Category Archives: Heart Disease Treatment

Q&A: Why is salt bad for your heart?

with Dr. Bussie Evans, CardiologistDr Evans

Why is salt bad for your heart?

Dr. Evans: Our bodies need a little salt for optimal health, however the typical American diet can contain two or three times the amount needed.  Too much salt causes the body to retain water.  This increase in fluid in the body increases blood pressure which puts a strain on blood vessels, the heart and kidneys.  As a result, people with high blood pressure have an increased risk of heart disease and stroke.

Does everyone need to monitor their salt intake?

Dr. Evans: It’s safe to say that everyone eating an American diet could benefit from paying attention to and reducing their salt intake. Most people have no idea how much salt they consume.  People assume that if they don’t use their salt shaker much, they aren’t eating much salt.  But salt / sodium is already present in many of the foods we eat.  Especially processed foods. It is important to pay attention to your salt intake if you have high blood pressure, and if you have heart failure, too much sodium and the accompanying fluid retention can be very dangerous.

How much salt is too much?salt shaker

Dr. Evans: The Heart Association recommends no more than 2,300 milligrams of sodium a day, however for most adults, especially seniors, no more than 1,500 milligrams is a better guideline.  Our blood pressure tends to increase as we age, so lowering salt intake can help to keep it in check. To give you an idea, one teaspoon of salt is 2,300 mg of sodium.  In packaged foods, the amount of sodium is on the nutrition label, but pay close attention to the serving size.  Let’s say that a can of soup has 800 mgs of sodium per serving, but a serving is only 1/2 a cup. To be realistic, you are likely to eat one whole cup of soup if not more and then you’ve already exceeded your recommended daily sodium intake.  It’s just that easy to take in too much salt if you’re not paying attention.

How can I reduce salt if it’s already in the food I eat?

Dr. Evans: Ideally, eating more fresh foods that are prepared at home rather than packaged foods can make a big difference not just in salt consumption but in your overall health.  And when cooking at home, use more herbs and spices for flavor and less salt.  For recipes and meal plans, there are a lot of free resources you can find online by looking up the DASH Diet. When buying packaged foods, read the labels and look for lower sodium alternatives. It really doesn’t take long for your tastes to adjust to less salt and you’ll soon find that some foods taste way too salty.  Certain foods are known for containing a lot of salt, and unfortunately, they are American favorites:  pizza, sandwiches, soup, breads and baked goods, cold cuts, poultry, cheese, and of course condiments and sauces.  People tend to ignore the nutritional labels on condiments, but soy sauce or barbeque sauce, for example, can really blow up your daily sodium intake.  There are ways to make some of these salty favorites less salty and more healthy like getting the thin crust pizza with more vegetables, half the cheese and an uncured meat instead of pepperoni.  However at the very least, limit your portions of salty foods.

If I limit my salt intake will my blood pressure be normal?

Cutting back on salt is one of the easiest things you can do to help your blood pressure, but it is not a cure all.  There can be other causes of high blood pressure such as family history, poor diet, lack of exercise, being overweight, smoking, and excess alcohol consumption.  Limiting salt intake should be part of an overall heart healthy lifestyle that includes regular exercise, a heart healthy diet, and maintaining a healthy weight.  High blood pressure, much like high cholesterol, is a silent risk factor of heart disease, so having your blood pressure and cholesterol checked regularly can help you and your doctor find lifestyle modifications, or medications if needed, to reduce your risks for cardiovascular disease.

 

What is a Silent Heart Attack?

A study of approximately 9,500 middle-age adults found that nearly half of the heart attacks that occurred during the study period were “silent”. TheDr Haghighat patients were not aware they had a heart attack and did not seek medical attention however, their electrocardiogram (ECG) screening during a regular follow-up appointment showed that a heart attack had occurred.

The study, Atherosclerosis Risk in Communities (ARIC), analyzed the causes and outcomes of atherosclerosis – hardening of the arteries. Over an average of nine years after the start of the study, 317 participants had silent heart attacks while 386 had heart attacks with clinical symptoms.

Amir Haghighat, M.D., interventional cardiologist at the Cardiovascular Institute in Panama City, clarifies that “Silent does not necessarily mean a total lack of symptoms. More likely, it’s that the symptoms were subtle or not recognized as a heart problem.”   Frequently, television and movies depict a heart attack as a dramatic event with crushing chest pain. “Chest pain is a common symptom, however everyone experiences heart symptoms differently.” says Dr. Haghighat. “For some, it may be shortness of breath, pain in their left arm, in their neck or jaw, or even in the shoulder blades, and it may not be as dramatic as you think.”

“The outcome of a silent heart attack is as bad as a heart attack that is recognized while it is happening,” said Elsayed Z. Soliman, M.D., MSc., M.S., study senior author and director of the epidemiological cardiology research center at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. “And because patients don’t know they have had a silent heart attack, they may not receive the treatment they need to prevent another one.”

Dr. Haghighat stresses that these study results are further proof that patients should see their primary care providers regularly and discuss any unusual symptoms they may be experiencing. “We all know when we’re feeling something different in our bodies and it’s important to discuss it with a healthcare provider,” says Dr. Haghighat. “Take note of when your symptoms occur, do they happen with exertion or at rest? Don’t ignore symptoms just because they come and go. Your primary doctor may be able to identify the issue with basic screenings and prescribe preventative measures. Or in the case of a “silent” heart attack, coordinate treatment with a cardiologist that can lower your risk of having additional heart attacks.”

After following participants in the ARIC study for 20 years, researchers found that having a silent heart attack increased the chances of dying from heart disease by three times. As a result, silent heart attacks should be treated just as aggressively, once discovered, as a heart attack with recognizable symptoms. “For both kinds of heart attacks,” says Dr. Haghighat, “the risk factors and the treatment are the same. Even though a patient may not have experienced a scary heart event in an ER, they still need to be proactive and make lifestyle changes to reduce their risk such as quitting smoking, losing excess weight, eating healthy and getting regular exercise.”

What To Expect at Your Stress Test

A Q & A with Cathy Rodes, MSN, ARNP with the Cardiovascular Institute of Northwest FloCathy Rodesrida

Under what circumstances would a patient need a stress test?

Patients may be scheduled for stress tests to evaluate symptoms of chest pain, for an exercise prescription, to evaluate for exercise induced arrhythmia or for surveillance of known coronary artery disease.

Do all stress tests require physical exercise?

Graded exercise tolerance tests (GXT), whether with or without imaging require exercise on a treadmill to achieve the patient’s target heart rate, which is determined by patient’s age. Pharmaceutical Nuclear stress tests do not require exercise.

When is a nuclear stress test needed versus an exercise stress test?

Pharmaceutical Nuclear stress tests are utilized when patients are unable to exercise, in cases of certain ECG (electrocardiogram) abnormality, when the patient is unable to reach the target heart rate with exercise due to medications, or when a patient has certain brady arrhythmias (slow heart rates requiring pacemaker). Nuclear stress tests, where treadmill exercise is used along with nuclear images, are generally ordered versus a standard GXT when the baseline ECG is abnormal, when imaging is desired because of the patient’s coronary anatomy or a previous standard GXT was not quite normal.

With an exercise stress test, what sort of physical activity should I expect?using a treadmill for a stress test

GXT or Stress Nuclear test requires walking on the treadmill long enough to raise the heart rate to target as well as long enough to be physically stressed (tired, short of breath, etc.). The treadmill gradually speeds up and elevates incline every three minutes. Most patients exercise for 7-9 minutes, depending on functional capacity. Be sure to dress comfortably with appropriate shoes for exercise.

With a nuclear or medication-induced stress test, what should I expect?

With a pharmaceutical nuclear study, the patient does not exercise. Lexiscan Nuclear dilates the patient’s arteries as if they have exercised. They may experience shortness of breath with the medication. Also, patients are encouraged to eat 2 hours prior to the test to reduce any GI effects. Patients must avoid all caffeine products for 24 hours prior to Nuclear stress tests.

How long does the test take?

Patients are usually here for about 30 minutes for a GXT secondary to paperwork, setup and recovery. We ask patients to anticipate being here for 2 hours for a Nuclear stress test to allow for imaging. There is a second day of testing required for Nuclear stress tests, however patients are usually only here for approximately one hour for injection and imaging.

What can be revealed about your heart health during these types of tests?

All stress tests are screening tests and cannot exclude the presence of Coronary Artery Disease (CAD) or progression of CAD, but exercise stress tests give a good idea of functional capacity and prognosis if the patient does have CAD. Also, nuclear imaging gives a good idea of coronary perfusion which helps the cardiologist determine if further testing is needed.

If I “fail” my test, what’s the next step?

If a GXT is abnormal, your provider may recommend a Nuclear stress test or a cardiac catheterization. Every situation is different and other health history comes into play for this decision. Nuclear stress tests that are abnormal may indicate older heart damage or narrowing / blockages in the arteries. Therefore the provider would recommend catheterization vs. medical management based on the particular situation. Next steps are usually discussed at a follow up appointment after all testing is completed.

Heart Disease Patient Benefits from World’s Smallest Heart Pump

Nellie Smith was suffering from severe abdominal cramping and was convinced she needed to have her gallbladder removed. The problem with havingNellie_Smith this routine surgery however was Nellie’s heart. Nellie had survived a heart attack seven years ago and was told that her heart disease was severe. Multiple vessels around her heart were narrowed. She had previously been very active, but following her heart attack found that she tired very easily, was frequently short of breath and experienced chronic chest pain. She hoped to avoid further heart procedures by taking medications.

Eventually, Nellie’s abdominal pain became so severe she found herself at Bay Medical. Her cardiologist Dr. Michael Stokes was called to assess her heart health and delivered dire news. The blockages around her heart had left her with only one main vessel supplying blood flow to her heart and her ejection fraction (a measure of how well the heart is pumping blood) was only 15%. In this condition, it was far too risky to have surgery on her gallbladder and it was very high risk to perform a standard cardiac catheterization to open her heart blockages as well.

Fortunately, Bay Medical is the only hospital in the region with a unique technology designed to support heart function during high-risk cases. Dr. Stokes contacted his partner Dr. Amir Haghighat, one of three local cardiologists trained to use the Impella, the World’s Smallest Heart Pump, to help with Nellie’s case.

The Impella is roughly the size of a small writing pen and, using guide wires, can be inserted through a small incision in the groin area and navigated through the major blood vessels into the heart. The device can continuously keep blood pumping while the dangerous work of opening multiple blockages takes place.

 

Unlike an open surgery, a cardiac cath requires only mild sedation and patients are awake and able to interact with their physician. Nellie was able to see the images on screen of her blood vessels during the procedure and noted that “as he opened each blockage, it was like a road map suddenly began to appear on screen.” The previously blocked vessels filled with blood to feed the heart muscle. “I felt a difference immediately, right there on the table,” said Nellie.

The next day in the hospital, Nellie was up and walking around the cardiac nursing floor. “I feel really good,” she says. “I’m looking forward to going home, cleaning my house and cooking a meal. I know that doesn’t sound like much, but it was too tiring and too difficult to do those things before.” To her surprise, Nellie noted that she was no longer experiencing abdominal pain. She excitedly put her grandchildren on notice to expect “a NEW Granny” when she returned home.

Prior to the availability of Impella technology, patients like Nellie would not be able to have a cardiac procedure to open narrowed vessels due to the high risk involved. In many cases, bypass surgery would be too risky as well, leaving these patients with little hope of recovery. CVI cardiologists Dr. Samir Patel, Dr. Amir Haghighat and Dr. Thompson Maner have used the Impella technology to give many of these patients deemed too high-risk a second chance. “This is why we’re always learning and working to bring the latest technology to Bay Medical,” says Dr. Haghighat. “To have a great save like this one and to give those grandkids ‘a NEW Granny’ is why we do what we do.”

 

New Technique Opens Hardened Coronary Arteries

The rotating Diamondback 360 device sands a tunnel through the calcified plaque lesion to restore blood flow.

Plaque build-up in the arteries, or atherosclerosis, is the cause of heart attack. This plaque is usually soft and pliable and a cardiologist uses a procedure called balloon angioplasty to push open the plaque build-up in narrowed arteries to restore blood flow. However, in up to 40 percent of patients who need this procedure, this plaque that has been building for a long time can become calcified or hardened where a standard balloon procedure is not effective. Fortunately, the FDA has approved a new technology to remove this hardened plaque called the Diamondback 360.

 

The Diamondback 360 is essentially an orbital sander literally coated with diamonds for an extra-fine grit to open hardened plaque build-up. Interventional cardiologist, Dr. Samir Patel, who was first to use the technology in the coronary arteries in our area says ” This technique has been successful for several years in treating the long, relatively straight blood vessels in the legs when calcified lesions are present, however this is the first device approved for use in the arteries around the heart.”

The tiny round device uses centrifugal force to sand away the calcification while the flexible, healthy tissue flexes away. As with any sanding process, particulates are produced, however these are far smaller than the blood cells and do not create any further blockages. Once the hardened plaque is removed, a stent can be placed to hold open the artery.

“Clinical trials of this device prior to FDA approval have shown it be highly safe and effective in treating patients with these very difficult coronary lesions,” says Dr. Patel. “At medical centers without advanced technology and techniques such as this for blocked and calcified arteries, these patients might not receive treatment other than medications. The blockage would remain and so would the symptoms that come with it such as chest pain and shortness of breath and leave the patient at increased risk of heart attack.”

Dr. Patel used the new coronary device for the first time in April at Bay Medical Sacred Heart, the only facility in our area offering this technology.  For a local news story with WMBB-News13 featuring Dr. Patel and an animated video of how the new technology works – click here.

Cardiovascular Institute Offers Heart Failure Clinic

hrtflr-01Heart Failure is a chronic and progressive disease, but for patients who are willing to work closely with healthcare providers and manage their diet and exercise there can be improvement in heart function and quality of life. The Cardiovascular Institute developed a Heart Failure Clinic in the Fall of 2014 with the primary goal of helping our heart failure patients stay healthy and out of the hospital. Nurse Practitioner Karen Williams, who helped develop the program, says that she has seen marked improvement in our patients who participate fully, including increased activity levels and a reduction in hospitalizations.

The three main components of the Heart Failure clinic include Monitoring, Management and Education.

Heart Failure is caused by other conditions that have damaged the heart muscle, making it weak and unable to supply the body with sufficient blood and oxygen. In addition to monitoring the symptoms of heart failure for any changes, contributing conditions such as high blood pressure, coronary artery disease, and sleep apnea are treated in conjunction with each patient’s healthcare team.

Education plays a vital role in our Heart Failure Clinic. Patients are taught how to read food labels and plan meals that keep sodium intake in check and provide enough fluid but not too much. Excess sodium can cause fluid to back up in the lungs and swelling of the feet and ankles. Patients will learn more about their medications, how they work, potential side effects and the importance of following a proper dosage schedule. We also work with our patients to find fitness activities that are best for their condition and offer a cardiac rehab program.

“Our patients who participate in the Clinic definitely feel more empowered to manage their condition,” says Williams. “While there isn’t a cure for heart failure, our patients can regain a sense of well-being knowing that they have the knowledge and the tools to keep their symptoms in control.”

For patients with advanced stage disease, our clinic provides information for patients and their family members to make end of life care decisions and assists in connecting them with any other necessary services for their continued comfort.

Heart Failure clinic appointments are available five days a week. The frequency of visits to the clinic is dependent on each patient’s condition, however, most patients visit weekly or monthly for ongoing monitoring and treatment of their condition. Clinic visits are covered by all insurances. Talk with your primary care provider or cardiologist about your condition and if participating in our Heart Failure Clinic could be beneficial for you.

News on Local Hospital Quality & Pricing Data — Bay Medical Recognized for both Quality & Value

Patients today are fortunate to have an increasing amount of public data available to them about hospitals and healthcare providers in order to make the most informed decision on where and from whom to receive care.  In June 2015, several sources published data regarding outcomes and charges for hospital care.  Here at the Cardiovascular Institute, we see patients from all over Northwest Florida, so we reviewed the data currently posted for all Northwest Florida hospitals from Pensacola to Tallahassee, as well as the hospitals in Dothan, to see where area patients can go to receive the best quality and value care.

The data most accessible to the public comes from Medicare and is used by a variety of websites to report on mortality rates for the most common conditions and procedures.  The data we found for Coronary Interventions showed Bay Medical with an in-hospital mortality rate of 0.80% – the lowest in the region.   Most other area hospitals had rates in the 2 – 5% range.  Heart Failure is another commonly rated condition and several sites noted that Bay Medical’s in-hospital mortality rates were among the best in the nation.  We certainly found them to be the best in the region in our review of the available data, with a 1.6% mortality rate out of 1,315 cases.  Only one other hospital came close, West Florida , located in Pensacola, with a 1.71%.  All others were in the 2-7% range.

Coronary Bypass Surgery (CABG) is another procedure that is commonly rated in public data, however not all hospitals who offer Coronary Interventions provide this next level of service.  Having the back-up of cardiothoracic surgeons who can offer this procedure in the facility where you have a coronary intervention gives you added security and can be life-saving.  In this category, Bay Medical had a 0.0% in-hospital mortality rate.  Once again, this was the lowest rate in the region by far.  Gulf Coast Regional Medical Center and Sacred Heart on the Emerald Coast do not offer this procedure and were not rated. However, most other hospitals in the region had rates in the range of 2-6%.

Heart Attack is also rated.  Bay Medical Center was the second lowest in-hospital mortality in the region, behind West Florida Hospital in Pensacola, at 5.27%.  The other hospitals in our region had rates ranging from 6-11%.

As the only cardiology group practicing at Bay Medical Center, we were excited to see how favorably Bay Medical compared with others in the region as this reflects directly on the care that we provide.  At Bay Medical, we have the support of administration as they continually invest time and resources into a top of the line heart program and the clinical expertise of well-trained nursing staff caring for our patients.  Together, we make a great team and it shows in these publicly reported outcomes.

In addition to quality data, average charges are also available to the public if you know where to look.  In Florida, the easiest place to find this information is a state site called www.floridahealthfinder.gov.   A recent independent analysis of this charge information found Bay Medical Center to be among the Top 10 Best Values in Florida based on price and quality.  In a separate nationwide study recently reported in the Washington Post, three hospitals in our region were listed among the Top 50 for over-charging with an average charge that is 10 times what Medicare will cover.  One is here in Panama City.   For those who have Medicare, or in-network insurance plans, this practice of overcharging may not have a direct impact on what you pay, however, it does impact overall insurance rates .  As a tourist community, we have many out-of-state visitors who unfortunately find themselves in need of medical care out-of-network.  It is in cases such as these, where insurers and consumers are faced with this price gouging.   Insurers pass this cost along in the form of higher rates for everyone the following year.  In addition, with insurance policies having increasing deductible and out-of-pocket expenses, charges matter.

In the past, consumers did not have access to this information and frequently had no idea of the hospital’s reputation for caring for their condition or of what the charges might be until after they’ve received the care.  As a result, pricing and quality in healthcare have varied widely and often do not go hand-in-hand.

We encourage you to do your research and support institutions who are offering a quality service at a value price.  This is how we will make a difference in the American healthcare system.

For those who wish to research hospital quality in our area or look at how our local hospitals fare on other types of conditions, we recommend:

www.HealthGrades.com   –  This website uses star ratings, however we encourage you to look at the detail information provided to see actual mortality rates.  The stars are based on the actual versus a predicted rate.  Some hospitals have a much higher predicted rate and as a result may have a higher star rating than another hospital with a lower actual mortality rate.

www.medicare.gov/HospitalCompare   – This website only monitors mortality rates for several of the most common conditions. It includes other quality data and patient satisfaction data to help you get a broader picture of a hospital’s overall care.

www.floridahealthfinder.gov  – This website allows you to compare hospitals versus state averages to see a clear picture of price, length of stay for a certain conditions and roughly how many cases a hospital treats of that condition.  When a hospital treats far less of a certain condition than another, it’s possible they have less expertise in that area.

www.consumerreports.org (subscription required)

*The rates reported here were posted in June 2015.  These sites are updated and rates change as newer data becomes available.  Before making your healthcare decisions, please check for the most current quality data available.

High Risk Patients Successfully Treated with the IMPELLA LVAD at the CardioVascular Institute of Northwest Florida

Interventional cardiologists at the CardioVascular Institute of Northwest Florida have a new tool in their fight against coronary artery disease and heart attacks.  The AbioMed’s IMPELLA 2.5 Liter Left Ventricular Assist Device (LVAD), also touted as the “world’s smallest heart pump”, has been successfully used by interventional cardiologists at the CardioVascular Institute of Northwest Florida since March 2011.  The patients considered needful of this device were those with severe, non-operable coronary disease.  Indeed, some patients were suffering from massive heart attacks.

 

The IMPELLA heart pump is a new minimally invasive treatment option for the most serious of cardiac patients who are deemed too high-risk for surgery.  The IMPELLA is inserted through a small incision in the groin and advanced into the main pumping chamber of the heart, the left ventricle.  Once placed, the heart pump essentially “takes over” the pumping function of the heart, allowing cardiologists to perform high-risk angioplasty procedures for non-operable coronary disease while reducing the risk of heart attack or death during the procedure.  After the procedure is successfully completed, the heart pump is removed with minimal recovery time.  Since the IMPELLA allows the heart to rest and recover by actively taking over the work load of the heart’s main pumping chamber, patients in cardiogenic and advanced heart failure may also benefit from the IMPELLA heart pump.

 

With the support of Bay Medial Center/Sacred Heart Health Systems, the CardioVascular Insitute of Northwest Florida was instrumental in bringing this new technology to Bay County and the Florida Panhandle.  Prior to the use of the IMPELLA heart pump, patients with severe coronary disease or massive heart attacks who were not candidates for traditional coronary bypass surgery would be faced with extremely high risk of complications or death.  The IMPELLA heart pump is one more option in our treatment of the “sickest of the sick” cardiac patients.  The CardioVascular Insitute of Northwest Florida strives to remain in the forefront of the constantly evolving medical landscape to provide its patients the most progressive cardiac care and the widest selection of treatment options.