Heart Health 2024

An Issue We Can’t Ignore

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 ÃȊŋêĀŠĞÃŋȊÞÃŒĉŒȊǽȊĀÃĉĥĉĥĀȊĉĥŚêŋĥÃŚĉĬĥÃĞȊÃŚŚêĥŚĉĬĥȊÃĞĬĥĀȊŚąêȊŷÃŽǡȊ 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/HeartEast

Sponsored by

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PA’s finest knows Lebanon’s best. ŒȊÃȊŋêŚĉŋêåȊŒŚÃŚêȊňĬĞĉßêȊĬÿƌßêŋǢȊTĬêȊ#ĉňĉêŋŋĬȊěĥĬŷŒȊÃȊŚąĉĥĀȊĬŋȊŚŷĬȊÃÞĬŠŚȊąĉĀąêŋȊ ŒŚÃĥåÃŋåŒǡȊ ßßĬŋåĉĥĀȊŚĬȊąĉĤǢȊŒĬȊåĬêŒȊ#ŋǡȊFĤňêĞĞĉƅƅêŋĉǡȊBêȊąêĞňêåȊĞĬŷêŋȊTĬêȉŒȊŋĉŒěȊ ĬÿȊŒŚŋĬěêȊÞŽȊßĞêÃŋĉĥĀȊÃȊßÃŋĬŚĉåȊÃŋŚêŋŽȊÃŚȊ°êĞĞ ňÃĥȊ=ĬĬåȊ ÃĤÃŋĉŚÃĥȊBĬŒňĉŚÃĞǡȊ Ȉ°ąêĥȊÞĞĬĬåȊƍĬŷȊŚĬȊŚąêȊÞŋÃĉĥȊĉŒȊĉĥŶĬĞŶêåǢȊŽĬŠȊĀĬȊŷĉŚąȊŚąêȊÞêŒŚǢȈȊŒÃŽŒȊTĬêǡȊ ĬåÃŽǢȊTĬêȉŒȊŒŚĉĞĞȊêĥĘĬŽĉĥĀȊŋêŚĉŋêĤêĥŚȊĉĥȊąĉŒȊŒĉĀĥÃŚŠŋêȊŷÃŽȊǽȊßŋŠĉŒĉĥĀȊĬĥȊ ąĉŒȊĤĬŚĬŋߎßĞêȊŷĉŚąĬŠŚȊÿêÃŋȊĬÿȊÃȊŒŚŋĬěêȊÃŋĬŠĥåȊŚąêȊÞêĥåǡ

WellSpan.org/HeartEast

Heart Health Awareness 2024 Publisher Donna K. Anderson

Editorial Vice President & Managing Editor Christianne Rupp Editor Megan Joyce

Contributing Writers Kimberly Blaker Sandra Gordon Lynda Hudzick Barry Sparks

Art Department Production Coordinator Lauren Phillips

Business Development Senior Marketing Consultants Josh Binkley Angie Willis

Dear friends and colleagues, You probably know someone who has or had heart disease. For me, it keeps hitting close to home. Many years ago my mother had to have stents inserted, but recently my brother was rushed to the hospital for labored breathing and chest heaviness and had five stents inserted.

And a friend of mine had two stents inserted shortly after that.

According to the Centers for Disease Control and Prevention, someone dies from cardiovascular disease every 34 seconds.

Adults over 65 are more likely to experience cardiovascular disease than younger persons.

However, a recent study indicated that heart attacks in people under 40 have been increasing over the past decade. Why? Because obesity and high blood pressure, conditions that lead to heart disease, have increased in younger people.

And although women may experience the classic indicators of a heart attack, it is also common to have symptoms such as indigestion, shortness of breath, and back pain without the obvious symptoms of chest pain or discomfort.

What can we all do? Know the risk factors that contribute to heart disease: high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity. Then do something to mitigate your risks, which may include losing weight, stopping smoking, talking to a nutritionist to eat better, and getting more exercise.

And make sure your doctor hears your concerns.

We are fortunate to have WellSpan Health in our region. WellSpan Health continues to expand their reach so their life-saving services are more easily accessible to the larger community.

We thank them for partnering with us to bring Heart Health magazine to the community.

Vital information about their heart health research, progress in cutting-edge treatments, and their highly trained staff of surgeons and physicians is included in this issue.

Please take time to read the important articles included in this special feature. They could save your life.

Here’s to your heart health!

Events Manager Kimberly Shaffer

Christianne Rupp, Vice President and Managing Editor

Business Manager Elizabeth Duvall

Inside:

4-5 The Gene Health Project Targets Early Detection Copyright © 2024 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.

6-7 Skilled WellSpan Surgeons Using the Latest Techniques 8-9 WellSpan Known Internationally for its TAVR Expertise 10 WellSpan Expands its Vascular Surgery Services 11 A Matter of the Heart 12-13 Pressure Pointers

On-Line Publishers, Inc. P.O. Box 8049, Lancaster, PA 17604 717.285.1350 • fax 717.285.1360

14 Atrial Fibrillation: Take Your Fluttering Heartbeat Seriously 15 Resource Books www.BusinessWomanPA.com

Heart Health 2024

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The Gene Health Project Targets Early Detection

By Barry Sparks WellSpan Health and Helix have partnered on The Gene Health Project, a community health research project designed to use a person’s genetic information to help identify and better understand some of their hereditary health risks, such as heart disease and certain types of cancer.

“At WellSpan, we want to be at the leading edge of what we are able to offer our patients and the community, and The Gene Health Project allows us to offer the next level of care to them,” says Dr. C. Anwar Chahal, principal investigator for the study, the director of the Center for Inherited Cardiovascular Diseases at WellSpan, and co-medical director of Precision Medicine at WellSpan.

Typically, projects like this are only available to patients in select metropolitan areas at university academic settings, according to Chahal, but The Gene Health Project is open to all community members over the age of 18.

Participants have blood drawn locally at WellSpan and mailed to Helix, the country’s leading population genomics and viral surveillance company, for analysis.

Based on the results, clinical follow-up may be needed to discuss a personalized health plan. This is done at no cost to participants.

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“Early detection is powerful,” stresses Dr. David Kann, co-medical director of Precision Medicine at WellSpan. “This study can identify potential risks before they are detected by other means. By knowing someone’s genetic makeup, physicians are able to prevent and treat diseases more effectively.”

The DNA screening test may indicate elevated inherited risk for breast and ovarian cancer, colorectal cancer related to Lynch syndrome, as well as heart disease from very high cholesterol levels, also known as familial hypercholesterolemia.

The Centers for Disease Control and Prevention (CDC) has labeled these disorders tier one because they are common and very treatable.

“Through early detection we can save lives, decrease the impact of the disease, and prolong lives with a higher quality of life,” says Chahal.

For every 100 people studied, one or two will have a genetic variant that may put them at risk for one of the conditions reported as part of The Gene Health Project. Those found to have an increased risk will be contacted and offered a no-cost appointment with a genetic counselor to discuss their results.

A genetic counselor is a medical professional specifically trained to help people understand how their genetic information may impact their health or their family’s health. Those participants will also be offered a visit in one www.BusinessWomanPA.com

of WellSpan’s subspecialty clinics that follow patients with those genetic variants.

To participate in The Gene Health Project, visit wellspan.org/ GeneHealth to learn more about the consenting and enrollment process.

Participants will have the opportunity to read more about the research program C. Anwar Chahal, M.D., director and proceed to an of the Center for Inherited enrollment website, Cardiovascular Diseases and hosted by Helix, co-medical director of Precision to complete their Medicine at WellSpan. eligibility criteria and review and electronically sign the research consent form.

After the consent form is signed, participants will be asked to schedule a blood draw for DNA collection at a WellSpan laboratory. There is no cost to participate and no need for health insurance for this genetic test.

Results generally take eight to 12 weeks. They will be sent to participants at their MyWellSpan account, the electronic medical record, and to the WellSpan study team. The results, which are strictly confidential, may show whether a participant is at increased genetic risk for the conditions mentioned above.

The contributed information to The Gene Health Project may be used by researchers to study a wide range of questions around how DNA may impact health and what may cause certain diseases. Researchers also want to learn more about how to best treat a variety of diseases. No researcher outside of WellSpan will have access to any personal information

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that may directly identify the participants.

“Our goal is to enroll 100,000 people,” says Chahal. “Everyone aged 18 years and above is welcome.

This study is easily accessible to the communities we serve. Insights we gain from this study will help us provide more personalized healthcare for David Kann, M.D., co-medical our patients and director of Precision Medicine community. It is at WellSpan. an opportunity for people to make an impact on their own health, the health of family members, and the future of healthcare.”

Chahal is very proud of WellSpan’s team of physicians, advanced practice providers, genetic counselors, laboratory staff, and information group who have been working on setting up The Gene Health Project over the past 18 months. It launched on Aug. 1, 2023.

“We already have more than 5,000 participants enrolled and are gaining strength daily,” says Chahal.

In an interview with the York Dispatch, William Lee, the chief science officer at Helix, said, “Genetics is underutilized in healthcare right now worldwide. I think in the American health system, in particular, things are set up in a way that it’s difficult to really change how things are done.

“And so, I’m grateful to work with partners like WellSpan, who are willing to put in the investments on their side because it is the right thing to do in order to benefit their patients.”

Heart Health 2024

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Skilled WellSpan Surgeons Using the Latest Techniques

By Barry Sparks Skilled WellSpan surgeons are using the latest techniques and technologies to improve outcomes for patients.

Cardiac surgeon Martin LeBoutillier III, M.D., performs off-pump coronary artery bypass graft (OPCAB) at WellSpan Good Samaritan Hospital in Lebanon, while Paul Impellizzeri, M.D., FACS, FSVS, and Leon Salem, M.D., perform mechanical thrombectomy intervention to treat deep vein thrombosis (DVT) at WellSpan Good Samaritan Hospital in Lebanon and WellSpan Ephrata Community Hospital in Ephrata, respectively.

While the OPCAB surgery is gaining in popularity, LeBoutillier has been using and perfecting the technique for more than a decade.

The procedure is often referred to as “beating heart surgery.” The traditional coronary bypass procedure requires the heart to be stopped and blood drained out of the body and pumped through a heart-lung machine, which adds oxygen to the blood before it is pumped back throughout the body.

“Taking blood from the body has risks,” he says. “Air may get into the line or the machine may work improperly.

There are risks of stroke, kidney damage, inflammation, and bleeding.

“The OPCAB procedure is possible because of the invention of stabilizers that hold a small portion of the heart and keep it still while the rest of the heart beats,” says LeBoutillier. “That allows us to do the bypass with no tubes, clamps, or heart-lung machine.”

Certain types of patients at high risk may be more likely to benefit from OPCAB. These include people with advanced atherosclerosis of the aorta, kidney problems, or chronic lung disease.

OPCAB seems to offer less risk of infection, bleeding, stroke, kidney failure, and cognitive (mental) problems.

Additionally, the length of stay

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Cardiac surgeon Dr. Martin LeBoutillier performs a procedure in the operating room at WellSpan Good Samaritan Hospital.

Dr. Paul Impellizzeri, vascular surgeon at WellSpan Good Samaritan Hospital, performs a mechanical thrombectomy to remove a blood clot. for OPCAB patients at WellSpan Good Samaritan Hospital is one day shorter than average, and the need for readmission rate is significantly less.

“Our patients spend less time in the ICU than average. They are out of the ICU in less than 24 hours, and they are up and taking short walks the morning

after,” says LeBoutillier.

He believes every patient diagnosed with a blocked artery or arteries should have an OPCAB procedure because of its advantages and his expertise.

“Patients feel better about the OPCAB procedure once I describe it to them,” he says. “They find comfort in the fact

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From left to right: Martin LeBoutillier, M.D., cardiac surgeon and Paul Impellizzeri, M.D., vascular surgeon at WellSpan Good Samaritan Hospital; and Leon Salem, M.D., vascular surgeon at WellSpan Ephrata Hospital. that we don’t have to stop and restart the The ideal treatment time is within heart. Plus, I’ve done thousands of these four weeks following the initial diagnosis. procedures.”

The best candidates for mechanical It is important to have the OPCAB thrombectomy are those with clots in performed by a surgeon with experience larger veins, the abdomen, the groin, with the procedure. LeBoutillier estimates, and the thigh region, according to however, that only 20% of surgeons are Impellizzeri. Clots in those areas usually comfortable doing the procedure. lead to more problems than clots below Vascular surgeon Dr. Paul Impellizzeri the knee. has been treating patients with deep vein Mechanical thrombectomy involves thrombosis (DVT) for more than 15 the surgeon making a small needle/ years. In the beginning, he treated them catheter puncture behind the knee, with a clot-busting or anticoagulation inserting thin tubes (catheters) through medication. the blood vessels to the clot. A tiny Today, however, he uses a minimally device, shaped like a basket, at the end of invasive surgical procedure called the catheter retrieves it, restoring blood flow. mechanical thrombectomy.

The outpatient procedure typically “Mechanical thrombectomy offers a takes one to two hours and uses a local number of advantages,” he says. “It’s safer, Photo courtesy of Getty Images. has a low complication rate, and has an anesthesia and minimal sedation. easy recovery.”

“With the mechanical procedure, patients experience rapid relief of their symptoms (swelling and More patients are eligible for mechanical thrombectomy than associated pain and heaviness in their limbs),” says Impellizzeri. clot-busting medication, according to Impellizzeri.

“Plus, they do not need to go to the ICU or stay at the hospital “Clot-busting medication can cause bleeding,” he says. overnight. They are up and mobile right away and usually go Deep vein thrombosis occurs when a blood clot forms in home the same day.” one or more of the deep veins in the body, usually in the legs. It Other benefits include reduced risk of long-term morbidity, can be serious because blood clots in the veins can break loose including chronic leg pain, swelling, ulceration, and recurrent and travel through the bloodstream and get stuck in the lungs, blocking blood flow. Severe clotting could threaten the viability DVTs. Patients also do not have to discontinue the use of blood of a limb. thinners.

DVT symptoms can include: For all of the reasons above, Impellizzeri believes even patients with minimal DVT symptoms of the larger lower•L eg swelling extremity veins should be considered for a mechanical •L eg pain, cramping, or soreness that often starts in the calf thrombectomy procedure.

“WellSpan has invested in the technology to allow us to •C hange in skin color of the leg, such as red or purple perform this advanced treatment,” says Impellizzeri. “And, it’s • A feeling of warmth of the affected leg greatly benefited patients in our region.” www.BusinessWomanPA.com

Heart Health 2024

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WellSpan Known Internationally for its TAVR Expertise

By Barry Sparks “It was humbling and flattering,” says James Harvey, M.D., vice president and chief medical officer of WellSpan Heart and Vascular, discussing his November 2022 trip to the Mayo Clinic in Rochester, Minnesota.

He traveled there to demonstrate to physicians how he performs the transcatheter aortic valve replacement (TAVR) procedure.

The Mayo Clinic is one of the leading medical institutions in the world. Over the course of its history, it has been at the forefront of countless discoveries and innovations that have impacted millions.

Each year Mayo Clinic sees more than 1.3 million people from all 50 states and 137 countries worldwide.

“Mayo Clinic is definitely a special place,” says Harvey. “It has some of the brightest and most talented physicians in the world. I felt like I was on hallowed ground.”

TAVR is a nonsurgical procedure generally performed on patients with severe aortic stenosis, which is a narrowing of the heart valve, who aren’t the best candidates for a surgical intervention because of other risk factors. For them, TAVR is the safest procedure to open the valve.

The procedure involves the insertion of a catheter into the patient’s femoral artery, a vessel that provides blood to the leg. Through this catheter, a new valve is delivered to the heart through the aorta. The new valve is supported by an expandable metal cage. It is placed inside the diseased valve to replace the old one with a new and normally functioning valve.

Some Mayo Clinic interventional cardiologists were having trouble navigating the valve to get back to the coronary artery (coronary access after TAVR). They mentioned it to their valve representative, who was familiar with Harvey’s work. He recommended Mayo Clinic invite Harvey to do a presentation.

“I was glad to share my insights and best practices,” says

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James Harvey, M.D., vice president and chief medical officer of WellSpan Heart and Vascular.

Harvey. “It was a memorable experience.”

Harvey has helped educate hundreds of interventional cardiologists worldwide about efficiently performing the TAVR procedure. Many have visited WellSpan York Hospital, while others have remotely observed him doing cases. He recently was a main faculty member for international conferences broadcasted remotely from China and India.

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Image provided courtesy of Boston Scientific. © 2023 Boston Scientific Corporation or its affiliates.

All rights reserved. This device is investigational and not available for sale.

ACURATE neo2™ Aortic Valve System.

James Harvey, M.D., preparing for surgery.

“Although many may not know it, the expertise of our TAVR program is known around the world,” proclaims Harvey.

Performing a large number of TAVR procedures has allowed WellSpan interventional cardiologists to hone their skills.

WellSpan York Hospital expected to do 350 TAVR procedures in 2023. They performed nearly 300 in 2022, 230 in 2019, and 50 in 2016.

“TAVR used to be reserved for patients who were too sick for surgery, but over the years we’ve found it works well for patients who also are at moderate or low risk for surgery,” comments Harvey.

You don’t become an expert without constantly challenging yourself.

“Members of our structural heart team are always thriving to improve and produce better outcomes for patients,” says Harvey.

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As part of that philosophy, Harvey serves on an advisory panel regarding the development of the next generation of a commercially available aortic valve. WellSpan York Hospital is participating in a clinical trial for the Boston Scientific ACURATE Neo Valve, which hasn’t been approved by the FDA yet.

The ACURATE Neo Valve is made up of a stent-like valve frame and animal tissue leaflets (part of the valve designed to open in the direction of blood flow and close to prevent back flow). It is designed to softly expand and adapt to one’s valve anatomy, fitting right into the native valve. A special seal outside of the valve is designed to minimize the risk of blood leakage outside the valve frame.

“We believe this aortic valve will combine the best features of the earlier generations of the device,” says Harvey. “And, we are excited about it.”

Heart Health 2024

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WellSpan Expands its Vascular Surgery Services

By Barry Sparks WellSpan has contracted with four vascular surgeons to expand its vascular surgery services to Hanover, Gettysburg, and Chambersburg.

“This is exciting news,” says Dr. Steven Busuttil of WellSpan Vascular Surgery.

“Although WellSpan has a large footprint in the region, we have not been able to Ann Kim, M.D. provide enough vascular surgery services in areas west of York, up until now.”

The four vascular surgeons will have offices in Hanover, Gettysburg and Chambersburg and will rotate between WellSpan Chambersburg Hospital and WellSpan Health and Surgery Center in Hanover.

“Prior to this, residents of those areas had to travel to York for vascular services and surgery. That puts stress on both the patient and Swati Chaparala, M.D. their family members,” says Busuttil.

The expansion of vascular services fits with WellSpan’s philosophy of treating people in their neighborhood and limiting their need to travel for services when feasible.

Busuttil says vascular patients can be evaluated locally.

If they can be treated medically, they will be. If surgery is required, they may be treated at the nearest WellSpan hospital.

If the procedure is more complicated, however, they may be required to travel to WellSpan York Hospital.

“Our goal is to do as many vascular procedures as safely as possible in Chambersburg Hospital and our Hanover sugery center,” says Busuttil, “which means keeping our patients close to home.”

WellSpan vascular surgeons treat a broad range of conditions. They include carotid artery disease, aneurysms, lower extremity peripheral artery disease, dialysis access needs, and varicose and spider veins and venous insufficiency.

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“WellSpan has recruited four very well-trained, experienced, and skilled vascular surgeons,” says Busuttil. “Recruiting vascular surgeons is difficult because vascular surgery is not a simple specialty. Patients can be very confident of the care these vascular surgeons provide.”

The vascular surgeons are Drs. Ann Kim, Mirnal Chaudhary, Swati Chaparala, Mirnal Chaudhary, M.D. and Daniel Neuzil. Their resumes are impressive.

Kim graduated from Johns Hopkins University and received her medical degree from Case Western Reserve University. She also served a residency in general surgery and a fellowship in vascular surgery at the university. Kim is certified by the American Board of Surgery in general and vascular surgery.

Chaudhary graduated from the University of Akron and received his medical Daniel Neuzil, M.D. degree from Northeast Ohio Medical University.

He completed graduate school at the University of Wisconsin Hospital. He served a residency in general surgery at Wright State University (Boonshoft School of Medicine) and a fellowship in vascular surgery at the University of Pittsburgh Medical Center. Chaudhary is certified in general and vascular surgery by the American Board of Surgery.

Chaparala graduated from Kent State University and received her medical degree from Northeast Ohio Medical University. She served a residency in vascular surgery at Mayo Clinic – Rochester. Chaparala is certified in vascular surgery by the American Board of Surgery.

Neuzil graduated from the University of Washington and received his medical degree from Johns Hopkins University School of Medicine. He completed residencies and fellowships at Vanderbilt University Medical Center. Neuzil is certified in general and vascular surgery by the American Board of Surgery.

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A Matter of the Heart

By Lynda Hudzick Nancy Heller loves the outdoors.

“I enjoy being outdoors, working in the yard, walking, hiking and riding bike,” she said.

This mother and grandmother from West York is a particularly avid walker, averaging 4 miles a day, usually five days a week.

“For years I have exercised regularly and followed a healthy diet,” Heller said.

So when she began to experience some discomfort while taking her walk, heart disease wasn’t the first thing she thought of, although she said there is a history of it in her family, with her father having had coronary artery bypass surgery when he was in his early 50s.

“One day while I was walking, I noticed some chest tightness that stopped when I rested and slowed my pace,” she said.

Several days later, she noticed the same tightness while working in her yard, which again stopped when she slowed down.

“I saw my family doctor, and the EKG they did in the office was normal,” she recalls. “I was sent for a stress test and was surprised when I was told it was abnormal and that I would be going to the emergency room at WellSpan Health.”

The results of her stress test indicated an abnormality. She was sent for a heart catheterization, which led to being diagnosed with coronary artery disease with blockages in two of her coronary arteries. The next step was to have stents inserted to open the blocked arteries. www.BusinessWomanPA.com

“My doctor, Dr. Davies, was wonderful as she explained what she found when she did the heart catheterization,” Heller said. “I received great care throughout my stay and treatment.”

She said she felt greatly supported and cared for during and following her treatment by her medical team, which included Colleen Webb, CRNP, and Nivedita Boinapally, M.D., at WellSpan Health Family Practice, and then with Casey Ryan, PA-C, at WellSpan Cardiology.

“My husband, children, and grandchildren were also a great source of love, caring, and support while I was in the hospital and after I came home,” Heller said.

Today, she’s doing well and still enjoys being very active, but she also advises women to be aware of what’s going on in their own bodies.

“My symptoms were very mild; I wasn’t sure they were urgent,” she said. “I am very grateful to be where I am today. I would encourage women to keep regular appointments with their healthcare provider.”

She also emphasized the importance of being mindful of warning signs or changes in a woman’s body that could be related to heart health, particularly if there is some history of heart issues in the family.

“Be aware of the role family genetics plays in the health of our hearts,” she said.

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Pressure Pointers

By Sandra Gordon You can’t see or feel high blood pressure (hypertension), which is why — unlike, say, nausea or fainting — it can be easy to ignore. A better tactic?

Learn more about it, starting with what high blood pressure is.

“Most people think blood pressure is the pressure in their arm, but in reality, it’s the pressure in every blood vessel in your body, including the pressure inside the chamber of the heart,” says cardiologist Dr. Anuj Shah.

Over time, unmanaged high blood pressure — blood pressure greater than 130/80 (Stage 1) or greater than 140/90 (Stage 2) — can lead to serious health problems, including kidney disease, heart disease, and stroke, all leading causes of death in the U.S. An estimated 50% of the U.S. adult population has blood pressure greater than 130/80. Normal blood pressure of 120/80 or less is the goal.

According to the Centers for Disease Control and Prevention (CDC), only about 1 in 4 adults with high blood pressure has it under control.

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The good news? There’s a lot you can do to manage your blood pressure. We investigated the latest medical updates to narrow your to-do list to these three important steps.

Push yourself. If you’re diagnosed with high blood pressure, your doctor may suggest focusing on lifestyle changes first before prescribing medication, including losing weight, reducing caffeine to less than 300 mg per day (about two to three cups of coffee), limiting alcohol to no more than two drinks daily (men) or one (women), and exercising 90-150 minutes per week.

Of those lifestyle changes, “exercise gives you the most bang for your buck,” Shah says. “Even if you’re overweight, there’s a higher chance you’ll be able to maintain all of your cardiovascular risk factors, including blood pressure control, if you exercise regularly.”

Aerobic exercise like brisk walking or jogging has been shown to lower blood pressure by 5-7 mmHg in adults with hypertension, which is significant.

To maximize exercise’s blood-pressure-lowering potential, do even more than 90-150 minutes of weekly aerobic exercise.

A study in Current Hypertension Reports, which reviewed

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33 studies on the blood pressure response to exercise, recommended aerobic exercise on most, preferably all, days of the week, and dynamic resistance training (strength training) on to two to three days in that same week, which can lower blood pressure by 2-3 mmHg. According to the researchers, this combination could lower cardiovascular disease risk by 20-30%.

Do a mental reset. There’s an emotional component to high blood pressure that’s gaining ground. Ongoing stress can set off a hormonal cascade that triggers the autonomic nervous system: the fight or flight response.

“Your autonomic nervous system is a set of nerves that controls blood pressure,” Shah says.

It knows no bounds. The autonomic nervous system can be helpful if you’re running out of the way of an oncoming car. But it can chronically raise your blood pressure if it’s constantly activated because you’re worried about losing your job or paying the bills.

To gain better control of your blood pressure, train your mind to deactivate the autonomic nervous system in your daily life. Physical activity is one way to help calm your nerves and another reason to be active.

Consider adding meditation to the mix. A study in

the International Journal of Hypertension found that meditation techniques may produce small yet meaningful reductions in blood pressure.

And don’t skimp on rest.

“Getting enough sleep also plays a role in controlling blood pressure,” Shah says.

Double up on medication. Besides lifestyle, genetics plays a role in hypertension.

“You’re more likely to have high blood pressure if one or two of your parents has it,” says Dr. Daniel Devine, an internal and geriatric medicine physician.

Under those circumstances, you may need medication in addition to modifying your lifestyle to control your blood pressure. There are four classes of blood-pressure-lowering medication: diuretics, angiotensinconverting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers.

“Any one of these four medications will help reduce blood pressure by 1015 mmHg,” says Devine.

The trend now is to prescribe two of these medications at once in lower doses.

“We’ve found that summation of two medicines has a greater effect at reducing blood pressure,” Devine says. “They have a synergistic effect.”

Blood Pressure Monitor Buying Tips Do you really have high blood pressure, or is it just elevated in the doctor’s office, a phenomenon known as “white coat hypertension”?

To get a true assessment, check your blood pressure at home in the morning and evening; keep a log for one to two weeks or longer, and bring it to your doctor.

Blood pressure monitors come with cuffs in pediatric, small adult, regular adult, and large and extra large, depending on the diameter of your arm. Blood pressure monitors aren’t regulated by the U.S. Food and Drug Administration.

For the most accurate home reading, buy an automatic home blood pressure monitor with an upper arm cuff, which measures blood pressure in the brachial artery, an artery close to the heart.

“There’s a bit of a goldilocks fit. You want to make sure the cuff is the appropriate size for the size of your arm,” Devine says.

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Heart Health 2024

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Atrial Fibrillation: Take Your Fluttering Heartbeat Seriously

By Kimberly Blaker When we think of heart conditions, we often associate them with older people. Although aging does increase the risk of atrial fibrillation (AFib), and it’s found more often in those over 60, it can affect people of all ages, including children.

This serious condition, which affects 2 million Americans, increases the risk of health complications, including heart attack and stroke.

What is AFib and its causes?

AFib makes the heart beat rapidly and irregularly — commonly felt like a fluttering of the heart.

According to the Mayo Clinic, “During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart.”

Atrial fibrillation, also known as arrhythmia, though a serious condition, is not deadly in and of itself. Rather, this condition is serious because it increases the risk of heart failure or stroke or can be caused by a significant underlying health problem.

There are several causes associated with AFib. Sometimes, it’s the result of an underlying health condition, such as one of several heart-related diseases; previous heart surgery; sleep apnea; lung disease; infection; or an overactive thyroid.

Other causes include caffeine, heavy alcohol use, street drugs, and certain medications. It can also be genetic.

Symptoms and Diagnosis The most common symptom of AFib is a fluttering heartbeat or palpitations. But other symptoms sometimes also accompany the condition, such as: • Fatigue • Dizziness • Thumping in the chest • Anxiety • Shortness of breath • Feeling faint or confused • Sweating • Chest pain or pressure In the event of chest pain or pressure, treat it as a medical

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Heart Health 2024

emergency, as it could indicate a heart attack.

Diagnosis of AFib is painless and relatively simple.

Your doctor will perform a physical examination and an electrocardiogram. A patient-activated cardiac event recorder might also be used to help with the diagnosis.

Types of AFib and Treatment There are four types of AFib, although one form of AFib can progress into another.

Paroxysmal AFib is intermittent. It can last for merely a few seconds or for up to a week. Symptoms can range from none to severe. Either way, it goes away on its own within a week or less.

It can occur after heavy drinking if your body isn’t used to this activity or possibly due to intense stress.

Persistent AFib doesn’t go away on its own. Instead, it lasts until it’s treated, either with medication or electric shock.

Physicians will treat the source of the irregular heartbeat as well.

Prior smokers who have high blood pressure, coronary heart disease, COPD, or heart valve disease may experience persistent AFib. Longstanding, persistent AFib doesn’t respond to the above typical treatments. Therefore, several forms of minimally invasive catheter ablation are considered. For this procedure, you’ll be given something to relax you and a local anesthetic to numb the groin or neck area where the catheter will be inserted to complete the procedure.

Finally, permanent AFib results when longstanding, persistent AFib is unresponsive to treatment. When treatment has been ineffective, your doctor and you will decide to continue or discontinue the treatment. Unfortunately, this form of AFib is associated with increased risk of a heart attack and can also impact the quality of your life.

Regardless of the form of AFib, take the condition seriously.

If you experience symptoms, seek medical attention without delay. www.BusinessWomanPA.com

Resource Books Living Well with Heart Failure: The Misnamed, Misunderstood Condition

By Edward K. Kasper & Mary Knudson Print Heart failure — the expression alone is scary. The idea that the blood-pumping organ in our chest can struggle, stutter, or suddenly stop is deeply disconcerting.

But for those who get the diagnosis, the future is not necessarily bleak. With the right treatments and a healthy lifestyle that includes exercise and good nutrition, many people with heart failure can improve their condition and live well.

Heart failure expert Edward K. Kasper, M.D., teams with journalist — and survivor — Mary Knudson to give readers an honest account of this misunderstood condition. The authors explain the complex science of heart failure and look critically at the care available.

Living Well with Heart Failure, the Misnamed, Misunderstood Condition will help readers understand: • The causes of the condition • Normal and abnormal heart rhythms • How to recognize symptoms and when to seek treatment • W hich diagnostic tests to expect • The best treatments for different types of heart failure • How pacemakers work • The advantages and disadvantages of implantable cardioverter defibrillators • How to be safer in a hospital • W hat exercises result in increased heart, leg, arm, and core body strength • W hat foods to eat and what to avoid Informed by the shared knowledge of doctor and patient, those diagnosed with heart failure and their loved ones will learn how to effectively manage the condition in this comprehensive and compassionate guide. www.BusinessWomanPA.com

A Statin-Free Life

By Dr. Aseem Malhotra Kindle; print Statins are among the most widely prescribed drugs in the world.

Yet many report serious side effects, and a U.S. survey revealed that 75% of respondents stopped taking them within a year.

So what is the evidence for their benefits? Dr. Aseem Malhotra, author of the bestselling The 21-Day Immunity Plan and co-author of the bestselling The Pioppi Diet, examines the claims for statins and their role in lowering cholesterol and preventing heart disease.

He introduces us to his targeted hearthealth plan, which, with a diet plan, recipes, and advice on reducing stress and increasing movement, can help us to live statin-free and take control of our own health.

The 30-Day Heart Tune-Up: A Breakthrough Medical Plan to Prevent and Reverse Heart Disease

By Steven Masley, M.D. Kindle; print Follow this step-by-step program to optimize your cardiovascular health, boost your energy, slim your waistline, and heat up your sex life — all while enjoying 60 delicious recipes!

Cardiovascular disease is the No. 1 killer of Americans today. But, the good news is that everyone — regardless of size, genetics, gender, or age — can treat arterial plaque and prevent heart attacks and strokes with this book. The keys to the program are shrinking arterial plaque, improving circulation, and strengthening your heartbeat.

The tools in this book include hearthealing foods, exercise that strengthens the

heart and arteries, stress management, and a customized heart-friendly supplement plan. The 30-Day Heart Tune-Up program is easy, fast, and could even be called sexy.

Masley devotes a chapter to showing how improving heart health enhances sex drive and function in both men and women.

Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience

By Brené Brown Kindle; print In her latest book, Brené Brown writes, “If we want to find the way back to ourselves and one another, we need language and the grounded confidence to both tell our stories and be stewards of the stories that we hear. This is the framework for meaningful connection.”

In Atlas of the Heart, Brown takes us on a journey through 87 of the emotions and experiences that define what it means to be human.

As she maps the necessary skills and an actionable framework for meaningful connection, she gives us the language and tools to access a universe of new choices and second chances — a universe where we can share and steward the stories of our bravest and most heartbreaking moments with one another in a way that builds connection.

Over the past two decades, Brown’s extensive research into the experiences that make us who we are has shaped the cultural conversation and helped define what it means to be courageous with our lives.

Atlas of the Heart draws on this research, as well as on Brown’s singular skills as a storyteller, to show us how accurately naming an experience doesn’t give the experience more power — it gives us the power of understanding, meaning, and choice.

Brown shares, “I want this book to be an atlas for all of us, because I believe that, with an adventurous heart and the right maps, we can travel anywhere and never fear losing ourselves.”

Heart Health 2024

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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 ÃȊŋêĀŠĞÃŋȊÞÃŒĉŒȊǽȊĀÃĉĥĉĥĀȊĉĥŚêŋĥÃŚĉĬĥÃĞȊÃŚŚêĥŚĉĬĥȊÃĞĬĥĀȊŚąêȊŷÃŽǡȊ 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/HeartEast