cardiac HEALTH ON TIME SUMMER 2015
The Heart-Lung Connection HEART DISEASE CAN AFFECT YOUR LUNGS AND VICE VERSA. HERE IS WHAT YOU SHOULD KNOW.
IT’S NO COINCIDENCE that your heart is located right between the major lobes of your lungs. The heart-lung function (“cardiopulmonary” function) is crucial to human life, and failures in the system can cause big problems. Your heart pumps blood throughout your body, but blood must first go through your lungs. In the lungs, blood picks up inhaled oxygen, which will feed all the cells in your body. When the blood returns to your lungs, carbon dioxide gets released and exhaled, and the blood goes back into your heart to start the trip all over again. On top of all that, your heart and lungs have direct blood vessel connections that feed each other.
For most people, this complicated “plumbing” system works fine. However, blockages or breakdowns within the system are a serious matter. Here are a few of the most common cardiopulmonary problems. Congestive heart failure (CHF). CHF means the heart is damaged and weakened and does not pump blood throughout your body as efficiently as it should. Of course, this affects lung function as well. Chronic obstructive pulmonary disease (COPD). COPD is usually diagnosed when you have a combination of two diseases: chronic bronchitis and emphysema. Chronic bronchitis means lung tissue stays inflamed and irritated, and emphysema causes lung tissue to lose elasticity. The combination diminishes breathing function, which can affect the heart. Pulmonary hypertension. Also known as pulmonary arterial hypertension (PAH), this condition involves abnormally elevated blood pressures in the blood vessels that directly connect the heart and lungs. There are various causes for PAH, including narrowed
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
Renetta DuBose
Like many diseases, the risk factors for cardiopulmonary diseases fall into two categories: factors you can control and those you cannot control. Understanding both types can help you to avoid or lessen the chances that you will suffer from cardiopulmonary diseases. Since your heart and lungs are so closely connected, the major risk factors for heart and lung diseases overlap significantly. For example, smoking is a major risk factor for most heart and lung diseases, and quitting smoking is the No. 1 way to reduce your risks for all these diseases. However, your genetic makeup is something you cannot control, and genes are increasingly being shown to play a prominent role in many diseases, including heart and lung diseases. Therefore, if you have a family history of heart or lung disease, it’s even more important that you talk to your doctor and educate yourself about the best lifestyle choices for your individual circumstances. or inelastic blood vessels. Left untreated, it can cause heart failure. Healthy cardiopulmonary function is important to your overall health. If you have heart or lung disease, make sure you understand its effects on the other organ.
The Cardiovascular Center 15th Street is now open! See inside for more information!
Reporting from the Heart IT’S NOT EVERY DAY that you see a heart. Let me correct that: It’s not every day that you see a heart beating, stop beating, and then start beating again. This is a testament to the amazing work of GRHealth’s Heart &
CAN CARDIOPULMONARY DISEASES BE PREVENTED?
BY RENETTA DUBOSE, DIGITAL JOURNALIST, WJBF NEWS CHANNEL 6
Cardiovascular team. There are powerful hands at work, which I have witnessed during open heart surgery at Georgia Regents Medical Center. Interestingly, these patients had no idea they were living with heart disease. I was introduced to the heart of 53-year-old Wayne Curtis of Augusta on February 23, 2015. He was undergoing triple bypass surgery, and News Channel 6 cameras were inside the operating room, Blockage in the artery with his consent, to document what I believe was nothing short of a miracle. Heart surgeons Drs. Vinayak Kamath and Vijay Patel, along with a fierce medical team, uncovered two
additional blockages, which resulted in quintuple bypass surgery. Doctors removed a vein from Mr. Curtis’ leg and put it in a heparin solution to prevent clots. They stopped his heart with the help of perfusionist Bryan Boden. They sewed the vein into the heart, allowing the blood flow through the heart to be redirected away from the blockages. Mr. Curtis lived. Fifty-nine-year-old Nancy Payne received cardiac catheterization for her 70 percent blockage and is keeping fit with GRHealth’s Cardiac Rehabilitation program. While exercise and clean eating help, if that fails due to a family history of heart disease, GRHealth will have talented hands ready to help.
For more information, visit grhealth.org/cardio. GRU-017
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
TAKE ACTION AGAINST H COPD: Chronic Obstructive Pulmonary Disease COPD IS A POTENTIALLY fatal disease that is the convergence of closely related lung diseases, most often emphysema and chronic bronchitis. The major cause of COPD is smoking; in fact, approximately 90 percent of deaths from COPD are caused by smoking. About 15 million U.S. adults are estimated to have COPD, and it’s the third-leading cause of death in the U.S., with approximately 134,676 deaths in 2010 (the latest year available). In the early stages of COPD, a person may not be aware of the damage to their lung function. The early symptoms of COPD are similar to those often experienced by smokers: shortness of breath, wheezing, chest tightness, excess lung mucus, chronic cough, frequent respiratory infections and lack of energy. COPD can cause heart failure, Approximately affecting the right side of the heart in particular. Damaged lung tissue makes it harder for the heart to do its job of pumping of deaths from blood through the lungs and out COPD are caused to the body. Additionally, diminby smoking. ished blood flow can damage the kidneys, which can lead to fluid buildup and other problems throughout the body. The good news is that COPD is largely preventable. If you don’t smoke, don’t start. If you do smoke, stopping can help you to avoid or postpone getting COPD. COPD cannot be reversed or cured. However, there are lifestyle changes you can make and medicines you can take to alleviate the symptoms to improve your quality of life.
90%
COPD can strike adults younger than age 40 if they have a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency— even if they have never smoked.
COPD is the thirdleading cause of death in America, with
134,676 deaths in 2010.
Lung with COPD Walls of alveoli are destroyed, forming fewer, larger alveoli. Healthy lung
Lung irritants, such as chemicals, dust, secondhand smoke and other harmful airborne pollutants, can lead to COPD after long-term exposure.
YOUR PHYSICAL FITNESS AND HEART HEALTH TIMELINE
5–17 years
18-64 years
Growing Strong. Engage in at least 60 minutes of moderateto vigorous-intensity physical activity daily. Do not start smoking! And if you have, quit before too much damage is done.
On the Move. To strengthen your heart and lungs, you need at least 150 minutes of moderateintensity physical activity throughout the week, at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity. Add muscle-strengthening activities two or more days a week. At Full Strength. For additional heart-health benefits, increase your moderate-intensity physical activity to 300 minutes per week.
65+ years
Keep the Beat. For ultimate cardio health, aim for at least 150 minutes of moderate-intensity physical activity throughout the week, at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity.
Call 706-721-2426 to request a same-day appointment with Heart & Cardiovascular Services.
EART DISEASE A LOOK INSIDE THE CARDIOVASCULAR CENTER 15th STREET GRHEALTH’S HEART & CARDIOVASCULAR SERVICES opened a new center on campus June 19. The Cardiovascular Center 15th Street is located at 937 15th Street, Augusta, Georgia, at the site of the former sports medicine center. The center houses general cardiology, interventional cardiology, cardiac rehabilitation and an outpatient echocardiography lab. It offers stateof-the-art cardiac rehabilitation monitoring equipment and on-site cardiology diagnostic testing, as well as convenient parking and close proximity to hospital-based services. Cardiac rehabilitation was the first service to join the Cardiovascular Center 15th Street after sharing space and equipment with the Wellness Center on Georgia Regents University’s Health Sciences Campus since August 2007. The new location not only gives the program its own space, but it also resides in the same building as the clinic. This allows patients to schedule upcoming clinic appointments and cardiac rehabilitation sessions during one visit. The importance of emotional and social support in the rehabilitation process inspired the setup. For instance, the exercise machines encircle the monitoring station from which all patients can be observed, receive education as a group and interact with one another.
PULMONARY HYPERTENSION: THE HIDDEN “OTHER” HIGH BLOOD PRESSURE
The area also includes the following amenities: n B rand-new, state-of-the-art equipment geared specifically toward rehabilitation n Walking track
n
n
T ables and chairs so caregivers can observe the sessions C onference room for group cardiovascular risk management classes and individual counseling
Heart Failure
Pulmonary artery
Pulmonary arteries have narrowed or become inelastic
HYPERTENSION IS the formal medical term for high blood pressure. Most diagnoses of high blood pressure indicate elevated pressure throughout the body. However, pulmonary hypertension is specific to the blood vessels that connect the right side of the heart and the lungs. This hypertension is a sign that the pulmonary arteries are not working, because they have narrowed or become inelastic. Patients with pulmonary hypertension usually do not know they have the condition until symptoms appear. The disease can appear at any age, even in otherwise healthy people. Symptoms include several that are common with problems in the heart or lungs: chest pressure, shortness of breath, fainting/lightheadedness during physical activities, fatigue, unusual swelling in feet and ankles, bluish skin tone and heart palpitations. Although regular high blood pressure is simply measured with a blood pressure cuff, measuring pulmonary hypertension requires specialized medical training and equipment. Doctors have to be specifically looking for pulmonary hypertension to find it, and it’s often overlooked or misdiagnosed, because the symptoms are so common. Pulmonary hypertension can lead to heart failure and other fatal complications. The disease is not preventable, nor is there a “cure.” However, good treatments are now available that alleviate the symptoms, allowing patients to live better and much longer lives. Research is also ongoing on new treatments that show potential.
THE MEDICAL TERM “heart failure” can be a little confusing. If you have heart failure, your heart hasn’t completely “failed” or stopped. It just means that your heart is not pumping as much blood as it should. Reduced blood flow means a reduction in the oxygen and other nutrients your cells need to function, which can lead to bigger problems. There are different kinds of heart failure, based on which part (or parts) of your heart aren’t working well. Also, as heart failure advances, it can cause a buildup of fluid in your lungs and other organs, which is a condition called congestive heart failure (CHF). The causes of heart failure are numerous. Some causes can be prevented or controlled, but many cannot. For example, uncontrolled high blood pressure, diabetes and obesity can lead to heart failure. Good medical care and lifestyle changes can reduce or eliminate these problems. However, defective heart valves and other heart diseases you are born with can also cause heart failure. Additionally, coronary artery disease, a past heart attack, heart muscle disease, severe lung disease and sleep apnea can also lead to heart failure. TREATMENT OPTIONS FOR HEART FAILURE INCLUDE: n M aking healthier lifestyle choices about your diet, exercise and weight; n T aking medications to reduce fluid retention and increase blood flow; n H aving surgery to implant medical devices that will help your heart pump better; n H aving surgery to correct defective valves, remove blockages or get a heart transplant; and/or n G etting regular medical care to monitor your condition.
For more information on cardiovascular health, go to grhealth.org/cardio, or call 706-721-2426.
MAINTAINING A CLEAR PATH AFTER JODY STAFFORD, a Savannah, Georgia, paramedic, finished an 18-hour shift and his usual gym workout, he suddenly felt like he — or maybe a mule — had pulled a muscle in his chest.
Q&A
The paramedic in his head was saying: “heart attack.” His father had had a massive attack at age 49, followed by multiple bypasses. Even though his father died at 78 of an unrelated problem, the legacy prompted his son to become a “gym rat.” “I found out the hard way, you can’t fight genetics,” Stafford says.
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
How is pulmonary hypertension different from general hypertension, and who is at risk? Unlike general hypertension (high blood pressure), pulmonary hypertension refers to high blood pressure caused by the narrowing, blocking or destruction of pulmonary arteries in the lungs. The blocked or destroyed arteries make it harder for blood to flow through your lungs, raising your blood pressure in that area and eventually causing serious medical issues such as congestive heart failure. People of any age can be affected by pulmonary hypertension, and it occurs more often in people who are overweight. Other risk factors include having a family history of the condition; other problems, such as heart and lung disease, HIV, blood clots or liver disease; using illegal drugs such as
cocaine; using certain diet medicines; and living at a high altitude. If you think you may have pulmonary hypertension, speak to your doctor. Luckily, making lifestyle changes, such as staying active, losing weight and stopping smoking, among others, will reduce pulmonary hypertension symptoms and improve the condition.
What medicines are available for people living with heart failure? Heart failure can have many negative effects on your quality of life, including fatigue, shortness of breath and swelling. Medication, along with diet and lifestyle changes, can help to alleviate some of these problems. Many of the suggested medications for heart failure patients lower blood pressure, as high blood pressure leads to
heart failure and its undesirable symptoms. For example, angiotensin-converting enzyme (ACE) inhibitors, which are used to treat people living with heart failure, lower blood pressure as well as decrease the workload placed on the heart. Other heart failure medications that lower blood pressure, in addition to providing other benefits, include angiotensin receptor blockers (ARBs), beta-blockers and vasodilators (which actually relax, or dilate, your blood vessels). Your doctor may also recommend other medications to treat heart failure, such as diuretics, which help your body expel extra water and sodium — the buildup of which is a common problem for heart failure patients — or digitalis preparations, which slow irregular heartbeats and relieve other heart failure symptoms.
HEALTHY NEWS Seeing Is Believing A recent study performed at Aarhus University Hospital in Denmark showed a significant drop in smoking and eating of unhealthy foods in participants who were shown a CT scan of their clogged arteries. The study included 189 people who had recently been diagnosed with early-stage heart disease. After the diagnosis, half of the participants received a standard follow-up, where a nurse offered advice on risk factors and lifestyle changes, while the other half were shown a CT image of buildup in their arteries, in addition to receiving advice from a nurse. The study’s author then analyzed whether the participants took the nurse’s advice and made lifestyle changes to reduce their risk of advanced heart disease. The author found that 22 percent of the standard group continued to smoke after the follow-up, while just 9 percent of the group that had seen the CT images did so. As for diet, 64 percent of the standard group continued eating unhealthy foods, and only 44 percent of the group that saw the CT image continued eating poorly. Although this effect has yet to be studied widely, it does suggest that people who get more involved in
their own health care end up being healthier. So don’t be afraid to start a conversation with your doctor or ask to see your X-rays or CT scans; they could help to motivate you.
The Value of Silence According to a recent study published in the American Journal of Preventive Medicine, reducing noise levels in loud areas of the United States could save more than $3 billion each year by helping to reduce levels of hypertension for people living in the loudest areas of the country. The study found that every 10-decibel increase in the average amount of noise a person is exposed to over a 24-hour period caused an increase in that person’s risk of hypertension, anywhere from 7 to 17 percent for each 10-decibel increase. Overall, the study’s authors found that if noise was reduced by even 5 decibels in these loud areas, cases of hypertension would decrease by 1.4 percent, and coronary heart disease would decrease by 1.8 percent. The study suggested that more than 100 million Americans are living in areas that would benefit from noise reduction.
In the St. Joseph’s/Candler emergency room, Stafford was diagnosed with a STEMI, or ST-segment elevation myocardial infarction. He was at immediate risk of death or disability. The staff, led by cardiologist W. Bryan Hartley, M.D., had Stafford in the catheterization lab within five minutes, where they reopened and placed a stent in his left anterior descending artery. Thanks to the swift response, Stafford sustained no permanent damage, but he still felt sluggish and had some chest pain. The Savannah team found that there was additional rock-hard blockage of Stafford’s circumflex artery, which supplies blood to both the receiving and pumping chambers of the heart. Deepak Kapoor, M.D., a GRHealth interventional cardiologist, diagnosed Stafford with chronic total occlusion (CTO), a condition in which blood vessels are nearly entirely blocked by plaque deposits. Throw in a genetic predisposition and age — as was the case with Stafford — and the danger of a lethal event was increased. Recent North American reports indicate CTOs are found in roughly 31 percent of patients with coronary artery disease and in even higher percentages in patients who have had coronary bypass surgery. In fact, CTOs are the main reason that patients are referred for bypass surgery, even though patients with near-total blockage of a single vessel are often not considered bypass candidates, particularly if they have other health problems. Fortunately, these patients can be aided with the placement of one or more drug-eluting stents that open vessels and help to reduce scarring and the settling of new plaque deposits. With his additional stents in place, Stafford is feeling great and back at the gym, fighting genetics after all.
Paul Poommipanit, M.D. Coronary and Vascular Interventional Cardiologist Dr. Poommipanit is board certified in internal medicine, cardiology, nuclear cardiology and interventional cardiology. In addition to serving as the associate director of the Cardiac Catheterization Lab, he is also a fellow of the American College of Cardiology and the Society of Cardiac Angiography and Interventions. He practices general and interventional cardiology. His clinical and research interests lie in the field of coronary and structural heart disease interventions.
Deepak Kapoor, M.D. Interventional Cardiologist Dr. Kapoor is board certified in interventional cardiology, nuclear cardiology, cardiology and internal medicine. He is focused on interventional cardiology, particularly in emerging therapies for coronary artery disease. He has participated in clinical trials studying drug-eluting stents, high-risk coronary interventions, and new treatment modalities for acute coronary syndromes and peripheral vascular diseases.
Be proactive about your health! Visit us online at grhealth.org/cardio.
Copyright © 2015 GLC, Skokie, IL 60077 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
FIGHTING CHRONIC TOTAL OCCLUSION OF CORONARY ARTERIES