An Issue We Can’t Ignore
We know your heart should only skip a beat for loved ones. We also know that isn’t always the case. So if a heart scare happens, know that internationally renowned doctors aren’t worlds away. They’re here, mastering game-changing procedures that get you back to what you love. So take heart, friend. Because we know you and your heart, too. WellSpan.org/Heart
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Greetings from your friendly neighborhood world-renowned heart experts. WellSpan is the health partner you already know. But what you might not know is that our heart doctors master game-changing procedures on a ŋêĀŠĞÃŋȊÞÃŒĉŒȊǽȊĀÃĉĥĉĥĀȊĉĥŚêŋĥÃŚĉĬĥÃĞȊÃŚŚêĥŚĉĬĥȊÃĞĬĥĀȊŚąêȊŷÃŽǡȊ ĥåȊŷąĉĞêȊ the recognition tells us we’re doing something (or a lot of things) right, it’s not our purpose. That would be you, our patient. So take heart, friend. Because we know you and your heart, too. WellSpan.org/Heart
Heart Health Awareness 2023 Publisher Donna K. Anderson
Editorial Vice President & Managing Editor Christianne Rupp Editor Megan Joyce
Contributing Writers Jennifer H. Mieres, M.D. and Stacey E. Rosen, M.D. Sandra Gordon Barry Sparks
Dear friends and colleagues, Ladies, we need to talk about your heart. It doesn’t seem to be on our radar, yet heart attacks are the No. 1 killer of women each year. Heart disease in women — especially young women — has been increasing over the past 10 years. In a 2008 interview with Glamour magazine, first lady Laura Bush noted that “because women don’t expect to have heart disease, a lot of times they don’t seek help if they have the early symptoms of a heart attack.” Women and men, different in so many respects, both experience classic symptoms of a heart attack, such as chest pains and discomfort. But women are much more likely to have less common symptoms, such as indigestion, shortness of breath, and back pain. The obvious symptoms of chest pain or discomfort may be absent. Women generally have smaller hearts and smaller arteries than men, and the smaller arteries cannot always clearly be seen during an angiogram. This causes women to be misdiagnosed, often with gastrointestinal problems or anxiety. Make sure your doctor hears your concerns. We thank WellSpan Health for partnering with us to present this vital heart-health information. They have become a leader in all facets of cardiology care and cardiovascular surgery and an integral part of the region. WellSpan Health has a vision for the future, which includes continuing to keep abreast of new technology and treatment options, complemented by their excellent staff of expert surgeons, physicians, and personnel. You’re always helping others. Help yourself right now. Please take time to read the vital information included in this special feature. It could save your life. Love yourself … love your heart.
Art Department Production Coordinator Lauren Phillips
Christianne Rupp, Vice President and Managing Editor
Business Development Senior Marketing Consultant Josh Binkley Events Manager Kimberly Shaffer Business Manager Elizabeth Duvall
Inside:
4 Cardiovascular Genomics Can Transform Lives 5 WellSpan Offers Complex Care for Heart Blockages 6 WellSpan Pioneers Use of Implantable Heart Devices
Copyright © 2023 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.
7 WellSpan Leads the Way in Structural Heart Programs 8 WellSpan York Hospital Offers Expert Congestive Heart Failure Treatment
9-10 WellSpan Builds an All-Star Cardiac Surgery Team 10-11 Resource Books 12-13 Are You Headed Toward Heart Disease?
On-Line Publishers, Inc. P.O. Box 8049, Lancaster, PA 17604 717.285.1350 • fax 717.285.1360
14-15 Common Heart Health Mistakes and How to Avoid Them
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Cardiovascular Genomics Can Transform Lives By Barry Sparks
heart muscle to become thin and weak. It can lead to heart failure.
Actively watching your diet and ensuring • Familial Hypercholesterolemia: A regular exercise are exceptional ways to lessen disease that causes too much cholesterol the risk of heart disease. However, many to accumulate in your body, especially people aren’t aware that heart disease is also low-density lipoproteins (LDL), the bad directly connected to genetic factors that cholesterol. This narrows the arteries, further heighten your risk. either partially or completely blocking In fact, about 40% of heart disease is blood flow, which can cause a stroke or caused by genetic factors, according to heart attack. Circulation Research. WellSpan wants patients to know their • Marfan Syndrome: A disease that affects risks so they can take steps to lead healthier the body’s connective tissue, which lives. plays a role in the body’s growth and WellSpan offers patients a program that development. includes comprehensive cardiovascular evaluation, genetic counseling, and testing, Dr. C. Anwar Chahal, WellSpan, • Long QT Syndrome: A disease that as well as screening of family members. cardiology, electrophysiologist. causes fast and chaotic heartbeats. Based on the results, a WellSpan team of experts can develop a personalized treatment WellSpan takes a team approach to cardiovascular genomics. plan for patients that considers their genetic risk for heart “We have a wonderful team that includes electrophysiology, disease. “Cardiovascular genomics can dramatically change outcomes structural imaging, interventional cardiology, cardiac surgery, a lipid team, rehab, genetic counselors, and nurses,” says Chahal. and transform the lives of patients and their family members,” “We are blessed to have a full complement of experts and says Dr. C. Anwar Chahal, WellSpan electrophysiologist. “The subspecialists. We also have a wide range of testing options, such future is bright and holds promise.” as MRI and CT.” In 2020, the American Heart Association specifically The team identifies signs and symptoms of inherited heart recommended genetic testing for patients diagnosed with disease, arranges for appropriate cardiac and genetic testing, all forms of cardiomyopathy, arrhythmic disorders, vascular determines diagnoses, and provides individual treatment plans. disorders, and lipid disorders, so their family members can be After determining the cardiovascular disease, the team focuses armed with the knowledge if they are at risk. on the effects on the patient and their family members. The goal “Most people with inherited heart conditions don’t is to prevent hospitalizations, according to Chahal. experience symptoms and don’t know they’re at risk,” says WellSpan is taking steps to increase the use of cardiovascular Chahal, the lead content developer for the American Heart genomics, developing a clinical fellowship in the field at Association’s certificate in cardiovascular genomics. “If left WellSpan York Hospital. undetected and untreated, inherited heart conditions can lead Medical experts believe technological advances, along with to problems and coronary heart disease, such as heart attacks, consumer demand, will help increase the use of cardiovascular sudden cardiac arrest, or heart failure.” genomics. Some common heart diseases that can be inherited include: Researchers have gained more information on how genetics contributes to cardiovascular disease, and that has led to some • Familial Hypertrophic Cardiomyopathy: A disease that exciting developments. thickens part or all of the heart muscle. In extreme cases, it “We are using this information to study the effects of known can cause sudden death. drugs on selected groups of patients and to develop new drugs,” • Familial Dilated Cardiomyopathy: A disease that causes the says Chahal. “These new drugs are game changers.” 4
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WellSpan Offers Complex Care for Heart Blockages By Barry Sparks
and restores blood flow to the heart. The doctor may place a stent, a small mesh tube, into the newly opened section of the blood vessel to hold the artery open. “Most patients feel substantially better and their symptoms are improved after the procedure,” says Davies. “This improves their quality of life, which is the goal.” In most cases, patients spend just one night in the hospital following the procedure.
Patients with complete blockages in their hearts can undergo a complex yet minimally invasive procedure by experts at WellSpan York Hospital, allowing them to avoid surgery and quickly return to their normal life. Called complex chronic total occlusion percutaneous coronary intervention, or CTO/PCI, the procedure is an alternative for patients who have had a complete blockage of one or more coronary arteries The Signs and Diagnosis of CTO for at least three months. Patients who are at risk of chronic WellSpan York Hospital performs total occlusion (CTO) are those who about 250 of these procedures a year, smoke or have high cholesterol, diabetes, making it one of the top hospitals in high blood pressure, a history of heart the country to offer the technically attack, or known coronary disease and challenging treatment. Its expertise obesity. Their symptoms can include chest results in referrals from physicians across discomfort, shortness of breath, dizziness, the East Coast, who send their patients to fatigue, nausea, pain in the upper body or York to undergo the procedure. Dr. Rhian Davies, director of arm, and rapid or irregular heartbeat. “Cardiologists must undergo intense Complex Coronary Interventional Diagnosis of CTO involves a patient’s training to be able to perform CTO/ Cardiology at WellSpan. medical history, a physical exam, and a PCI efficiently,” says Dr. Rhian Davies, coronary angiogram procedure, which who completed a year-long fellowship, takes images of the arteries. Other tests for CTO may include during which she performed more than 400 of these complex electrocardiograms, echocardiograms, stress tests, nuclear procedures. “The more procedures you perform, the better medicine PET scans, and cardiac MRIs. prepared and equipped you are.” Besides CTO/PCI, other treatment options for CTO include CTO/PCI is a minimally invasive procedure. An medications, which can have side effects, and open-heart interventional cardiologist inserts a small tube called a sheath surgery, which may not be an option for all patients. into blood vessels in the wrist or groin. Davies says CTO/PCI treatment will continue to evolve. Next, a catheter (a smaller tube) is placed within the sheath “Technology and technique are becoming more refined,” and directed through the heart and to the affected coronary she says. “We’re seeing new developments in catheters artery. The interventional cardiologist then inserts a thin guide and devices to help facilitate opening of these blockages. wire through the catheter and across the narrowed or blocked Interventional cardiologists are becoming more comfortable section of the artery. with the procedure, and complication rates are decreasing. The This is followed by insertion of a second smaller catheter, procedure is becoming safer.” equipped with a balloon that is inflated within the narrowed or blocked section of the artery. The balloon opens the artery www.BusinessWomanPA.com
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WellSpan Pioneers Use of Implantable Heart Devices
Implantation of WATCHMAN device
Left atrial appendage with WATCHMAN implant
By Barry Sparks
a catheter carrying the device into a vein near the groin. The Watchman device seals off the opening to the pouch where clots can form. WellSpan York Hospital is pioneering the After implanting the Watchman device, use of implantable devices that prevent the heart tissue forms over and around the device, risk of stroke in patients with an abnormal permanently sealing off the opening. Most heartbeat. patients are discharged after one night in These devices include the Watchman and the hospital and most can return to normal Amulet devices and are designed for patients activity within a week. with atrial fibrillation, when electrical impulses WellSpan York Hospital also is on the that control the heartbeat don’t travel in an leading edge of developing new technology orderly way through the heart. As a result, related to the procedure. In 2019, WellSpan blood may pool in a small pouch in the heart cardiologists were among the first in the and form clots. United States to employ Avail MedsystemsTM The Watchman device is about the size of camera and video technology to collaborate a quarter and shaped like a parachute. It is Dr. Brian Schuler, with fellow physicians doing complex used to close off the pouch, so blood clots can’t cardiology physician at cardiovascular procedures. form. The device is an alternative to long-term WellSpan, specializing in “Avail allows us to remotely collaborate use of blood thinners for patients who have electrophysiology. on a case utilizing live-feed data from the atrial fibrillation. equipment in the room,” says Schuler. The hospital rates in the top 10% of hospitals in the country, In addition to the camera system, the team started to use a 4D based on the volume of Watchman implant procedures. As of CT scanner for real-time procedural guidance for more accurate November 2022, WellSpan York Hospital had implanted 633 and precise device implantations. WellSpan York Hospital of the devices, including 320 Watchman FLX (the latest version established the country’s first 4D CT angio suite in 2019. of the device) and 50 Amulet devices. It was the first hospital in “It was a game changer for us,” says Schuler. “The technology Pennsylvania to implant the latest version of the Watchman as allows us to see the implant device from all angles. It allows us well as Amulet devices. to perform and develop very precise placement. We are the only “These are exciting and amazing times,” says Dr. Brian hospital in the world using this technology.” Schuler, who specializes in electrophysiology or treating cardiac WellSpan York Hospital also is conducting clinical research problems that involve electrical activity and arrhythmia. in the field. It has participated in five studies related to the “WellSpan York Hospital has assembled an incredibly talented, well-trained, and diverse team of innovators who are pushing the Watchman devices and three studies involving the Amulet device. “Our team works together toward the same goal — improving field forward. We are doing things that most people expect only cardiovascular care,” Schuler says. “We think freely, innovate, from academic university institutions.” and we are nimble. That’s why we believe we can be worldwide WellSpan York Hospital’s team of experts, including leaders in the field. We have an opportunity to change the field, cardiologists, electrophysiologists, interventional cardiologists, and we don’t believe we should be limited. I’m very proud of our and nurses, work together to implant the Watchman under team.” general anesthesia. Using advanced imaging, a physician inserts 6
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WellSpan Leads the Way in Structural Heart Programs By Barry Sparks
“We have a comprehensive structural heart program,” says Harvey. “We can perform every cardiovascular procedure with the exception of heart transplants. We have a wellestablished and highly experienced team trained to recognize patients at risk and how to properly treat them.” WellSpan brings together the expertise of diagnostic cardiologists, interventional cardiologists, electrophysiologists, cardiac surgeons, vascular surgeons, advanced practice clinicians, and clinical staff to treat structural heart conditions. WellSpan’s team of cardiologists treats a wide range of structural heart conditions, including:
WellSpan cardiologists have become so adept at repairing heart defects with the latest techniques that they teach others around the country and the world. Dr. James Harvey, an interventional cardiologist and director of WellSpan’s structural heart program, has taught at the Mayo Clinic in Rochester, Minnesota. Groups of cardiologists from Texas and India have traveled to WellSpan York Hospital to observe Harvey perform procedures. “We have taught our techniques to physicians from more than 100 hospitals across the United States and around the world,” says Harvey. In particular, Harvey shares his • Aortic stenosis expertise in performing a transcatheter aortic • Atrial fibrillation valve replacement, called TAVR. WellSpan’s Dr. James Harvey, interventional high volume of TAVR cases and quality • Mitral regurgitation cardiologist at WellSpan and outcomes has generated tremendous interest. • Mitral stenosis director of WellSpan’s structural TAVR is one of several structural heart • Atrial or ventricular septal defect (a hole heart program. procedures performed at WellSpan York in the heart) Hospital. Structural heart disease refers to a defect in the heart’s valves, walls, or chambers. The • Failing surgical valves condition can be present at birth or develop over time. The • Hypertrophic obstructive cardiomyopathy chances of developing structural heart disease increase if you • Paravalvular regurgitation have high blood pressure or atherosclerosis, are taking certain medications, or have had a previous heart attack, rheumatic fever, As part of its improvement process, WellSpan’s Heart and endocarditis, cardiomyopathy, or certain other infections. Vascular Service Line participates in clinical trials and conducts TAVR is a nonsurgical procedure that involves the insertion its own research. Clinical trials are designed to identify the of a catheter into the patient’s leg artery. Through this catheter, newest and most effective treatment methods for cardiovascular a new valve is delivered to the heart through the aorta and disease. supported by an expandable metal cage. It replaces the diseased Harvey attributes much of the success of WellSpan’s valve with a new and normally functioning valve. structural heart program to its team approach. Because the procedure is minimally invasive, most patients “In our program, all the heart and vascular physicians are are able to go home within one day. Patients usually feel better located in the same building, often with offices next to each immediately. other. We interact with each other, share information, and work “TAVR use to be reserved for patients who were too sick for toward a common goal — the improved health of the patient. surgery, but over the years we’ve found it works well for patients There’s incredible synergy,” he says. who also are at moderate or low risk for surgery,” says Harvey. The result is a broader, multidisciplinary perspective that “There’s been a paradigm shift. And technology has made the benefits patients. difference.” “Our care is designed around the patient,” Harvey says. “As WellSpan York Hospital has one of the busiest structural heart programs in the region, performing more than 500 procedures in a result, it’s a seamless experience, one that has generated a lot of positive feedback.” 2022, including nearly 300 TAVR procedures. www.BusinessWomanPA.com
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WellSpan York Hospital Offers Expert Congestive Heart Failure Treatment By Barry Sparks
“CHF can be difficult to diagnose, and sometimes there may be a delay,” he says. “If we diagnose it early, we WellSpan offers state-of-thehave a full toolbox of treatments art treatments that include new we can use. If you’re experiencing medications and new devices to treat symptoms of CHF, ask your provider congestive heart failure (CHF), the to check to see if you have CHF. Our leading cause of hospitalization for current treatments can improve the people older than 65. quality of life and extend life by years. “We have developed an expertise Many patients reach their normal in treating CHF patients,” says Dr. lifespan.” Adnan Malik, medical director of Great improvements in the heart failure services at WellSpan. treatment of CHF have been made in “We treat more than 1,000 CHF the past two or three years, according patients a year. The high volume to Malik. New classes of medications allows us to build a larger team, — such as SGLT2 inhibitors and provide cutting-edge treatment, and IMPULSE Optimizer® Smart device delivers the drug Entresto — have improved acquire the latest technology.” precisely timed energy pulses to the heart. outcomes. Specialized pacemakers are CHF is a chronic, progressive now available. Patients with advanced condition in which the heart is unable CHF may be candidates for left to pump blood well enough to meet ventricle assist device (LVAD) surgery. the body’s needs for blood and oxygen. WellSpan York Hospital recently Almost 6 million Americans have implanted its first Optimizer Smart CHF. device, which can help patients with Many medical conditions that moderate to severe CHF. Designed damage the heart muscle can cause to increase the strength of the heart’s CHF, including: contractions and allow it to pump • Coronary heart disease more blood, the FDA-approved device, which is about the size of a pacemaker, • Heart attack is implanted in a small pocket under • Cardiomyopathy the skin of the upper chest. • Congenital heart disease Using pacemaker leads, the device sends electrical pulses to the heart • Diabetes muscle for five to seven hours a day, • High blood pressure in one-hour treatments separated by regular intervals. Most patients can • Tobacco and recreational drug return home soon after the implant use is completed and return to everyday • Chemotherapy drugs Dr. Adnan Malik, medical director of activities shortly afterward. heart failure services at WellSpan. Malik believes WellSpan’s team “The symptoms of CHF are very approach to treating CHF works best unsettling and include shortness of breath, feeling tired, less able for patients and produces the best outcomes. to exercise, and swollen feet, ankles, and abdomen,” Malik says. “Our patients have access to a highly skilled and trained Malik says it’s important for patients to seek medical team of cardiologists and nurse practitioners, plus the best and attention as soon as possible. newest treatments,” he says. “Taking care of patients in their Some of the complications of CHF include irregular community improves care by dramatic measures. Patients heartbeat, sudden cardiac arrest, heart valve problems, fluid have easy access to our team, caregivers, and loved ones who in the lungs, pulmonary hypertension, kidney damage, liver participate in their care.” damage, and malnutrition. Ultimately, it can be fatal.
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WellSpan Builds an All-Star Cardiac Surgery Team
By Barry Sparks WellSpan has built an expert, all-star cardiac surgery team since 2020, focused on increasing its volume of cases and having top-notch outcomes. The WellSpan team more than doubled its number of open-heart surgery cases in the last three years, going from 198 in 2019 to more than 400 in 2022. It also improved its outcomes, with mortality rates for 2021 and 2022 lower than those predicted by the Society of Thoracic Surgeons’ risk calculations. WellSpan’s cardiac surgery team treats many kinds of heart conditions, including: • Atrial fibrillation • Atrial and ventricle septic defect (hole in the heart) • Adult congenital heart disease • Coronary artery disease • Heart valve disease • Patent foramen ovale • Ascending aortic aneurysm and dissection • Cardiac trauma • Cardiac tumors
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Some of the advanced cardiac surgery procedures and treatments WellSpan offers include: Aortic valve replacement. The aortic valve controls the flow of blood from the left ventricle into the aorta, the major artery that carries blood to the rest of the body. If this valve doesn’t work properly, it can affect blood circulation, causing fatigue, dizziness, and other symptoms. Extracorporeal membrane oxygenation (ECMO). With ECMO, a machine routes blood from the body, oxygenates it, and returns it to the body for circulation. This gives the heart and lungs time to rest, helping patients recover from heart or lung failure or surgery. Tricuspid valve repair. The tricuspid valve helps keep blood flowing out of the heart and into the body. It separates the heart’s right atrium and right ventricle. When it is not working properly, blood leaks backward into the right atrium, which can cause serious health issues. Off-pump coronary artery bypass. Like any other muscle, your heart requires a steady blood supply. When blood flow is blocked, coronary bypass surgery may be necessary. Traditionally, this surgery has required the heart to be stopped and the patient to be on a heart-lung machine. WellSpan physicians use a newer technique called “off pump” coronary artery bypass, in which the heart remains beating throughout surgery. The credentials of the WellSpan cardiac surgery team are impressive. Continued on page 10.
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Continued from page 9. Dr. Mark Burlingame has been a fixture in south central Pennsylvania for three decades. He graduated from Creighton University School of Medicine and completed residencies in general surgery at the University of Alabama and in cardiothoracic surgery at the Medical College of Wisconsin. Dr. David Robaczewski joined WellSpan in April 2020. He received his medical degree from Wake Forest University, graduated from a general surgery residency at Wake Forest Baptist Hospital, and completed a fellowship in thoracic surgery at the University of Virginia Hospital. Dr. Mark Burlingame
Dr. Ronson Madathil
Dr. Ronson Madathil came to WellSpan in August 2021. He graduated from the University of Pittsburgh School of Medicine and completed residencies in general surgery at Case Western Reserve University School of Medicine and in thoracic surgery at UCLA Medical Center. He completed a fellowship program in critical care surgery at University of Washington Medical Center and a fellowship in cardiothoracic surgery at Brigham & Women’s Hospital. He is board certified in thoracic surgery and surgical critical care. Dr. Alan Borkon joined WellSpan in December 2021. He received his medical degree from Johns Hopkins University and completed a residency in general surgery and a fellowship in cardiothoracic surgery at Johns Hopkins Hospital. He is board certified in thoracic surgery and surgical critical care. After serving on the Johns Hopkins faculty, he joined the MidAmerica Cardiac Surgery program in Kansas City, where he excelled in complex adult cardiac surgery and cardiac transplantation.
Dr. David Robaczewski
Dr. Alan Borkon
Resource Books The Heart Healthy Cookbook for Beginners By Sharon Rush Kindle; print The Heart Healthy Cookbook is designed to assist you in unfolding a world of great-tasting food that supports and strengthens a heart that has become weakened from an unhealthy diet. This heart-healthy cookbook covers the following: • How to safeguard your heart and blood pressure without giving up delicious food • How to better organize meals and grocery shopping and balance your needs with those of your family 10
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• Changing your eating habits with eight heart-healthy diet tips: which foods to eat more of and which foods to limit • 1,500 quick and easy recipes to create heart-healthy meals even when you’re busy • A n organized four-week meal plan ready to for your use • Guidance on how to read food labels without being tricked • A HA recommendations for diet and lifestyle for general heart health Your heart is the central organ of your body; because of it, you work efficiently. An easy and effective way to keep it working and healthy is to aid it with a healthy meal.
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Heart Smarter for Women — Six Weeks to a Healthier Heart By Jennifer H. Mieres, M.D. and Stacey E. Rosen, M.D. Kindle; print Heart disease is the No. 1 killer of women. Yet far too few women recognize its risks, and there are tremendous disparities in how women are diagnosed and treated. This book is your invitation to become heart smarter — to combat statistics with knowledge and understanding. Leading cardiologists Drs. Jennifer Mieres and Stacey Rosen have revised their bestselling Heart Smart for Women for a new audience of readers, partnering with Lori Russo and Marissa Licata to add brand-new content designed to equip you with the insights and solutions to live better and feel better — to take charge of your health. The book is centered around a six-week plan that has equipped countless women to become more knowledgeable about their hearts and take simple steps to improve the quality of their lives. Ninety percent of women have one or more risk factors for heart disease. But you can prevent or stop the spread of heart disease with targeted, smart actions designed to modify your risks and equip you to make healthier life choices. It’s time to take control of your health. It’s time to become heart smarter. Note: Please see article on pages 12-13 submitted by Drs. Mieres and Rosen. Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a HeartHealthy Life By Dr. Suzanne Steinbaum Kindle; print As a cardiologist with a specialization in women’s heart disease, Dr. Suzanne Steinbaum has helped thousands of patients resolve their heart issues and aims to do the same for readers in her inspirational book that will change the way we think about heart health. She guides readers through the risk factors of heart disease, from the traditional physical benchmarks like weight, cholesterol, and blood pressure, to lifestyle habits, emotional awareness, and even the way they see themselves in the mirror — and in the world. In Dr. Suzanne Steinbaum’s Heart Book, readers are shown clear, easy steps on how to maximize heart health. This is a life book that will teach women how to regain control over all aspects of their busy lives, including how to finally achieve: • A heart-healthy diet • Heart-supportive exercise www.BusinessWomanPA.com
• Heart-enhancing stress management • Heart-filling relationships • A sound night’s sleep • A more satisfying sex life • A calm, focused mind • A deep level of self-care • And much more Dr. Suzanne Steinbaum’s Heart Book strives to bring forth a new approach to heart-centered healing so that readers everywhere may experience a fulfilling life of health and happiness. Restart Your Heart By Aseem Desai, M.D. Kindle; print Restart Your Heart contains compelling, expert advice on how to live fearlessly with atrial fibrillation. AFib patients, their family, friends, and caregivers are often misinformed about the latest research, advancements, and treatments. In this life-changing book, renowned cardiac electrophysiologist Dr. Aseem Desai diminishes the worry and confusion that come with an AFib diagnosis by presenting you with the latest medical information in a concise and positive way. Desai has made it his mission to significantly improve the lives of those diagnosed with AFib and to offer hope and encouragement to patients and their loved ones. Filled with innovative knowledge and vivid illustrations, Restart Your Heart will empower and inspire you by providing straightforward answers and options to deal with this complex disease. In this comprehensive guide to living your best life with AFib, you will: • Be informed about what AFib is, why it happens, and simple steps to take after being diagnosed • Be prepared to deal with the diagnosis and condition on mental and emotional levels and create a toolbox for resilience in challenging times • Be in control by gaining crucial knowledge about trigger and risk factor modifications, the latest treatment options, and how to monitor the disease for progression or recurrence Restart Your Heart delivers cutting-edge information, options, and solutions that will afford you a newfound sense of comfort, confidence, and control. For more information, visit draseemdesai.com. Heart Health 2023
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Are You Headed Toward Heart Disease? Take These 6 Steps to Reduce Your Risk
By Jennifer H. Mieres, M.D. and Stacey E. Rosen, M.D. Here’s a health fact that should get every woman’s attention: Women are far more likely to die of heart disease than from all forms of cancer. That is a clear indication of how important it is to know how to prevent or minimize your risk for heart disease. But having that urgency can sometimes be difficult because heart disease can masquerade as indigestion, breathlessness, or general fatigue, thereby delaying early diagnosis. For women, heart disease can present with symptoms other than chest pain or chest pressure. It can develop silently over many years and does not always announce its presence and prompt you to seek treatment. According to the American Heart Association, 9 out of 10 women have one or more risk factors for heart disease, and 1 in 3 women will die of heart disease. While most women are worried about breast cancer, heart disease will claim the lives of more women than from all cancers combined. Women and men share certain risk factors: smoking, high
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blood pressure, diabetes, a sedentary lifestyle, high cholesterol, and a family history of heart problems. But there are important differences that are unique to or more dangerous for women: • Diabetic women are three to seven times more likely to die from heart disease than diabetic men. • Women tend to be more obese, more inclined to have a sedentary lifestyle, and more likely to suffer from hypertension and diabetes than men. • There are sex/gender-specific risk factors for heart disease and heart attacks in women. These include women who have had early menopause and those with pregnancyrelated complications such as gestational diabetes, preeclampsia, and eclampsia. Women with inflammatory or auto-immune diseases, such as lupus or rheumatoid arthritis, are at increased risk for heart disease, as well as women with cardiac issues related to breast cancer treatment and those with stress, depression, and anxiety.
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For women, heart disease can present with symptoms other than chest pain or chest pressure.
It’s important to know that heart disease is largely preventable and treatable. Simple lifestyle changes can make a huge impact in reducing risk. One way to incorporate those changes is a program we call Six S.T.E.P.S in Six Weeks to a Healthier Heart. Week 1: Stock the kitchen with healthy food choices Open your refrigerator, pantry, and freezer and get rid of all the foods that are high in fat, sugar, and/or sodium. Purge the ultra-processed foods. Foods high in calories and low in nutrients have no place in a heart-healthy kitchen. Restock with healthy foods, such as fresh fruits and vegetables; salmon and other cold-water fatty fish; whole-grain and sprouted grain breads, pasta, and cereals; high-fiber foods; brown and wild rice; skinless chicken breast; and extra-lean ground chicken and turkey. Week 2: Take control of your activity You need a daily routine focused on three types of activity: walking, strength and flexibility training, and moving your body more in general. An eight-year study of more than 70,000 women found that brisk walking and vigorous exercise substantially reduced the incidence of heart attacks. Ideally, walk 30 minutes a day. Strength training builds muscle mass and improves your metabolism. And remember, prolonged sitting throughout the day can be damaging to your health, even if you already exercise on a regular basis. So find ways to keep your body moving. Week 3: Eat for a healthier heart Plant-based foods should be the primary staples in your diet. Eat at home more often and cut back on eating processed foods. Unprocessed foods are whole foods in their natural state. With these foods, the vitamins, minerals, and nutrients are intact. Remember that eating food and drinking beverages containing large amounts of sugar are directly related to an increased risk of Type 2 diabetes. The American Heart Association recommends that women limit added sugars to no more than 100 calories per day, or 6 teaspoons. Week 4: Partner with your doctor If you go to the doctor only when you are sick, rethink that strategy. Far too often, women schedule regular doctor visits for everyone but themselves. It’s time to reprioritize. Remember that many people who suffer fatal heart attacks didn’t even know they had heart disease.
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The way to forge a true partnership with your physician is through an annual well-woman visit, giving the doctor a chance to learn about you, examine you for signs of heart disease, and discuss appropriate screening measures. Week 5: Sleep more Getting enough sleep is essential for a healthy heart. Too little sleep can make you susceptible to weight gain and increases the risk of Type 2 diabetes and high blood pressure. The American Heart Association says that most people need seven hours of sleep a night. A 2020 study found that sleep is an important marker of cardiovascular health. Week 6: Put it all together Week six is the time to review your successes and evaluate where you have opportunities for improvement. You will learn a lot from your failures when you identify what didn’t work and understand why. It’s common for one aspect of the program to work better than another when taking on new lifestyle changes over a fairly short period of time. Your commitment to living a heart-smart life is long term, and remember, taking small steps of progress will make a big difference. Jennifer H. Mieres, M.D., co-author of Heart Smarter for Women: Six Weeks to a Healthier Heart (www.heartsmarterbook.com), is a professor of cardiology and associate dean of faculty affairs at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. She also is a senior vice president and chief diversity and inclusion officer at Northwell Health. Mieres is a leading advocate for patient-centered healthcare and medical education reform and has authored or coauthored over 70 scientific publications. Dr. Stacey E. Rosen, M.D., co-author of Heart Smarter for Women: Six Weeks to a Healthier Heart (www.heartsmarterbook.com), is a practicing cardiologist and senior vice president for Northwell Health’s Katz Institute for Women’s Health, which focuses on the elimination of healthcare disparities through comprehensive clinical programs, gender-based research, community partnerships, and education. Rosen also is a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and is a national spokesperson for the American Heart Association’s Go Red for Women movement. Editor’s Note: Please see their book review for Heart Smarter for Women: Six Weeks to a Healthier Heart on pg. 11.
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Common Heart Health Mistakes and How to Avoid Them By Sandra Gordon Every day we make dozens of decisions that affect our well-being. We do the best we can, but some choices do more harm than good. Top doctors from across the country list the mistakes they wish their patients would avoid. MEDICAL MISTAKE 1: You don’t have a primary care doctor. Women who have a gynecologist but not a primary care doctor need to go doctor shopping. “Women should have both an OB-GYN and a primary care provider (PCP),” says Michael Roizen, M.D., coauthor of You: The Smart Patient. Primary care providers have broad-based medical knowledge and training in prevention. “There are so many nuances in drug therapy and drug interactions that PCPs are expert in,” Roizen says. If your blood pressure is creeping up, for example, your gynecologist shouldn’t be the one to write a prescription for blood pressure medication. Both men and women need a primary care doctor to ensure they undergo age-appropriate screening tests, such as a colonoscopy (starting at age 45 or before if at high risk). If a specialist is needed, primary care doctors are responsible for coordinating care. To-do tactic: Interview two or three doctors until you find one you’re compatible with. Clues a doctor is right for you: The waiting room has patients similar to your age. The doctor seems knowledgeable about the health issues that concern you. “If you have a family history of heart disease, you want a physician who focuses on heart-disease prevention and knows the current medical literature,” Roizen says. MEDICAL MISTAKE 2: You haven’t had a physical in years because, well, you feel fine. If you don’t have your blood pressure, cholesterol, and blood glucose tested regularly — preferably every five years if you’re in your 20s and 30s and otherwise healthy, and yearly after that — you don’t know if you’re at risk for a heart attack or stroke. “Denial can be deadly,” says Nieca Goldberg, M.D., author of The Complete Guide to Women’s Health. To-do tactic: Schedule a physical and get the facts on your blood pressure, total cholesterol, LDL or “bad” cholesterol, HDL or “good” cholesterol, triglycerides, glucose, body mass index, and waist circumference.
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MEDICAL MISTAKE 3: You ignore troubling symptoms. A common heart-related ailment ignored by many women is atrial fibrillation, says preventive cardiologist Lori Mosca, M.D. This is an irregular rhythm that causes one of the heart’s chambers to beat improperly, and postmenopausal women are at an increased risk. Symptoms include the sensation of feeling your heart beat or a fluttering pulse. “Atrial fibrillation is one of the most common causes of stroke in women,” Mosca says. A clot can develop because of the abnormal blood flow. To-do tactic: If you notice your heart develops the tendency to beat rapidly, then slow down, see your doctor. You might also experience lightheadedness or difficulty breathing. A stroke from atrial fibrillation is preventable, Mosca says. Bloodthinning drugs, such as aspirin or warfarin (sold as Coumadin), can help. MEDICAL MISTAKE 4: You think you might be having a heart attack, so you take an aspirin and wait for the pain to subside. Chewing an uncoated aspirin (not Advil, Aleve, Tylenol, generic acetaminophen, or Tums) isn’t a bad idea if you think you’re having a heart attack (symptoms: chest pain; discomfort in the back, neck, jaw, or stomach; shortness of breath; cold sweats; nausea; or lightheadedness). Aspirin, an anticoagulant, has been shown to help keep arteries open. “But while you’re chewing aspirin, you should call 911,” Goldberg says. The faster you can get treatment during a heart attack, the better your chances of survival and a full recovery. Unfortunately, half of all people with heart attack symptoms die before reaching a hospital. To-do tactic: Know the signs and symptoms of a heart attack and keep aspirin handy at home and in the car. Call 911 immediately if symptoms occur. (Never drive yourself to the emergency department. If you try to drive yourself or have someone else do it, you could collapse en route or get stuck in traffic.) MEDICAL MISTAKE 5: You take over-the-counter supplements to lower cholesterol or blood pressure without telling your doctor. Most patients don’t like taking prescription medicine,
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but they’re all too willing to ingest supplements to treat high cholesterol without alerting their doctors, says Leslie Cho, M.D. Over-the-counter supplements aren’t clinically tested, so you don’t know if they work or not. And because the U.S. Food and Drug Administration doesn’t regulate supplements, you can’t be sure of what you’re taking. You won’t be monitored like you would be if you were on a prescription, and supplements can negatively affect some medications. “Gingko and Echinacea, for example, can interfere with blood-thinning medication,” says Dawn Calderon, D.O., FACC, a cardiologist. To-do tactic: Talk to your doctor or pharmacist before taking a supplement. If you don’t want to take medication, change your diet and try to lose weight. Some people can get to their goals with diet and exercise alone, Cho says. Just tell your doctor. MEDICAL MISTAKE 6: You stop taking your prescription medication because you’re scared of possible side effects. TV commercials for prescription drugs are required by law to present a balanced view of the risks and benefits of the medication, and that includes mentioning possible side effects. But that doesn’t mean they’re common. You’ll hear, for example, that statins (to control high cholesterol) can adversely affect the liver. “That’s rare unless you drink a lot of alcohol or take another
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medication that interacts with a statin,” Cho says. Likewise, patients have been known to take themselves off statins or antihypertension medication because they don’t feel any different. Many heart disease risk factors, such as high blood pressure or high cholesterol, don’t hurt. Stopping a medication on your own can result in devastating consequences, such as a heart attack or stroke. To-do tactic: Before going off any chronic pharmaceutical, such as a statin, talk with your physician about your concerns. At every visit after that, it’s fair to ask whether you still need to be on whatever you’re taking. Taking a medication doesn’t mean you’re unhealthy or a failure. “We’re lucky to live in an era in which there are medications that can help prevent heart attacks and stroke,” Cho says. MEDICAL MISTAKE 8: You don’t hear back about your test results, so you just assume they’re normal. No news isn’t necessarily good news. Doctors are especially pressed for time these days, so things can fall through the cracks. “From a physician standpoint, it’s always a concern,” Calderon says. To-do tactic: Don’t let your doctor drop the ball. If you don’t hear from your doctor’s office when you thought you would after you’ve taken medical tests, it’s your responsibility to call the doctor or the doctor’s nurse to follow up. “Just like in school, you’ve taken the test, so you deserve to get the grade to see how well you’ve done,” Calderon says.
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We know your heart should only skip a beat for loved ones. We also know that isn’t always the case. So if a heart scare happens, know that internationally renowned doctors aren’t worlds away. They’re here, mastering game-changing procedures that get you back to what you love. So take heart, friend. Because we know you and your heart, too. WellSpan.org/Heart
