cardiac HEALTH ON TIME
FALL 2016
Put the Brakes on Heart Attacks YOU CAN PREVENT AND CONTROL THE NO. 1 CAUSE Heart attacks are not only life-threatening — they’re also common. Every year, about 515,000 people in the United States have their first heart attack, and they account for 1 in every 4 deaths. The No. 1 culprit is coronary heart disease, or CHD, due to a buildup of sticky plaque in the blood vessels that lead to the heart. CHD can worsen over time, often with no early symptoms, until plaque blocks an artery and limits or cuts off blood flow to the heart muscle, causing heart cells to die — this is a heart attack. The good news is that CHD and many heart attack risk factors can be controlled with lifestyle changes and medication. Your doctor can help to identify your level of risk and perform diagnostic tests if needed. If CHD is diagnosed, the next step in treatment is to modify the factors that may contribute to the disease. This is important, because even the early, “silent” stages of CHD can be unsafe. A recent study of 37,000 veterans conducted by the U.S. Department of Veterans Affairs found that those with non-obstructive CHD — plaque buildup that doesn’t block blood flow or cause chest pain — had a significantly higher risk of heart attack compared to those with no apparent disease. While there are some risk factors for CHD and heart attack that can’t be changed, such as age, heredity and gender (males have a higher risk), many risk factors can be controlled or even reversed, including: • Smoking • Diabetes • High cholesterol • Physical inactivity • High blood pressure • Overweight or obesity Increased physical activity alone can have a positive impact on a number of these risk factors by lowering blood pressure, helping to control diabetes, reducing stress and helping to control weight.
LOWER YOUR RISK Take the following steps to tackle the top risk factors for coronary heart disease, and lower your risk of heart attack. ■ If you smoke, find support to help you quit. Look for a smoking cessation program in your community. ■ Lower cholesterol through diet, exercise and medication, if needed. ■ Control blood pressure with diet, exercise and medication, if needed. ■ Keep diabetes well controlled with help from a doctor. ■ Exercise for at least 30 minutes a day, or for 10 minutes three times a day. ■ Eat healthy foods and exercise portion control. If you need to lose weight, try joining a weightloss program.
IF YOU SUSPECT YOU ARE HAVING A HEART ATTACK, call 911 immediately. Otherwise, to request a same-day appointment, call 706-721-2426.
Augusta University educates community on early heart attack care
Heart attack patients receive lifesaving care in the cardiac cath lab minutes after arriving in the emergency department.
HAVING AN ACCREDITED CHEST PAIN CENTER comes with the important responsibility of educating the community on early heart attack care. Augusta University Health takes this to heart by arming people with potentially lifesaving information and training. “The more people who are trained in early heart attack care, the more patients can receive the care they need in a timely manner,” said Michael Cunico, a registered nurse and chest pain coordinator at Augusta University Heart and Cardiovascular Services. “Time is muscle.” In the eight years that the chest pain center has been accredited, Augusta University Health has focused on educating all of its employees, who have in turn shared this vital information on early heart attack care with the
community through health fairs and screening events. “Chest pain accreditation is a hospital-wide program,” Cunico said. “It belongs not only to the emergency department and cardiac catheterization lab, but also to the entire organization. Everyone has to be involved to make a true chest pain center work — quality management, pharmacy, administration, the lab, etc.” This is just one of the ways that Augusta University Health works to offer the highest level of care. In addition to housing the region’s first chest pain center, Augusta University Health is the location for Georgia’s first Level I trauma center, which provides care for accident victims. Patients can turn to Augusta University Health for prompt and complete care.
EARLY HEART ATTACK CARE A national campaign disseminated by the Deputy Heart Attack program raises awareness of the fact that heart attacks can be prevented by recognizing warning signs (such as chest pain) and acting on them. The campaign also underscores the importance of educating the public about early heart attack symptoms and the role that local EMS, emergency departments and cardiac catheterization labs play in the timely care of the heart attack patient.
Learn about our heart and cardiovascular services. Visit augustahealth.org/cardio. UVY-021
Augusta University 1120 15th St. Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID AUGUSTA UNIVERSITY
IN A HEARTBEAT Heart-stoppers THE HEART IS A REMARKABLE ORGAN that has two primary systems for keeping blood circulating to every part of the body. To keep blood flowing, cardiac muscle depends on oxygen and nutrients arriving from arteries to work, and electrical impulses to tell the muscles to contract in a regular rhythm. A HEART ATTACK IS A “PLUMBING” PROBLEM When blood vessels are blocked, heart muscle cannot function, and a heart attack occurs. In the movies, heart attacks come on suddenly, with crushing chest pain. In real life, the symptoms are often more ambiguous. Heart attacks often start slowly with only mild pain and discomfort. Atypical symptoms are even more likely in women and people with diabetes.
Heart attack symptoms hest pain C ■ Discomfort in other areas of the upper body ■ Shortness of breath ■
34 seconds, someone in America Every
has a heart attack.
reaking out in a cold sweat B Nausea ■ Light-headedness ■ ■
Even if you’re not sure you’re having a heart attack, err on the side of caution. Don’t wait too long to get help. Call 911. When a heart attack strikes, there’s no time to waste.
Average age for first heart attack
Men Women 64.5 70.3 years years
Healthy Artery
Blocked Artery
SUDDEN CARDIAC ARREST IS AN “ELECTRICAL” PROBLEM Cardiac muscles keep a steady rhythm because of electrical impulses generated in a special bundle of heart cells. When those impulses are disrupted, the heart can stop.
Atrial Fibrillation
Cardiac arrest symptoms
oss of consciousness (fainting) L ■ No pulse ■ Some people also experience shortness of breath, chest pain or nausea in the hour or so before sudden cardiac arrest. ■
It is imperative that the heart be restarted as soon as possible. Call 911 and begin CPR. If an automated emergency defibrillator (AED) is available, even an untrained bystander can use this portable device to shock the heart back into action.
Atrial fibrillation impulses Chaotic signals Rapid ventricular impulse
As the region’s only academic health center, Augusta University Health offers you a remarkable advantage when it comes to your health care. To learn more, visit auhealthadvantage.com.
This year,
515,000 people will have their first heart attack, and 205,000 will have a recurrent attack. About 15 percent of people who have a heart attack will die from it.
LAB PARTNERS The catheterization lab is where heart attacks are stopped. These procedures can also be used diagnostically or for implanting medical devices less invasively. Cath lab procedures include:
Angiogram
Angioplasty and stenting This is the most significant procedure in saving the lives of those having a heart attack. By using balloon-tipped catheters inserted through the groin, cardiologists can open arterial blockages, allowing blood to flow freely to the heart. Cardiologists may also insert small mesh-like tubes called stents to reduce the chance of another blockage.
Using catheters, cardiologists can determine, with the aid of imaging fluids and X-ray technology, where a blockage may be located. This diagnostic study is considered the gold standard for identifying blockages to the heart.
Pacemakers and defibrillators
Vascular procedures
Heart disease is the leading cause of death for both men and women.
Vascular specialists use balloons, stents and other devices to open arterial blockages in the legs. Catheters are also used to dissolve clots in the veins.
These implanted devices help to keep the heart beating at the right pace and rhythm.
Each minute, someone in the U.S. dies from a heart diseaserelated event.
WITHOUT WARNING
Abdominal aortic aneurysm (AAA)
More than 1 million people are living with an undiagnosed abdominal aortic aneurysm (AAA), a bulge that develops in the abdominal aorta, the main supplier of blood to the lower part of the body. When the bulge stretches too far, it poses the threat of rupture. When an aneurysm ruptures, internal bleeding and shock occur, and, oftentimes, death is the result. There are no warning signs for the vast majority of AAAs. However, some people may notice symptoms such as strong pulsations in the abdomen or pain in the chest or lower back. The risk of rupture is high when there are symptoms or the aneurysm expands, and surgery is most likely needed. AAA is a medical emergency. If you or someone you know is experiencing symptoms of AAA, seek medical care immediately.
AAA risk factors
Aneurysm
Normal artery
Smoking tobacco products High blood pressure ■ History of heart or peripheral arterial disease ■
Over the age of 60 (particularly males) ■ Family history of AAA ■
Stent-graft
■
Partnering for patient success A PATIENT’S CHANCE OF SURVIVING A HEART ATTACK dramatically increases if the patient or a bystander calls 911 and uses emergency medical services (EMS). That’s why Augusta University Health invests not only in early heart attack care (see page 1) but also in ensuring an efficient critical care process — and it starts with EMS. This process, managed by Michael Willis, EMS coordinator at Augusta University Health, includes timely feedback to EMS, and between EMS and critical care areas. “My main focus is to provide EMS with the information that they need so we can work together to strengthen and improve the care our patients receive and their outcomes,” Willis said. “If EMS gets an early electrocardiogram reading, then we can activate critical resources faster. This partnership increases the chance of recovery dramatically.” (story continues on page 4)
Emergency department at Augusta University Medical Center
Be proactive about your health! Visit us online at augustahealth.org/cardio, or call 706-721-2426.
(continued from page 3)
Partnering for patient success Until Augusta University Health created the EMS coordinator role, each individual hospital department designated a staff member who took on the responsibility of reporting back to EMS. The benefits of centralizing this process into one role include better and increased communication and training to the field, faster communication between the EMS and the hospital regarding the incoming heart attack patient and, ultimately, a dramatic increase of chance of survival for Augusta University Health patients.
Benefits of calling 911
• EMS providers are licensed and trained to assess, recognize and treat chest pain. They provide care to the patient on the way to the hospital and can administer medications orally and intravenously. • After the EKGs go from the EMS to the emergency department, the emergency department physician can activate the catheterization lab before the patient gets there. • There is less time between a heart attack patient’s arrival at the hospital and the time he or she receives care (“door-to-balloon time”).
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
NEW PHYSICIANS HERE FOR YOU
MY DOCTOR SAYS I HAVE DIABETES. DO I HAVE TO WORRY ABOUT CARDIAC DISEASE, TOO? According to the American Diabetes Association, nearly 23.5 million Americans have diabetes. An estimated 1 in 3 children born this decade will develop diabetes during his or her lifetime. Diabetes increases the risk of heart disease and stroke. Consider one more number: 2 out of 3 people with diabetes die from heart disease or stroke. Heart attacks in people with diabetes are more serious and more likely to result in death. That’s why it’s vital that people with diabetes seek out a diabetes education and support program to successfully manage their disease and possibly avoid heart complications.
Dr. Jacob A. Misenheimer Interventional Cardiologist Services:
• Clinical cardiology • Echocardiography • Diagnostic coronary angiography • Diagnostic peripheral vascular angiography • Peripheral vascular and coronary intervention CAN POOR SLEEP BREAK YOUR HEART? Loud snoring, pauses in breathing, daytime sleepiness and depression are common signs of sleep apnea, which can damage the heart and blood vessels. Studies have shown that: • Obstructive sleep apnea more than triples the risk of developing high blood pressure and doubles the risk of having a heart attack or stroke. • Sleep apnea can lead to diabetes, or a worsening control of blood sugar in patients with pre-existing diabetes. Diabetes can also damage the blood vessels that supply energy to the heart and other vital organs.
HEALTHY NEWS Bad vs. Good Cholesterol
Artery
stores cholesterol in the blood stream
regulates LDL storage and promotes excretion
Atherosclerotic plaque (LDL accumulation)
FOR ‘GOOD’ MEASURE New research reported in the New England Journal of Medicine revealed that measuring cholesterol efflux is a better indicator of cardiovascular risk than standard measures of HDL (“good” cholesterol). This new method measures how effectively HDL is functioning in the circulatory system to remove cholesterol from plaque in blood vessels and deliver it to the liver for excretion, thereby reducing heart attack risk. Scientists have known for a while that people with higher HDL levels tended to have less cardiac disease. However, vitamins and drugs that increased circulating HDL levels did not translate into the expected decrease in cardiac events. By looking at exactly how HDL functions, physicians hope to develop a better way of assessing risk and limiting atherosclerosis and heart attacks.
EYEING TRIGLYCERIDES For three decades, cholesterol-lowering drugs known as statins have been the main treatment prescribed to reduce heart-attack risk. Recent studies have looked at a different blood component, triglycerides, as a target for future medical management. Triglycerides are a fatty molecule that naturally occurs in the blood, and high levels are highly correlated with heart disease. The studies, reported in the New England Journal of Medicine, have shown that a genetic mutation in some people keeps triglyceride levels much lower than those of the majority of the tested populations, and those people also had a significantly lower number of heart attacks. Large-scale development and testing of triglyceride-lowering drugs is still a ways off, but it may lead to another promising treatment.
Cholesterol Levels Chart (All figures in mg/dL) Total Cholesterol Desirable 200 Borderline 250 HDL Cholesterol Too Low 40 Male 50 Female
High Satisfactory
60
Desirable
Board certifications: • Internal medicine • Cardiovascular disease
Dr. Misenheimer is available to see patients at the following locations: Cardiovascular Center on 15th Street, 937 15th St., Augusta, GA 30912 Washington County Regional Medical Center, 610 Sparta Rd., Sandersville, GA 31082
Dr. Haitham Hreibe Cardiac Electrophysiologist Services:
• Cardiology • Cardiac electrophysiology • Complex ablation procedures
Board certifications:
• Internal medicine • Cardiovascular disease • Cardiac electrophysiology
Dr. Hreibe is available to see patients at the following locations: Cardiovascular Center on 15th Street, 937 15th St., Augusta, GA 30912
LDL Cholesterol Normal 100 Borderline 160
High
190 Excessive
Cardiovascular Center on Chafee Avenue, 1003 Chafee Ave., Augusta, GA 30912
Triglycerides Normal 150 Borderline 200
High
500 Excessive
Wills Memorial Hospital, 120 Gordon St., Washington, GA 30672
For people with established heart disease or diabetes: Total Cholesterol 180 or lower; LDL Cholesterol 100 or lower
For an appointment with Drs. Misenheimer, Hreibe or any of our cardiovascular physicians, call 706-721-2426.
Copyright © 2016 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.
Q&A
Willis and paramedics review the electrical activity of a patient’s heart.