Heart and Vascular Institute
Healing The Heart - A Lifelong Partner
in the Health of Your Heart
Learn More About Your Heart and Vascular Health (Click on one of the articles below)
90 Minutes to Save A Heart
Door to balloon time is the standard of care that hospitals traditionally follow to gauge their responsiveness to a patient with an ST segment elevation myocardial infarction (STEMI). The interval starts with the patient’s arrival in the emergency room, and ends in the Cardiac Catheterization Lab when a catheter guidewire crosses the blockage in the coronary artery and a balloon on the catheter is inflated to open up the blockage. Because of the adage that “time is muscle,” meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage, the American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon interval of no more than 90 minutes. With the goal being to open the coronary artery as quickly as possible, alerting the on call team as early in the process as possible is the key. Many times, people believe they can get to the ER more quickly if they simply drive themselves. The reality is demonstrated in the following scenario.
The 911 Call
7:32 pm: Call comes into 911 of a 67-year-old male with chest pains
7:45 pm: Ambulance arrives at home
7:47 pm: 12-lead EKG started by EMS providers and transmitted to UCMC ER. Start the15 mile
trip to the hospital.
7:52 pm: UCMC ER physician confirms STEMI diagnosis and pages on-call interventional
cardiologist and cardiac catheterization team; about 20 minutes sooner than if the
patient drove to the hospital.
The Clock Starts
8:17 pm: The patient arrives in the Emergency Department. An initial assessment
is performed.
8:25 pm: Cath Lab on-call team arrives and sets up the Cardiac Catheterization Lab; about
30 minutes sooner than if the patient drove to the hospital.
8:30 pm: Cath Lab team picks up the patient from the ED, receiving report and letting the
patient know what to expect.
8:45 pm: Patient is brought into the Cath Lab and is prepped for the procedure.
8:50 pm: Diagnostic cardiac catheterization is performed and the blocked coronary
artery is identified.
9:10 pm: Balloon angioplasty (intervention) is performed. Door to balloon time:
54 minutes as compared to 85 minutes for patients arriving by car.
9:40 pm: The patient transferred to UCMC Intensive Care Unit where intensivists, charge
nurses and staff nurses provide round-the-clock care and monitoring
Recovery
- Recovery and observation continues on Intermediate Care Unit or STEMI/Stroke Unit,
- Patient and family education is provided. Patients are referred to the Cardiac Rehabilitation Program at UCH for continued follow-up care
Road to Lifelong Cardiac Health
- Cardiac Rehab begins at the gym located in the Ambulatory Care Center on the Upper Chesapeake Medical Center campus. This medically supervised exercise and education program helps improve heart health-whether recovering from a heart attack, bypass surgery, or angioplasty.
Since 2008, the Upper Chesapeake Cardiac Catheterization Lab has performed more emergency cardiac intervention procedures to save lives than any other community hospital in Maryland. That translates into mending over 300 hearts in Harford County through October, 2010.
“The gold standard is to ensure that individuals experiencing a STEMI heart attack receive life-saving balloon angioplasty in less than 90 minutes from arriving at the hospital,” said Dr. Michael Drossner, Medical Director of the UCH Cardiac Catheterization Lab. “I am proud to say that Upper Chesapeake Medical Center exceeds this benchmark set by the American College of Cardiologists, American Heart Association and the Maryland Healthcare Commission. Our average ‘door to balloon’ time is 76.3 minutes,” he added.
Upper Chesapeake Health received a waiver from the Maryland Health Care Commission to provide cardiac intervention without cardiac surgery capabilities on site for individuals experiencing a STEMI. “We have also applied to be a certified Cardiac Intervention Center as designated by the Maryland Institute for Emergency Medical Management Systems (MIEMSS),” said Mark Lewis, Director of the Upper Chesapeake Cardiovascular Institute. “Receiving this designation will ensure that individuals in our community who experience a heart attack will continue to receive life-saving care close to home. It is up to these same individuals to use the EMS system rather than taking themselves directly to the hospital so that we can provide the best result possible.”
You Got the Rhythm
This devastating killer strikes suddenly and often with few warning signs or symptoms. Taking more lives each year than lung cancer, breast cancer and AIDS, it is the leading cause of natural deaths in the United States. And yet most people are unaware of the danger sudden cardiac death (SCD) poses. SCD, also called cardiac arrest, occurs when the heart abruptly and without warning stops working, so no blood can be pumped to the rest of the body. It is responsible for half of all heart disease deaths in the United States. And, it often strikes individuals in the prime of their lives – mid-30s to mid-40s.
“SCD is not a heart attack which results from a blockage in a blood vessel, interrupting the flow of oxygen-rich blood to the heart,” says Joyce A. Zeno-Moreira, M.D., Board Certified Cardiologist and Clinical Cardiac Electrophysiologist at Upper Chesapeake Cardiology. “Sudden cardiac death occurs when the heart’s electrical system malfunctions, resulting in an irregular heartbeat,” she explained.
The most common cause of SCD is a specific heart rhythm disorder or arrhythmia called ventricular fibrillation (VF). Each heartbeat is controlled by electrical impulses traveling through the heart. In a normal heart, these impulses occur in regular intervals. In ventricular fibrillation, the electrical signals that control the pumping of the heart suddenly become rapid and chaotic.
SCD is reversible if it is treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A person’s chances of survival are reduced by seven to ten percent with every minute that passes without defibrillation. The American Heart Association supports the “chain of survival” to rescue people who suffer a sudden cardiac arrest.
The chain of survival consists of:
- Early access to medical care. If someone becomes unconscious, call 9-1-1 immediately.
- Begin chest compressions.
- Early defibrillation. Many communities have defibrillators in public places.
- Prompt medical attention saves lives.
Remember: When sudden cardiac arrest strikes, EVERY SECOND COUNTS.
“While SCD often occurs in people who appear healthy, sudden cardiac death is not a random event,” says Dr. Zeno-Moreira. “There are numerous contributors to cardiac arrest, but two of the most important ones are coronary artery disease and a previous heart attack,” she adds. A majority of the individuals who died of SCD showed signs of a previous heart attack and 80 percent had signs of blocked or narrowed arteries.
Dr. Zeno-Moreira also points out that there are a number of symptoms and signs that may indicate that a person is at increased risk for SCD. These include:
- An abnormal heart rate or rhythm of unknown cause.
- An unusually rapid heart rate (tachycardia) that comes and goes, even when the person is at rest.
- Episodes of fainting (called syncope) of unknown cause.
- A low ejection fraction (EF): a measurement of how much blood is pumped by the ventricles with each heartbeat.
At the Upper Chesapeake Cardiovascular Institute, there are a number of tests that can be performed to determine if an individual is at high risk for cardiac arrest. These procedures include:
Echocardiogram – an ultrasound test that can measure the pumping ability of the heart.
Electrocardiogram – An ECG or EKG test records the electrical activity of the heart.
Holter monitor – A Walkman-size recorder that patients attach to their chest for one to two days, recording a longer sampling of their heart rhythm.
As with any cardiovascular disease, adopting a healthy lifestyle can reduce your risks for SCD. This includes exercising regularly, eating healthy low-fat foods and avoiding smoking. Keep conditions that can contribute to heart problems such as high blood pressure, high cholesterol and diabetes under control.
“If you have abnormal heart rhythms that may trigger ventricular fibrillation, seeking treatment is vital to preventing sudden cardiac death,” said Dr. Zeno-Moreira. Treatment may involve medications, including beta blockers or implantable devices that regulate the heartbeat
“Implantable cardioverter defibrillators (ICDs) have been proven successful in preventing SCD in certain high risk patients,” said Dr. Zeno-Moreira. “ICDs as well as pacemakers can be implanted at Upper Chesapeake Medical Center.”
For more information on all the services provided by the Upper Chesapeake Cardiovascular Institute to detect and treat heart and vascular disease, go to uchs.org/CVI or call HealthLink at 1-800-515-0044 for a referral to one of our cardiologists.
Type II Diabetes and Your Heart
Individuals with diabetes should have their heart disease risk factors treated as aggressively as people who have already had heart attacks according to the American Heart Association. While everyone with diabetes has an increased risk of developing heart disease, the condition is more widespread in individuals with type 2 diabetes.
The more health risks factors that individuals have for heart disease, such as high blood pressure, smoking and high cholesterol, the greater the chances that they will develop heart disease. The probability of dying from heart disease is dramatically higher in a person with diabetes.
“The most common cause of heart disease in a person with diabetes is hardening of the coronary arteries or atherosclerosis,” says Dr. Funmi Ono, board certified endocrinologist with the Upper Chesapeake Diabetes and Endocrine Center. “There is a build-up of cholesterol in the arteries causing narrowing.”
When the cholesterol plaque in an artery breaks apart, the result can be a blood clot or blockage in the artery. This can lead to a heart attack or stroke or peripheral vascular disease. Treatment options for heart disease, depending on the severity, may include:
• Aspirin therapy
• Exercise for weight loss and to improve blood sugar levels
• Diet
• Medication
• Surgery to remove plaque and open arteries.
Peripheral vascular disease can also be treated with aspirin therapy and medications as well as participation in a regular walking program. Symptoms of peripheral vascular disease include:
• Cramping in your legs while walking
• Cold feet.
• Decreased or absent pulses in the feet or legs.
• Loss of fat under the skin of the lower parts of the legs.
• Loss of hair on the lower parts of the legs.
“The best way individuals with diabetes can reduce the risk of heart disease is to carefully manage their diabetes, as well as controlling other risk factors” explains Dr. Roy Phillips, board certified endocrinologist and Medical Director of Endocrinology at Upper Chesapeake Health. “This means keeping your blood sugar, blood pressure and cholesterol under control, exercising regularly and eating a heart healthy diet that is low in fat and salt,” he added.
Getting a team of experts behind you can help. The Upper Chesapeake Diabetes and Endocrine Center team of endocrinologists and certified diabetes educators (registered nurses and dietitians) offer support, treatment and education. Together with your primary care physicians and other physician specialists they will help you manage your diabetes successfully.
The Diabetes and Endocrine Center utilizes the latest in medicine and technology, including insulin pumps and continuous glucose sensors to help individuals manage their diabetes to the best of their abilities. For more information about the services provided by the Diabetes and Endocrine Center and how they can help you, call 443-643-3200.
New CPR Guidelines
The American Heart Association recently made changes in the guidelines for delivery of CPR (cardiopulmonary resuscitation). The major shift in the new guidelines is the order in which the rescuer or bystander executes the steps of CPR.
It is now recommended that CPR be carried out in the following order: Compressions –Airway- Breathing or CAB. The earlier the chest compressions are started on a heart attack victim, the better chance they have of survival. By doing chest compressions first, you get vital blood flow to the brain and the heart, which is critical to increasing the chance of survival.
Weighing the Risks and Benefits of Cardiac CT Scans
Cardiac CT imaging or CT angiography is a minimally invasive test that has the potential to offer early diagnosis and thus early and better treatment for many heart and vascular conditions. For the first time, CTA provides the ability to image coronary arteries noninvasively. As with most medical procedures, there are benefits and risks to the patient.
Exposure to x-rays during a CT angiogram is the most documented and commonly debated risk to patients. CT angiograms produce “ionizing radiation” in the process of creating images. While the overall risk of this radiation is low, its impact on overall health is still uncertain and varies among different populations.
In the fall of 2010, the American College of Cardiology and the American Heart Association along with other national medical societies released guidelines on the use of cardiac CT imaging. The participating societies recognized how technological progress in cardiac imaging has improved the care of patients with heart disease.
In general, the published guidelines stated that the use of CT angiography for the diagnosis and risk assessment of heart disease was viewed acceptable for many patients. Cardiac CT may be beneficial in:
• The early detection of calcium in coronary arteries.
• Non-invasively detecting blockages in coronary arteries.
• Detecting certain congenital heart conditions.
• Detecting certain heart masses or tumors.
Patients advised to have a CT angiogram should discuss the benefits and risks of the procedure with their physician. Remember, a CT angiogram should only be completed if there is a good medical reason for the scan. Currently, a CT angiogram is not recommended for routine prevention due to exposure to radiation.
How Does Carotid Artery Disease Happen?
When you think of arteries clogged by fat and cholesterol build-up, you usually think of the heart. Like the coronary arteries that supply blood to the heart, the carotid arteries supply oxygen-rich blood to the brain, specifically to the part of the brain that controls speech, personality and sensory and motor functions. A blockage in the carotid arteries increases your risk for a brain attack or stroke, the third leading cause of death in the United States.
Similar to a heart attack, a stroke occurs when blood flow is cut off. In the case of a stroke, the blood flow is cut off to the brain. If the lack of blood flow lasts for more than three to six hours, the damage is usually permanent. Carotid artery disease (CAD) also shares the same risk factors as coronary disease.
They include:
• Age
• Smoking
• High blood pressure
• High cholesterol
• Diet high in saturated fats
• Diabetes
• Obesity
• Sedentary lifestyle
• Family history.
Men under the age of 75 have a greater risk for carotid artery disease than women, but a woman’s risk increases after age 75. If you have coronary artery disease, you also have an increased risk of developing carotid artery disease.
“Carotid artery disease can be so dangerous because there are often no symptoms until a transient ischemic attack (TIA) or a stroke occurs,” said Dr. Andre Biuckians, a board certified vascular surgeon with Vascular Surgical Associates. “Plaque can build up over time with no warning signs until you suffer a TIA. Then it becomes a medical emergency because a TIA can progress into a major stroke,” he adds.
Since carotid artery disease rarely displays symptoms, Dr. Biuckians stresses the importance of seeing your doctor regularly for physical examinations. Your physician may listen to the carotid arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard, it may indicate carotid artery disease. Your doctor may order additional testing to confirm a diagnosis, including carotid ultrasound, magnetic resonance angiography, CT angiography or a carotid angiogram.
If there is severe narrowing or blockage in the carotid artery, a procedure called a carotid endarterectomy can be performed to isolate the artery and surgically remove the plaque and diseased portion of the artery. This will increase blood flow to the brain to prevent a future stroke.
Patricia Tenly, a 77-year-old widow from Havre de Grace, has undergone carotid artery surgery. When it came time to have the surgery again to remove plaque build-up, the mother of five daughters, chose a hospital and surgeon closer to home. She also chose a relatively newer treatment option – carotid artery stenting.
Less invasive than carotid endarterectomy, the stenting procedure involves inflating a small balloon to open the affected artery. Then, a stent is placed in the artery and expanded to keep the artery open.
“Dr. Gonze and his team at Vascular Surgery Associates prepared me well for the stent surgery,” said Pat. “I was worried about the pain involved but the local anesthesia they gave me kept the edge off and Dr. Gonze was able to tell me what he was doing as it was happening. This was very comforting,” she exclaimed.
The stent procedure performed by Dr. Mark Gonze, board certified vascular surgeon and Co-Medical Director of the Upper Chesapeake Cardiovascular Institute took about 1-1/2 hours. Pat was able to go home after a one-night hospital stay.
“I had 100% confidence in Dr. Gonze,” said Pat. And, Pat has high praise for Upper Chesapeake Medical Center where the surgery was performed. “I give them an A+. You can tell that they care which means a lot because as a patient you tend to feel vulnerable. I will take my local hospital over another hospital any day.” For a referral to one of our vascular surgeons, call HealthLink at 1-800-515-0044.
A Ticking Time Bomb
Causing no symptoms and with the potential to turn deadly, aortic aneurysms are like ticking time bombs in the body. The aorta is the body’s main artery, carrying oxygen rich blood from the heart to the rest of the body.
An aneurysm can develop when the generally elastic artery walls weaken and a bulge in a section of the aorta forms. Aneurysms can occur in any section of the aorta, but they most commonly appear in the abdomen and in the upper body or thoracic region. Because the section with the aneurysm is overstretched and weak, it can burst causing serious bleeding that can quickly lead to death.
“Patients often ask ‘how could this happen’ especially when they don’t have any symptoms,” said Dr. Mark Gonze, board certified vascular surgeon and Co-Medical Director of the Upper Chesapeake Cardiovascular Institute. “Atherosclerosis can weaken the artery walls. Risk factors such as high blood pressure, smoking and diabetes along with the wear and tear that naturally occurs with aging can result in a weak aortic wall,” he continued.
Richard Sanko, a 78-year-old retired army counselor at Aberdeen Proving Ground, knows all too well about this silent danger. His aneurysm was discovered after a routine visit to his primary care physician, Dr. Robert Ishak, of Upper Chesapeake Primary Care.
Dr. Ishak sent Richard for an x-ray which showed a “shadow.” After additional testing, including a CT scan, revealed an aortic aneurysm, Richard was referred to Vascular Surgery Associates and Dr. Gonze. “One of the first steps we had to take was to determine if Richard was a good candidate for minimally invasive surgery,” said Dr. Gonze. Fortunately for Richard, he was. Surgery for aortic aneurysms involved repairing the damaged part of the aorta with a stent or replacing it with a graft.
“Prior to 10 years ago, we had limited options for fixing aortic aneurysms and, if the aneurysm ruptured, it was fatal 95 percent of the time,” said Dr. Gonze. “Now with new materials and techniques, surgeons can repair aneurysms using a minimally invasive procedure. Patients are surprised by the streamlined and simplicity of the procedure,” said Dr. Gonze. Compared to the two to three-month recovery time required 10 years ago, patients today can often go home the same day and be back to work in as little as 48 hours.
Richard said that Dr. Gonze did an excellent job explaining the procedure to him and “there were no surprises.” However, he does admit it is hard to believe he had surgery. “With no symptoms, the whole problem appeared invisible. But I have the reassurance the ticking time bomb that was inside of me is fixed,” Richard said.
For a referral to a vascular surgeon, call HealthLink at 1-800-515-0044.
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