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2 THURSDAY, FEBRUARY 28, 2013

HEART TO HEART

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Heart disease: Are you at risk? Healthy lifestyle, diet choices can help you keep your ticker healthy By DIANE WETZEL dwetzel@nptelegraph.com

The number one leading cause of death for men and women in America is preventable and controllable. According to the Centers for Disease Control and Prevention, one out of every four deaths in the United States each year is the result of heart disease. “Despite making all the advancement in the last 40 years, cardiovascular disease is still the number one killer,” said Dr. Satya Nelluri, interventional cardiologist at Great Plains Heart and Vascular Center in North Platte. “We have made significant strides over the past four decades, thanks to public awareness, more sophisticated tools to diagnose early and advancement in treatment options, not only in medications but in all the aggressive treatment options like angioplasty, stents and bypasses.” While “heart disease” can mean several types of heart conditions, the most common cause is coronary heart disease. The buildup of plaque in the arteries that supply blood to the heart can create a mismatch in the demand for

oxygen and the amount of supply, leading to a major heart attack. Symptoms of a heart attack include pain in the jaw, neck and back, feeling weak, lightheaded and faint, chest pain or discomfort, shortness of breath and pain in the arms or shoulder. Plaque formation is a chronic process, Nelluri said, that starts with cell formation and can be seen in children and teenagers, which is why it is so important to take steps to prevent heart disease. Diabetes, high blood pressure, high cholesterol, obesity, family history and smoking all are risk factors for heart disease. “Risk factors like diabetes, high blood pressure, smoking, all lead to different way of interacting and lead to trauma to the lining of the vessels and will start plaque building up,” Nelluri said. “The inner most layer [of the heart vessels] are a barrier between blood stream and inside of vessel wall. If the barrier should break down and some of these factors in blood stream seep into vessel wall and initiate the reaction and start the plaque build up. That’s why

Courtesy photo

Dr. Satya Nelluri (right), interventional cardiologist at Great Plains Heart and Vascular Center, explains information to a patient using a model of a heart.

it is so important to take care of ourselves.” Cardiologists want to see people eat healthier and work to eliminate the risk factors, Nelluri said. “What we preach is people to cut back on total fat content to less than 30-35 percent of total calories,” he said. “Try to each 15-20 percent of calories in proteins. Eat more fish and cut down on red meat. Eat right, do some regular exer-

cise 30 minutes a day and do not smoke. We tell people that quitting smoking is a huge incentive in eliminating one risk factor.” The more risk factors involved, the greater the odds are for developing coronary heart disease. Some risk factors for heart disease cannot be changed, such as age or genetic makeup. Other factors can be modified to lesson the risk.

“We cannot change people’s behavior,” Nelluri noted. “In order to slow down the process of the disease, you want to have good control on everything. Blood pressure, cholesterol, diet, exercise. Even in patients with diabetes, we can slow down the process. We can modify the risks with medication and treatment. And we want to get to people earlier in the game so they have better prospects.”

Heart attacks — know the signs to save a life While some heart attacks are sudden and intense like in the movies, most start slowly, with mild pain or discomfort. Signs of a heart attack include:

n Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes or goes away and comes back, n Shortness of breath or sudden fatigue, n Pain or discomfort in oth-

er areas of the upper body like one or both arms, the back, neck, jaw or upper stomach, n Other signs of discomfort like breaking out in a cold sweat, nausea or lightheadedness. As with men, women’s

most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Don’t hesitate to call 911. It could save your life. The American Heart Association cautions to learn the signs, and even if you’re not sure it’s a heart attack, have it checked out immediately and tell a doctor about your symptoms.


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THURSDAY, FEBRUARY 28, 2013

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Keeping pace Pacemaker technology evolves by leaps and bounds By ANDREW BOTTRELL abottrell@nptelegraph.com

Pacemakers have come a long way in 60 years — from the bulky contraptions of the 1950s, which had to be carried around and plugged in, to devices that are only slightly bigger than a quarter today. “The first was implanted in Minnesota,” recalled Dr. Roque Arteaga, an invasive cardiologist with Great Plains Regional Medical Center. “It was a device that was so big that it had to be pulled on a cart.” Even though it was bulky and hard to transport, it was a major breakthrough in the medical world for one reason. “It proved you can use electronic devices to pace the heart,” Arteaga said. In the 1960s, companies began to produce smaller pacemakers. However, they were still not small enough to implant, and so the patient had to carry the device around in a pouch with the wires surgically implanted through the belly. The problem this presented, Arteaga said, is it heightened the risk of infection. “Within a decade they downsized and that was a huge technological advance,” he said. “Size has contin-

Courtes y photos

Above: Dr. Roque Arteaga, an invasive cardiologist with Great Plains Regional Medical Center, displays a chart that shows the evolution of pacemakers from the 1960s through today.

Left: Dr. Arteaga discusses information with another Great Plains Regional Medical Center staff member, in the Heart and Vascular Center.

ued to be one of the big improvements in devices.” By the 1970s, companies began to build devices that were small enough to implant underneath the skin atop the pectoral muscle, which is where devices are placed today. The wires are inserted into a vein and then attach to the base of the heart. With the decrease in size, also came an increase in technology. “The devices got smaller,” Arteaga said. “But at the same time they got more complex.” The original devices did one thing, pace the heart at a specific rate. As technology developed, pacemakers began to monitor the heartbeat and then

change the pace of the electrical current to match what the body needed. Still other devices only kick in when heart rate goes below a specific beat per minute. For example, Arteaga said, devices have evolved to where they can recognize the body’s need for an increased heart rate while moving, or a decreased heart beat while sleeping. Small microchips were also inserted into pacemakers as technology allowed, making it easier for data to be stored and for doctors to access that data, which Arteaga said makes the patient more comfortable and lessens the amount of time they have to spend in

the doctor’s office. The computers can automatically store heart rate activity, sleep rate, battery life and many other factors that are important for the patient’s doctor to know. “It’s like a microcomputer,” he said. Early pacemakers also required battery charging, which forced the patient to sit for long periods of time while batteries charged. “You’d have to charge it like a cell phone, then you could unplug it an walk around,” he said. Now, battery life for pacemakers can be up to 11 years. “The battery progress was really significant.” He said that allowed pacemaker patients to

have more energy, a more active life and ultimately live longer. The latest technology upgrade is wireless capabilities. Arteaga said patients have a wireless monitor that they take home that can communicate with the pacemaker and store data. That data can then be accessed

by the doctor without the patient ever leaving home. “The was a big breakthrough when it comes to follow-ups,” he said. Another recent breakthrough in pacemaker technology is MRI-safe pacemakers.

Please see PACE, Page A2


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PACE from Page A1

In the past, pacemaker patients could not have an MRI because of the metal in the pacemaker. However, companies have recently developed pacemakers that have a MRI-safe mode.

Myths and truths

Telegraph file photo

The lobby of the Great Plains Heart and Vascular Center awaits patients on a February afternoon.

The most common myth about having a pacemaker, Arteaga said, is the use of a microwave. He said many patients believe that if they get a pacemaker, they can’t use a microwave, which he said is not true. “The only way it

can be affected is if the microwave is on and the door is open,” he said, which is impossible, he noted. “Assuming the door is closed, you can turn any microwave on.” However, there are things that pacemaker patients have to avoid, including direct contact between the pacemaker and a cell phone, contact with anything that vibrates the body or contact with anything that creates a large magnetic field. These items can change the way the pacemaker works and be harmful to the patient. In terms of

cell phones, Arteaga said that patients can still use them, but they can’t keep them in a breast pocket, they have to be kept in a pants pocket, or on a belt. Pacemaker patients also have to be leery of metal detectors, which give off a magnetic field and can affect the pacemaker. Large engines can also have a negative affect on pacemakers, because of the magnetic field that engines give off and because of the vibrations. Vibrating objects can make a pacemaker think that it needs to lower a patient’s heart rate.

You’re never too young for prevention Whatever stage of life you’re in, it’s the right time to take steps to protect your cardiac health Whatever your age, you should think about how nutrition and exercise can work together to help you live a heart-healthy lifestyle.

Staying heart healthy in your 20s In your 20s, it can be easy to overlook the importance of living a heart-healthy lifestyle. Yet, this is the time to check your family history of heart disease. Don’t smoke and stay away from secondhand smoke. Drink in moderation. Women, be

aware that some oral contraceptives can cause an increase in your blood pressure.

In your 30s In their 30s, many people get so involved with their careers and family, they neglect to pay attention to their own health. You’re young, but you’re not a kid anymore. Now is the time to build heart healthy habits. If you don’t already exercise regularly, now is the time to start. You don’t have to join

why it’s all the more important to manage stress and stick to a healthy diet and exercise routine now.

a boot camp class or run a In your 50s half-marathon. All it takes Unfortunately, the numis about 30 minutes of exer- ber of people who have cise a day on most days. heart attacks increases dramatically once they turn 55 In your 40s — especially, for women, afIn your 40s, you may feel ter menopause. like you are too set in your But the good news is that ways to make a change, but you have the power to reit’s never too late. Focus on duce your risk, and if you nutrition and working do have a heart condition, healthy foods into your diet. there is plenty that you can Make sure you are getting do to manage it. Rather than trying to look like you enough calcium. Sometime in your 40s or did 20 years ago, your goal 50s, you may notice it be- should be to feel like you comes harder to maintain did then. Finding the balance of your usual weight. That’s

healthy eating and regular exercise will allow you to feel better and reach or maintain a healthy weight.

In your 60s and beyond

The older we get, the trickier exercise can be. Whether you’ve been active for years or you are just getting started, it’s important to find an activity you enjoy that provides the right level of activity for your body. For some people, taking short brisk walks (as little as 10 minutes) throughout the day or water aerobics can be just the right amount of exercise. — Courtesy the American Heart Association


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HEART TO HEART

blood vessels then expanded to flatten plaque against the artery wall and open the channel. However, if there is too much calcification in the artery the balloon won’t be able to expand. Nelluri said patients who needed the rotablator procedure before it was offered in North Platte had to travel to Lincoln or Denver to have it done. Those who have blockages in delicate areas of the body, such as the left main coronary artery, are still sent out of town for bypasses. “It’s our hope and dream to be able to do Courtesy photo bypasses here one day,” Nelluri said. Dr. Satya Nelluri, interventional cardiologist, listens to a patient’s heart at the Great Plains Heart and Vascular Center in North Platte. The center implemented a “But, it’s a young prodevice called a rotablator this month, which is used to grind down plaque in heavily gram, so we have to take it one step at a calcified coronary arteries. time. Patient safety comes first.”

Rotablator procedure available at GPRMC New device can grind down plaque in coronary arteries By HEATHER JOHNSON hjohnson@nptelegraph.com

A new tool at the Great Plains Heart and Vascular Center in North Platte will limit the traveling local patients have to do for heart procedures. Doctors implemented a rotablator into a procedure this month. Although new to the center, it is equipment that Dr. Satya Nelluri and Dr. Arshad Ali, interventional cardiolo-

gists within the HVC, have each used for about 10 years. “Having this tool tremendously helps,” Nelluri said. The rotablator is a tiny, football-shaped device with diamond chips on one end. The other end is attached to a catheter, which is inserted into heavily calcified coronary arteries. “The rotablator works as a grinder of sorts,” Nelluri said. “It

pulverizes the plaque into small particles, smaller than red blood cells, which are absorbed by the body.” It does so by spinning at up to 200,000 rotations per minute. A foot pedal controls the speed, and the power comes from a tank of pressurized nitrogen. Speeds are monitored digitally. Nelluri said the rotablator is sometimes used to brush up plaque prior to balloon dilatation and stent implantation. During angioplastys, empty balloons are inserted into narrow or blocked

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Simple steps for heart health Getting and maintaining a healthy heart is vital to living a long and active life. Many people mistakenly believe that heart health is a goal they can’t obtain, but all it takes are a few simple changes to your everyday habits to be on the road to living longer. Visit www.MyLifeCheck.org to see how you’re doing right now in terms of a healthy heart and get tips on keeping that ticker going strong for years to come. Get active. Just 30 minutes of physical activity every day is enough to keep your heart, body and mind healthy. Play with your kids, walk the dog or so some quick laps around the office at lunch – find a way to work 20 minutes of movement into your day. Control cholesterol. Know your numbers and get your cholesterol checked. A cholesterol level of 200 mg/dL or higher puts you in a high-risk category and is cause to take action. Eat better. Aim for getting in more vegetables and fruits. They are high in vitamins, minerals and fiber and low in calories. Eating a variety of fruits and vegetables may help you control your weight and your blood pressure. Manage blood pressure. By keeping your blood pressure in the healthy range (less than 120 mm Hg systolic AND less than 80 mm Hg diastolic), you are: Reducing your risk of your vascular walls becoming overstretched and injured, reducing your risk of your heart having to pump harder to compensate for blockages, protecting your entire body so that your tissue receives regular supplies of blood that is rich in the oxygen it needs.


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Now, GPRMC is fixing him up Hospital’s director of engineering gets to see the other side of health care By DIANE WETZEL dwetzel@nptelegraph.com

Tom Didier is no stranger to the world of health care. For nearly 28 years, Didier has been responsible for the building and grounds, the medical equipment, security, safety and ongoing construction projects at GPRMC. “We have a lot stuff happening right now,” he notes with understatement. Recently, the 58-year-old director of engineering at Great Plains Regional Medical Center recently experienced it from the patient’s point of view. In August 2012, Didier decided to take advantage of the hospital’s offer of a reduced cost calcium screening. Although stress tests had shown that everything heartwise seemed to be all right, Didier decided to go ahead with the test. He had several of the risk factors associated with heart disease, including weigh issues and history of smoking. “My wife and I both decided it would be a good thing to do,” he said. “Her score was zero, mine was over 1,400.” A calcium test is one competition where the highest score is the worse score. For a coronary calcium screening, the patient is given a CT scan to check for buildup of calcium in plaque on the walls of arteries of the heart. The test is used to

check for heart disease in an early stage. A subsequent heart catheterization showed a 90 percent blockage in one artery, and a 60 percent blockage in another. Two weeks after his catheterization in North Platte, Didier was at Bryan Medical Center in Lincoln, where Dr. Richard Thompson performed a double bypass. “I was dismissed four days post op and did my cardiac rehabilitation here at Great Plains,” Didier said. A calcium scan is beneficial for people who have no cardiac symptoms but do have several risk factors for heart disease, said Dr. Satya Nelluri, cardiac interventionist with Great Plains Heart and Vascular Center. “There are a significant number of people who were asymptomatic before their first heart attack,” Nelluri said. “People with a strong family history of heart disease and one of two risk factors are at a moderate risk. This is a group you want to target the most. “I’m not saying we ignore people who at high risk, but an early detection of the plaque process means we can prevent progress of the disease. Calcium scores help because they are indirect evidence of plaque progress.” Didier says the treatment he received at Great Plains cath lab and from the physicians and staff was amazing. “Their model of taking care of patients like family is really true,” he said. “The quality of people and equipment here is second to none.”

HEART TO HEART Lose weight. 145 million Americans are overweight or obese. If you have too much fat — especially if a lot of it is at your waist — you’re at higher risk for such health problems as high blood pressure, high blood cholesterol and diabetes. Reduce blood sugar. The American Heart Association considers diabetes and high blood sugar one of the six major controllable risk factors for cardiovascular

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More simple steps for heart health disease. Adults with diabetes are two to four times more likely to have heart disease or a stroke. Stop smoking. Smoking is the most important preventable cause of premature death in the United States. Smokers have a higher risk of developing

many chronic disorders, including atherosclerosis, which can lead to coronary heart disease, heart attack (myocardial infarction) and stroke. Controlling or reversing atherosclerosis is an important part of preventing future heart attack or stroke.

Take charge of your health: Get a check-up Heart disease is the number one killer of Americans, but did most of the risk factors that cause heart disease are preventable. By taking charge of your health and scheduling yearly check-ups, you increase your odds of catching preventable conditions early. Check-ups may seem like a waste of time, but they are invaluable when it comes to detecting underlying problems. “The largest predictors of heart disease are conditions that you may not know that you have,” said Rebecca Rundlett, MD, cardiologist with Nebraska Heart Institute. “High blood pressure and diabetes often have no associated symptoms, yet; if left untreated can have very significant consequences on your health and will put you at a very high risk of a heart attack and stroke. A routine health exam could assess these, start treatment and reduce your risk substantially.” Major risk factors of heart disease include high blood pressure, high cholesterol, obesity, lack of physical activity, smoking, high blood sugar and lack of physical activity. At a routine yearly check-up, a doctor will take into account your overall health, including your risk factors, family health history, medications and any new conditions since your last visit. “The physician will conduct a physical exam basically to look for any early signs of preventable disease,” said

Rundlett. “This usually includes examination of your eyes, ears, mouth, throat, thyroid gland, heart, lungs, abdomen, skin and pulses. Your doctor may perform other exams as is appropriate given your individual health problems and concerns.” Rundlett recommends coming prepared to your check-up to make the most of your time: Go to your check-up fasting in case your doctor needs to order fasting labs. It may save you an additional trip to the lab on another day. Bring in a list of your medication prescribed by all of your doctors so that your primary doctor knows what your specialists are also prescribing you. Ask your family about their health history so that you can tell your doctor about your own possible risks. Between your regular visits keep track of any procedures that you may have had done by another physician or exams performed by other physicians such as your eye exams, mammograms, well-woman exams etc. Also keep track of your immunizations if not received by your regular doctor so that he can update you records. If need be, make a list of questions that you have been wanting to ask your doctor, likely if you don’t write it down you will forget when you are seen. — Courtesy the American Heart Association


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‘Mediterranean-style’ diet found to cut heart risks By MARILYNN MARCHIONE AP Chief Medical Writer

Pour on the olive oil, preferably over fish and vegetables: One of the longest and most scientific tests of a Mediterranean diet suggests this style of eating can cut the chance of suffering heart-related problems, especially strokes, in older people at high risk of them. The study lasted five years and involved about 7,500 people in Spain. Those who ate Mediter ranean-style with lots of olive oil or nuts had a 30 percent lower risk of major cardiovascular problems compared to those who were told to follow a low-fat diet but who in reality, didn’t cut fat very much. Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries. Mediterranean diets have long been touted as heart-healthy, but that’s based on observational studies that can’t prove the point. The new research is much stronger because people were assigned diets to follow for a long time and carefully monitored. Doctors even did lab tests to verify that the Mediterranean diet folks were consuming more olive oil or nuts as recommended. Most of these people were taking medicines for high cholesterol and blood pressure, and researchers did not alter those proven treatments, said one study leader, Dr. Ramon Estruch of Hospital Clinic in Barcelona. But as a first step to prevent heart problems, “we think diet is better than a drug” because it

has few if any side effects, Estruch said. “Diet works.” Results were published online Monday by the New England Journal of Medicine and were discussed at a nutrition conference in Loma Linda, Calif. People in the study were not given rigid menus or calorie goals because weight loss was not the aim. That could be why they found the “diets” easy to stick with — only about 7 percent dropped out within two years. There were twice as many dropouts in the low-fat group than among those eating Mediterraneanstyle. Researchers also provided the nuts and olive oil, so it didn’t cost participants anything to use these relatively pricey ingredients. The type of oil may have mattered — they used extra-virgin olive oil, which is minimally processed and richer than regular or light olive oil in the chemicals and nutrients that earlier studies have suggested are beneficial. The study involved people ages 55 to 80, just over half of them women. All were free of heart disease at the start but were at high risk for it because of health problems — half had diabetes and most were overweight and had high cholesterol and blood pressure. They were assigned to one of three groups: Two followed a Mediterranean diet supplemented with either extra-virgin olive oil (4 tablespoons a day) or with walnuts, hazelnuts and almonds (a fistful a day). The third group was urged to eat a lowfat diet heavy on bread, potatoes, pasta, rice,

The Associated Press

In this Jan. 17 file photo, a woman buys fruit at a market in Barcelona, Spain. Mediterranean diets have long been touted as heart-healthy, but that’s based on observational studies. Now, one of the longest and most scientific tests suggests this style of eating can cut the chance of suffering heart-related problems. fruits, vegetables and fish and light on baked goods, nuts, oils and red meat. Independent monitors stopped the study after nearly five years when they saw fewer problems in the two groups on Mediterranean diets. Doctors tracked a composite of heart attacks, strokes or heartrelated deaths. There were 96 of these in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the low-fat group. Looked at individually, stroke was the only problem where type of diet made a big difference. Diet had no effect on death rates overall. The Mediterranean diet proved better even though its followers ate about 200 calories more per day than the low-fat group did. The study leaders now are analyzing how each of the diets affected weight gain or loss and body mass index. The Spanish government’s health research agency initiated and paid for the study, and foods were supplied by

olive oil and nut producers in Spain and the California Walnut Commission. Many of the authors have extensive financial ties to food, wine and other industry groups but said the sponsors had no role in designing the study or analyzing and reporting its results. Rachel Johnson, a University of Vermont professor who heads the American Heart Association’s nutrition committee, said the study is very strong because of the lab tests to verify oil and nut consumption

and because researchers tracked actual heart attacks, strokes and deaths — not just changes in risk factors such as high cholesterol. “At the end of the day, what we care about is whether or not disease develops,” she said. “It’s an important study.” Rena Wing, a weightloss expert at Brown University, noted that researchers provided the oil and nuts, and said “it’s not clear if people could get the same results from selfdesigned Mediter-

ranean diets” — or if Americans would stick to them more than Europeans who are used to such foods. Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge, La., said he would give the study “a positive — even glowing — comment” and called it “the best and certainly one of the largest prospective dietary trials ever done.” “The data are sufficiently strong to convince me to move my dietary pattern closer to the Mediterranean Diet that they outline,” he added. Another independent expert also praised the study as evidence diet can lower heart risks. “The risk reduction is close to that achieved with statins,” cholesterol-lowering drugs, said Dr. Robert Eckel, a diet and heart disease expert at the University of Colorado. “But this study was not carried out or intended to compare diet to statins or blood pressure medicines,” he warned. “I don’t think people should think now they can quit taking their medicines.”



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