart & Vascular Center
Orange walnut Salad with chicken One serving
ingredientS 1/3 cup walnut oil
3 cups mixed greens
1/3 cup orange juice
1/2 cup diced or shredded cooked chicken breast
1 tablespoon red-wine vinegar 1 clove garlic, minced 1 teaspoon freshly grated orange zest 1 teaspoon reduced-sodium soy sauce
1 orange, cut into segments (see Notes) 2 tablespoons crumbled goat cheese 2 tablespoons toasted walnuts (see Notes)
1/4 teaspoon freshly ground pepper
preparatiOn Place oil, orange juice, vinegar, garlic, orange zest, soy sauce and pepper in a bowl or a jar with a tight-fitting lid; whisk or shake until well combined.
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A blood pressure reading consists of two numbers. The systolic (top number) is a measure of the pressure in the arteries when the heart beats; the diastolic (bottom number) measures the pressure in the arteries between heartbeats.
Your doctor will likely prescribe one or more medications if your blood pressure rises above 140/90, and he or she will likely Continued on page 7 Source: EatingWell.com
Make Ahead Tip: Cover and refrigerate leftover dressing for up to 5 days. Note: If you don’t have cooked chicken, you can quickly poach a boneless, skinless chicken breast for this recipe. Place the chicken breast in small skillet or saucepan. Add lightly salted water (or chicken broth) to cover and bring to a boil. Cover, reduce heat to low and simmer gently until the chicken is cooked through and no longer pink in the middle, 10 to 15 minutes. To segment citrus, slice both ends off the fruit. Use a sharp knife, remove the peel and white pith; discard. Working over a bowl, cut the segments from their surrounding membranes. You can also use canned Mandarin oranges.
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ore than 75 million Americans have been diagnosed with high blood pressure, also known as hypertension. About one in three adults have high blood pressure, and 23 percent of them are unaware of their condition.
A healthy blood pressure for adults is below 120/80.
Place greens in an individual salad bowl; toss with 2 tablespoons of the dressing. (Refrigerate the remaining dressing.) Top the greens with chicken, orange segments, goat cheese and walnuts.
tipS & nOteS
factS aBOut high BlOOd preSSure
HIGH BLOOD PRESSURE RISK FACTORS: Advanced age Gender: High blood pressure is more common in men, but the risk factor for women increases after menopause Tobacco use
Lack of physical activity Poor diet — esp. high salt diet Overweight Alcohol consumption Stress
UNTREATED HIGH BLOOD PRESSURE CAN LEAD TO: Heart attack Heart disease
To toast whole nuts, spread on a baking sheet and bake at 350°F, stirring once, until fragrant, 7 to 9 minutes.♥
Congestive heart failure
Nutrition
Stroke
Per serving: 466 calories; 29 g fat ( 6 g sat , 6 g mono ); 71 mg cholesterol; 24 g carbohydrates;
Kidney damage
Peripheral artery disease Memory loss Angina Erectile dysfunction
0 g added sugars; 31 g protein; 8 g fiber; 294 mg sodium; 1060 mg potassium.
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