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An Issue Women Can’t Ignore
H E A LT H Y HEARTS HERE
The Heart Group of Lancaster General Health Whatever comes next in your life, your heart has to come first. And with Penn Medicine Lancaster General Health, you’ll find a team of experienced doctors, advanced technologies and treatment options right in your own community. Whether you need a second opinion or a first, nationally recognized heart and vascular care is right here in Lancaster County.
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Heart Health Awareness 2022 Publisher Donna K. Anderson
Editorial Vice President & Managing Editor Christianne Rupp Editor Megan Joyce
Contributing Writers Matthew A. Bernabei, M.D., F.H.R.S. Kimberly Blaker Jeremy R. McGarvey, M.D., F.A.C.S. Barry Sparks
Art Department Production Coordinator Lauren Phillips
Business Development Senior Marketing Consultant Josh Binkley Events Manager Kimberly Shaffer Business Manager Elizabeth Duvall
Dear friends and colleagues, Did you know that heart disease is the leading cause of death for women in the United States? And although heart attacks generally occur in men at a younger age than women, survival rates are lower in women. Certainly, cardiac conditions can be genetic, including arrhythmias, congenital heart disease, and high cholesterol. However, you can control many of the contributing risk factors to heart disease, but it’s up to you to make a conscious effort to reduce those risks in your daily life. High blood pressure, one risk factor, can develop as a side effect of birth control pills containing estrogen, so changing to a different birth control method may be necessary for younger women. And women over 65 are more likely to have high blood pressure simply due to age. Most women start to notice perimenopause symptoms in their 40s, which is when hot flashes begin to rear their heated heads. This means estrogen levels start to drop, and an increase in high cholesterol becomes more likely in women, another risk factor. Whereas 71.6% of American adults aged 20 and over are overweight, nearly 40% of them are obese. This is a huge risk factor for not only heart disease, but also for developing Type 2 diabetes, another risk for heart disease. There is a plethora of diet commercials on television as well as local companies that offer services to help clients lose weight or manage hormones, which can contribute to weight gain. Smoking is a risk factor for many health conditions. Just stop smoking. Excessive alcohol use can cause heart disease. If you think your red wine is good for your heart, the American Heart Association recommends no more than one drink a day for women and two a day for men (one drink equals 5 ounces). Penn Medicine Lancaster General Health, the sponsoring partner of this specialty magazine, is a top research institution and understands that their discoveries ultimately saves lives. They are a not-for-profit health system with a network of care, including more than 300 primary care and specialty physicians; outpatient and urgent care services; and four hospitals. They are ranked among the top hospitals in Pennsylvania by U.S. News & World Report. Please take time to read the articles within. Included are pieces written by a Lancaster General Health cardiovascular surgeon and a cardiologist who offer their expertise. We would like to thank Chelsea Cunningham and Santo “Sam” Iacono for sharing their personal stories. They realized they were being given expert care and that they could rely on their medical team. The bottom line: It’s never too early or too late to adopt heart-healthy behaviors. Christianne Rupp, Vice President and Managing Editor
Inside:
Copyright © 2022 On-Line Publishers, Inc. All rights reserved. All listings and advertisements have been accepted for publication on the assumption that the information contained in them is true and accurate and that all merchandise or services offered in the advertisements are available to the customer according to the conditions warranted therein. The appearance of advertisements or products or services does not constitute an endorsement of the particular product or service. On-Line Publishers, Inc. disclaims any and all responsibilities and liability which may be asserted or claimed resulting from or arising out of reliance upon the information and procedures presented in this guide.
4 Understanding Mitral Valve Prolapse
Mitral valve prolapse is a common heart valve condition.
5-6 Heart Disease is Often Subtle in Women Know the signs, what to do, and how to prevent it.
7-8 Heart Conditions and Diseases are Pervasive
now about the symptoms and treatments for a variety of heart conditions and diseases. K 9-10 Chelsea’s Story A healed and grateful heart after open-heart surgery. 11-12 Sam’s Story iving heart-healthy after TCAR. L 13 Your Heart Skips a Beat What does it mean?
On-Line Publishers, Inc. P.O. Box 8049, Lancaster, PA 17604 717.285.1350 • fax 717.285.1360
14-15 Aortic Aneurysms are Often Undiagnosed
ortic aneurysms are the 13th leading cause of death in the United States. A
15 What to Eat for a Healthier Heart
What kinds of fruits and vegetables should you eat?
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Understanding Mitral Valve Prolapse with diuretics, blood pressure medications, or blood thinners for irregular heart rhythms. If the regurgitation is severe, cardiologists may recommend a surgical procedure.
By Jeremy R. McGarvey, M.D., F.A.C.S. Mitral valve prolapse is a common heart valve condition affecting approximately 2% of Americans. For many, the condition is not considered dangerous but does need to be monitored by a physician. When severe, an intervention may be needed to correct the problem. What Is the Mitral Valve? The mitral valve is an important valve in the heart that separates the left ventricle (the main pumping chamber of the heart) from the lungs. Regurgitation, or leakage through this valve, is relatively common and results from the valve’s two leaflets not closing properly for a perfect seal. The most common cause of regurgitation is mitral valve prolapse, where one or both of the leaflets bulge (prolapse) upward into the left atrium. This is often a result of the valve stretching, or a tear in the support structures that attach the valve to the underlying left ventricle. Symptoms of Mitral Valve Prolapse Many people show no symptoms of mitral valve prolapse and only learn of the condition when their doctor detects a heart murmur during a routine physical exam. However, some people may experience: • Fatigue • Shortness of breath with activity • Difficulty lying flat • Irregular heart rhythms • Leg swelling Mitral Valve Prolapse Treatment Initially, cardiologists often treat mitral valve prolapse
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Surgical Repair of the Mitral Valve In otherwise healthy individuals, mitral valve surgery is an option with an excellent safety record and results. For most patients, their own mitral valve can be repaired using minimally invasive techniques. A minority of people must have the valve replaced with a bioprosthetic (cow or pig) or a mechanical valve. People at high risk for surgery can undergo a less invasive, catheter-based option called MitraClip, offered at Penn Medicine Lancaster General Hospital. Staying Healthy with Mitral Valve Prolapse Most people with mitral valve prolapse live normal lives. To help prevent complications: • Don’t smoke. • Eat a heart-healthy diet and exercise regularly (after consulting your family doctor). • Take prescribed medications as directed. • Keep all scheduled physical exams and notify your doctor if you notice cold and flu symptoms like sore throat, achiness, and fever. This could signal endocarditis, a bacterial infection that affects the lining of the heart valves. • Maintain good oral hygiene, which can reduce the risk of endocarditis. Jeremy R. McGarvey, M.D., F.A.C.S., is a cardiovascular surgeon with Lancaster General Health Physicians Cardiothoracic Surgery and a clinical assistant professor of surgery at the University of Pennsylvania Perelman School of Medicine. Dr. McGarvey is a graduate of the University of Pittsburgh School of Medicine. He completed his general surgery residency at the Hospital of the University of Pennsylvania, a research fellowship at the Gorman Cardiovascular Research, and a cardiothoracic fellowship at the Hospital of the University of Pennsylvania.
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Heart Disease is Often Subtle in Women — Know the Signs, What to Do, and How to Prevent It
By Kimberly Blaker Heart disease is the leading cause of death among women in the United States. According to the Centers for Disease Control and Prevention (CDC), it accounts for 20% of female deaths. Coronary artery disease, also commonly known as coronary heart disease or atherosclerosis, is the most common type of heart disease. More than 6% of women over the age of 19 are afflicted by it, which can lead to a heart attack or heart failure. Heart conditions for which women are at higher risk than men include cardiac syndrome X, angina (chest pain), and broken heart syndrome (stress-induced cardiomyopathy). Women can also be affected by several other heart conditions. These include heart failure, heart valve disease, arrhythmia (irregular heartbeat), and atrial fibrillation (AFib). Prevention Several risk factors for heart disease cannot be modified. Family history, race, gender, menopause, and age all play a role in heart disease. Still, many risk factors can be changed, according to Cleveland Clinic. To reduce your risk for disease: • Quit smoking. • Lower your total cholesterol, LDL, and triglycerides. • Increase your HDL (good) cholesterol. • Reduce your blood pressure if it is high. • Keep diabetes under control. • Maintain a healthy body weight. • Eat heart-healthy foods. • Exercise regularly. • Reduce your stress.
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Although some studies suggest alcohol may be beneficial in moderation, others have shown the opposite.
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Also, a drink a day may offer some benefit to your heart by increasing your HDL cholesterol. But medical experts caution against more than one drink per day. Studies have found high alcohol consumption can damage the heart. Although some studies suggest alcohol may be beneficial in moderation, others have shown the opposite. Cleveland Clinic recommends if you don’t already drink alcohol, not to begin.
Heart Attack Signs Women can experience all the same symptoms as men. Often, however, women experience heart attacks differently. Most notably, women don’t always experience crushing chest pain. Instead, they may feel tightness or pressure in their chest. As a result, symptoms can go unnoticed or are easily brushed off. If the pain or discomfort goes away and then comes back or lasts for more than a few minutes, it could be a symptom. Other symptoms include: • Shortness of breath • Pain, discomfort, weakness, or heaviness in either arm • Discomfort in the neck, jaw, upper back, shoulders, or stomach • Indigestion, nausea, or vomiting • Cold sweats • Fatigue • Sleep disturbance • Dizziness or lightheadedness What to Do if You’re Having a Heart Attack Call 911 immediately and have them dispatch emergency medical services (EMS). This is usually faster than having someone drive you to the hospital. Also, if you’re in a public place, such as work or a store, a defibrillator may be available. Ask whoever you see first to check. Defibrillators come with easy instructions and could save your life. Finally, take an aspirin, says Anthony Komaroff, M.D., editor-in-chief of Harvard Health Letter. He recommends a standard dose of 325 mg that isn’t coated. “Chew it, and then swallow it with a glass of water,” says Komaroff, to quickly get it into your system. This can slow blood clotting and limit damage to your heart.
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Heart Conditions and Diseases are Pervasive By Barry Sparks Heart disease is the leading cause of death for men and women in the United States. Heart disease accounts for 1 in every 4 deaths. Here’s what you need to know about the symptoms and treatments for a variety of heart conditions and diseases. A heart attack occurs when the flow of blood to the heart is blocked. The blockage is usually a buildup of plaque in the arteries that feed the heart. Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted blood flow can damage or destroy part of the heart muscle. Common heart attack signs and symptoms include: • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw, or back • Nausea, indigestion, heartburn, or abdominal pain • Shortness of breath • Cold sweat • Fatigue • Lightheadedness or sudden dizziness 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. Women often chalk up the symptoms to less life-threatening conditions like acid reflux, the flu, or normal aging. www.BusinessWomanPA.com
It’s critical to call 911 or emergency medical help if you think you might be having a heart attack. You will receive medication during and after your heart attack to improve your heart condition. Physicians may need to perform a procedure to unblock your arteries. These procedures may include cardiac catheterization, balloon angioplasty, stent placement, and bypass surgery. Silent heart attack is a heart attack that has few, if any, symptoms. You might not have shortness of breath or chest pain, which is typically associated with a heart attack. A silent heart attack, like any heart attack, involves blockage of blood flow to the heart and possible damage to the heart muscle. Having a silent heart attack puts you at a greater risk of having another heart attack. There are no tests to determine your potential for having a silent heart attack. The only way to tell if you’ve had a silent heart attack is to have imaging tests, such as an electrocardiogram or echocardiogram. Heart Health 2022
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Angina is chest pain or discomfort caused when your heart doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may feel like indigestion. Angina is a symptom of an underlying heart problem, usually coronary heart disease. There are different kinds of angina. The triggers for angina and treatment vary depending on what type of angina you have. All chest pain should be checked by a physician. Not all chest pain, however, is a sign of heart disease. Treatment of angina includes lifestyle changes, medicines, cardiac procedures, and cardiac rehabilitation.
Cardiomyopathy refers to diseases of the heart muscle. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick, or rigid. In rare cases, diseased heart muscle tissue is replaced with scar tissue. As cardiomyopathy worsens, the heart becomes weaker. The heart becomes less able to pump blood throughout the body and incapable of maintaining a normal electrical rhythm. The result can be heart failure or irregular heartbeats. Cardiomyopathy can affect all ages, although certain groups are more likely to have certain types of cardiomyopathy. Treatments include lifestyle changes, medications, surgery, implanted devices to correct arrhythmias, and other nonsurgical procedures.
Coronary heart disease is the most common heart disease in the United States. It is caused by plaque buildup in the walls of the arteries that supply blood to the heart. Over time, coronary heart disease can weaken the heart muscle. Overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for coronary heart disease. A family history of heart disease, particularly if there’s a family history of members having heart disease at age 50 or younger, increases your risk for coronary heart disease. If you have coronary heart disease, there are ways you can help lower your risk for heart attack or worsening heart disease. Your physician may recommend lifestyle changes, such as eating a healthier diet, increasing physical exercise, reaching a healthy weight, and quitting smoking. He may also put you on medications to control your blood pressure or high cholesterol.
Atherosclerosis is a hardening and narrowing of the arteries. When your arteries become blocked, it affects the blood flow. It’s the most usual cause of heart attacks, strokes, and peripheral vascular disease. You can slow or stop atherosclerosis by minimizing your risk factors. That means a healthy diet, exercise, and no smoking. Medications for high cholesterol and high blood pressure also could lower your risk for heart attacks and strokes. Your physician may use more invasive techniques to open blockages from atherosclerosis or go around them. These include angiography, stenting, and bypass surgery. These procedures can have complications and are usually performed on patients with major symptoms or complications.
Atrial fibrillation, often called AFib, is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way. This causes the blood not to flow as well as it should. AFib may happen in brief episodes, or it may be a permanent condition. Some people who have AFib don’t know they have it because they don’t have any symptoms. Others may experience one of more of the following symptoms: irregular heartbeat, heart palpitations, lightheadedness, extreme fatigue, shortness of breath, and chest pain. Treatment for AFib can include medicines to control the heart’s rhythm and rate, blood-thinning medicine, surgery, and healthy lifestyle changes.
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Chelsea’s Story: A Healed and Grateful Heart after Open-Heart Surgery
The last thing Chelsea Cunningham ever expected was to undergo open-heart surgery. The healthy 26-year-old pharmacist led an active life and took good care of herself. However, over the two years prior to her 2018 surgery, Chelsea had experienced periodic chest pain and made an appointment with her primary care provider. Her doctor ordered a series of tests: an EKG, chest X-ray, bloodwork, and eventually a seven-day Holter monitor test to measure her heart activity. Nothing significant was found in any of the tests. As a final step, Chelsea’s doctor wanted her to have a transthoracic echocardiogram (TTE) — a noninvasive test that uses highfrequency soundwaves to create a moving picture of the heart. “If the TTE was negative, it would have been the end of the story,” says Chelsea. “The intermittent chest pain would have been chalked up to me being my odd self.” A Diagnosis: Myxoma The TTE did show an abnormality, and Chelsea was referred to a cardiologist at The Heart Group of Lancaster General Health. Although
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the function and structure of Chelsea’s heart were normal, a large, benign tumor known as a myxoma was found in the top left chamber of her heart. “The cardiologist explained that a myxoma is rare, but as far as heart tumors go, it is one of the most common types,” says Chelsea. “If unaddressed, my future might have included strokes, heart failure, and valve disease.” Following an additional test that provides better imaging of the heart, doctors determined Chelsea needed open-heart surgery and was referred to cardiothoracic surgeon Dr. Mark Epler. Preparing for Open-Heart Surgery Although Epler and all of Chelsea’s doctors assured her she did not have cancer, Chelsea was still in disbelief about what was happening. She recalls thinking, “This can’t be real. I can’t have a tumor inside my heart. I’m healthy and young. No. This can’t be reality. But it is. This is going to happen. There’s no way around it.” Epler explained that although Chelsea’s surgery wasn’t an emergency, there were risks to waiting, including stroke and damage to the heart due to the tumor’s size. Her surgery was scheduled. Epler performed a thoracotomy. During this open-heart surgery, an incision is made in the chest wall between the ribs to access the heart. Everything went exactly as planned, and after the five-hour surgery, Chelsea was on her way to a full recovery. There was no damage to her mitral valve or any other part of her heart. On to Recovery Chelsea remembers receiving the customary “heart pillow” to hug firmly when coughing or sneezing. Chelsea was out of bed and into a recliner chair a few hours after surgery, and a respiratory therapist was on hand to offer post-surgery treatment and equip her with a spirometer for breathing exercises that she would continue at home.
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“The idea of getting out of bed that soon was daunting, but I trusted the staff. The goal was always to keep me moving forward,” says Chelsea. Chelsea is grateful for the kind and skillful care she received in both the ICU and cardiology unit at Lancaster General Hospital. Epler and other team members from LG Health Physicians Cardiothoracic Surgery stopped by to check on Chelsea the next day. Pleased with her progress, they told her that as long as her pain level remained manageable, she would probably be ready for discharge soon. “They explained the steps that needed to be taken prior to my being discharged and asked if I had any questions,” says Chelsea. “I had many, and they patiently answered them all.” Back Home and Back to Work Back home, Chelsea continued her recovery, at first slowly walking around the house and doing the recommended openheart surgery discharge exercises, as she regained strength and mobility. She followed up with her primary care physician, cardiologist, and surgeon, and began cardiac rehab. “I was excited to exercise and make another step back to normal,” says Chelsea. “As I walked into their office, I realized it was more like a gym! It gave me a lot of comfort that I’d be hooked up to an EKG the entire time, with the nurses regularly monitoring my rate and rhythm.” One month after open-heart surgery, Chelsea was back to work part-time. “In another couple of months, things really started to feel normal again,” recalls Chelsea. “My incisions became scars. I resumed tap dance and horseback-riding lessons and went to my first swing dance since surgery.” Nearly three years later, Chelsea is doing well, with a healed and thankful heart: “I cannot sufficiently express my gratitude to all of those involved in my care.” Article courtesy of the Heart & Vascular Institute at Penn Medicine Lancaster General Health.
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Sam’s Story: Living Heart Healthy after TCAR
Santo “Sam” Iacono loves life. And thanks to decades-long care at Penn Medicine Lancaster General Health — along with a steadfast commitment to healthy living — this octogenarian is more active than many people half his age. The former owner of Sam’s Pizza, a once-iconic landmark on Columbia Avenue in Lancaster city, uses his well-honed cooking skills to prepare his own healthy meals of fish, chicken, and “lots of greens.” He spends at least a half hour each day working out in the family room he converted to a gym, maintains his own 1-acre yard, and serves as handyman at properties he manages. This is pretty impressive for anyone in their 80s, much less someone who has undergone quadruple bypass surgery, valve replacement, and two carotid artery procedures to prevent stroke, the most recent being a transcarotid artery revascularization (TCAR) when Sam was 82. The newer, minimally invasive TCAR procedure reduces operative risks. What’s behind Sam’s disciplined approach to health? “I like to live,” says Sam, who established roots in Lancaster after emigrating from Italy in the early 1960s. “I want to enjoy my kids and grandkids.” Longstanding Relationships with Penn Medicine Lancaster General Health Sam credits physicians at Lancaster General Health for “saving my life,” several times over. His primary care physician, Dr. William Roberts at Family Medicine Abbeyville, has monitored Sam’s health for years, referring him to specialists at The Heart Group of Lancaster General Health to treat his heart disease. Sam has been a patient at The Heart Group for more than 20 years. From prevention and diagnosis through disease management and cardiac interventions, The Heart Group team offers the latest advancements in care, along with educational opportunities to help patients live their heart-healthiest lives. The team works collaboratively with primary care physicians like Roberts and other specialists to help ensure a comprehensive and coordinated approach to care.
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Sam appreciated that Roberts was up to date throughout his treatment. “When I went to Abbeyville for my regular checkups, it was helpful and comforting that Dr. Roberts knew exactly what I had been through and could manage my health based on the latest information,” recalls Sam. “It helped me stay on track.” Carotid Artery Disease – Advances in Treatment In 1997 Sam was first diagnosed with carotid artery disease — one of the leading causes of stroke in the U.S. This buildup of cholesterol plaque in one or both of the major blood vessels in the neck can restrict blood flow to the brain and lead to stroke. Sam underwent a procedure called carotid endarterectomy to remove the plaque in the carotid artery on the right side of his neck. The surgery restores normal blood flow to the brain. Fast forward to fall 2018 when The Heart Group’s Dr. Todd Wood, chief of cardiology at Lancaster General Hospital, discovered a blockage in Sam’s left carotid artery. This time, due to his age and the severity of the blockage, Sam was a candidate for the less invasive TCAR stenting procedure, which can be done under local anesthesia with moderate sedation. A Team Approach to Treatment Wood and Dr. Meghan Dermody, a vascular surgeon with Lancaster General Health Physicians Surgical Group and chief of vascular surgery and medical director of the Interventional Vascular Unit at Lancaster General Hospital, teamed up to perform the TCAR procedure. The advanced system temporarily reverses blood flow away from the brain while a stent is inserted to open up the narrowed carotid artery. Reversing blood flow and filtering it outside the body prevents any fragments of plaque that may become loose during the procedure from entering the brain. This reduces the risk of a stroke occurring during the procedure. The minimal dissection also decreases the risk of local nerve injury and is easier to recover from for many patients. The Lancaster General Health Heart & Vascular Institute, which was the first in Lancaster County to offer TCAR, has successfully operated on more than 160 TCAR patients. “We’re one of the only TCAR teams in the country to pair a vascular surgeon with an interventional cardiologist,” Dermody says. “We take kind of a tag-team approach. While I’m working on the carotid, Dr. Wood is accessing the femoral vein. It cuts down on time, which is better for the patient.” Recovery usually takes one week, as compared to three to four weeks with a traditional carotid endarterectomy. Sam, one of the first to undergo TCAR at Lancaster General Health, was home the next day without missing a beat in his active life. “I’m a walking miracle,” he smiles, as he approaches 10 minutes on his treadmill … not winded at all. Article courtesy of the Heart & Vascular Institute at Penn Medicine Lancaster General Health.
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Your Heart Skips a Beat: What Does it Mean?
By Matthew A. Bernabei, M.D., F.H.R.S. Why does my heart skip a beat? Patients frequently ask this question. The answer may be related to a disturbance in the heart’s electrical system called an arrhythmia. Understanding Arrhythmias Normally, electricity moves through the heart in a very regular and controlled manner, causing the heart muscle to contract and circulate blood throughout the body. This consistent process creates a clocklike quality you can often feel or hear if you’re paying careful attention. It’s not uncommon for the electrical system to “misfire,” throw an extra beat, or even maintain an abnormal heart rhythm for a sustained period of time. These rhythm disturbances often cause a skipping sensation patients describe as jumping, fluttering, flip-flopping, palpitating, or seesawing. People may also experience shortness of breath, lightheadedness, or chest discomfort. And sometimes there are no symptoms at all, and the condition is discovered incidentally during a physical examination or cardiac test like an EKG. Most Common Arrhythmias The most common arrhythmias that cause heart-skipping are pre-atrial contraction (PAC) and pre-ventricular contraction (PVC). These extra heartbeats originate in the top or bottom part of the heart and occur between two normally timed beats. Usually, this isn’t a worrisome problem unless the symptoms are frequent and severe. Treatment may include lifestyle changes like avoiding caffeine and addressing any underlying causes. More Serious Heart Rhythm Disorders Sustained heart rhythm disorders like tachycardia (heart beating too fast) or bradycardia (heart beating too slow) are more concerning. Because these problems tend to last longer (minutes, hours, or longer), they’re more likely to cause prominent and persistent symptoms like passing out. They can also affect the heart’s long-
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term pumping ability. More aggressive evaluation, monitoring, and treatment (medication and/or procedures like ablation, pacemakers, or defibrillators) are almost always needed. A few conditions in this category include: • Atrial fibrillation (AFib), the most common of the persistent arrhythmias • Supraventricular tachycardia (SVT) • Ventricular tachycardia (VT) • Heart block (dropping heartbeats, rather than adding extra beats) What You Should Do If you feel your heart jumping or fluttering, see a healthcare provider. It’s important to differentiate among the many possible causes, as each has different implications and is managed differently. Your doctor will often refer you to a cardiologist and, in many cases, to an electrophysiologist — a cardiologist who has special training and expertise in heart rhythm management. Matthew A. Bernabei, MD, FHRS, is a cardiologist with The Heart Group of Lancaster General Health. Dr. Bernabei is a graduate of Temple University School of Medicine. He served residencies at the University of Virginia Health System and Lahey Clinical Medical Center, where he also completed a fellowship. Dr. Bernabei’s areas of expertise include atrial fibrillation, cardiac resynchronization therapy, pacemaker and defibrillator implants, and ventricular tachycardia.
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Aortic Aneurysms are Often Undiagnosed
By Barry Sparks Actor John Ritter died Sept. 11, 2003, as the result of an aortic dissection, which is a tearing apart of the layers of the body’s largest blood vessel; blood becomes trapped between the layers. Ritter, 54, had an undiagnosed aortic aneurysm, which is a widening or ballooning of a portion of the aorta. That weakens the aortic wall. Over time, the aorta may dissect or completely rupture. Aortic dissection or rupture is a medical emergency, and immediate help should be sought. The death rate increases 1% every hour the diagnosis and surgical repair are delayed, according to The John Ritter Foundation. Aortic aneurysms are the 13th leading cause of death in the United States, accounting for an estimated 15,000-20,000 deaths annually. It is unclear why people develop aneurysms or why they progress. Most aneurysms have no symptoms unless they rupture. They are often found when you are being evaluated for another condition. If an aortic aneurysm does rupture, you may experience one or more of the following symptoms: • Sudden pain in your abdomen or back • Pain spreading from your abdomen or back to your pelvis, legs, or buttocks • Clammy or sweaty skin
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• Increased heart rate • Shock or loss of consciousness Aortic aneurysms are commonly classified according to their location. Thoracic aortic aneurysms (TAA) involve the ascending or descending aorta. Abdominal aortic aneurysms (AAA) affect the aorta in the abdominal cavity. Who is at risk for an aortic aneurysm? They are most likely to occur if you: • Are male • Are obese or overweight • Are over age 60 • Have a family history of heart conditions or diseases • Have high blood pressure or high cholesterol • Have had trauma to your abdomen or other damage to your midsection • Smoke tobacco products Genetics also play a role. Aneurysms run in families. If a first-degree relative has had an aortic aneurysm, you are 12 times more likely to develop one, according to the Society for Vascular Surgery. Of patients in treatment to repair an aortic aneurysm, 15% to www.BusinessWomanPA.com
25% have a first-degree relative with the same type of aneurysm. If you have any of these factors, you may want to get screened for an aortic aneurysm or dissection. Screening is important because most aneurysms go undiagnosed. Effective imaging studies include an abdominal ultrasound, CT scan, or MRI. Depending on the size and exact location of the aneurysm, a physician may perform surgery to repair or remove the damaged tissue. This may be done either with open abdominal surgery or endovascular surgery. Open abdominal surgery is used to remove damaged areas of the aorta. It’s the more invasive form of surgery and may be necessary if the aneurysm is very large or has already ruptured. Endovascular surgery is a less invasive form of surgery than open abdominal surgery. It involves using a manmade graft to
stabilize the weakened walls of the aorta. If surgery is indicated, physicians will consider the location of the aneurysm, risk factors, anatomy, and overall health to determine what type of surgery would be best. Having an aneurysm, however, doesn’t mean you will have surgery. For a small abdominal aortic aneurysm that’s less than 5.5 centimeters wide, a physician may decide to monitor it regularly instead of performing surgery. Surgery has risks, and small aneurysms generally don’t rupture. Medical management is necessary to treat aneurysms, whether or not surgery is needed. Medical management includes risk-factor modifications, such as blood pressure and cholesterol control, healthy eating, exercise with possible restrictions, and taking medication.
What to Eat for a Healthier Heart Experts agree that fruits and vegetables maintain healthy arteries. But exactly what kinds of fruits and vegetables should you eat? Here are a few heart-healthy foods to add to or complement your diet. 1. Salmon. This fish improves heart health due to its omega-3 fatty acids. According to Rachel Johnson, Ph.D., “Omega-3s have an anti-clotting effect, so they keep your blood flowing.” These acids also lower triglyceride levels, reducing the chance of heart disease. 2. Walnuts. These nuts contain “good” fats, according to various experts. The fats within walnuts are monounsaturated instead of saturated. This means that consumption causes LDL (lowdensity lipoprotein) cholesterol levels to fall and HDL (highdensity lipoprotein) cholesterol levels to rise. Dr. Stephen Daniels, Chairman of Pediatrics at the University of Colorado School of Medicine, explains that good fats are named so because they lack the LDL cholesterol. “HDL cholesterol is kind of like a garbage truck,” he says. “When it flows through your bloodstream, it cleans the arteries. LDL cholesterol is like garbage that can clot and stick to the artery walls.” 3. Raspberries. Berries as a fruit group have a bunch of polyphenols (antioxidants) that lower the risk of stroke and provide vitamin C throughout the body. 4. Fat-free/low-fat milk/yogurt. In general, dairy products can raise cholesterol due to saturated fat. However, dairy products are also high in potassium, which lowers blood pressure.
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So, when you consume fat-free dairy products, you get all of the benefits of potassium without the cholesterol. 5. Chickpeas. These legumes can lower LDL cholesterol. Just make sure to buy the low-sodium option when you’re at your local supermarket. 6. Oatmeal. Oats have beta-glucan, a type of fiber that lowers LDL cholesterol levels. 7. Olive oil. This is a great alternative to butter when it comes to reducing saturated fat intake. 8. Dark chocolate. Dark chocolate contains flavanols, which lower blood pressure and can prevent blood clots. Additionally, dark chocolate (at least 70% cocoa) contains antioxidants, the stuff that keeps LDL cholesterol from attaching to artery walls. 9. Avocados. Avocados are a great food because they contain monounsaturated fats and antioxidants. Try using it as a spread in place of butter. 10. Red grapes. The red variety of grapes helps reduce platelets from coagulating (thanks to resveratrol), and that means lower blood pressure. © Content That Works
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HEARTPOUNDING
LIFE
Nationally recognized heart and vascular care. Wherever life takes you, we’ll be right by your side. With advanced heart and vascular care. Adapting new procedures. Applying new technologies. Redefining the way we treat end-stage heart failure. And a team that can handle even the most complex cases. For the best possible chance at a long, happy life. Discover more at LGHealth.org/HeartandVascular
Heart & Vascular Institute
