Heart & Vascular News from Upstate University Hospital

H E A RT & VA S C U L A R NEWS Winter 2012

i n t e r n at i o n a l o r g a n i z at i o n a p p l a u d S u p S tat e ’ S CardiaC Care

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pstate University Hospital received full accreditation from the Society of Chest Pain Centers in December as an Accredited Chest Pain Center.

The society is an international not-for-profit that is focused on helping hospitals improve quality, cost and patient satisfaction in cardiovascular care.

Hospitals that are Accredited Chest Pain Centers have developed an expertise in dealing with patients who arrive with symptoms of a heart attack. Their staff emphasizes the importance of standardized diagnostic and treatment programs for chest pain and heart attack.

They also evaluate and treat other medical problems and promote healthy lifestyles that can reduce the risk factors for heart attack. Upstate is an accredited Chest Pain Center with “PCI,” percutaneous

f r o m t h e Up s tat e H e a rt a n d Va s c u l a r C e n t e r , Up s tat e Un i v e r s i t y H o s p i ta l

Small world: How a m a n f ro m u g a n da B e C a m e a pat i e n t at u p S tat e

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eing a minister of a church in Uganda, Morris Bukenya believes in a God who helps people heal. He also realizes his good fortune to live in a world that can be so small.

Bukenya, 54, wound up a patient at Upstate, 6,000 miles from home, because a daughter is friends with a cardiologist in Oswego. Bukenya recovered from heart surgery at the home of Dr. Moses Kyobe, a native of Uganda.

Morris Bukenya chuckles with his surgeon, Charles Lutz MD during a follow up appointment.

Bukenya was surprised to learn he had trouble with his heart, though in retrospect he says he shouldn’t have been. He sometimes would become dizzy for no apparent reason. Sometimes he would break into a sweat, even before doing something strenuous. He would awake some mornings feeling as if he hadn’t slept.

“My wife sometimes would ask me ‘what’s wrong?’ and I would say ‘I feel so bad,’” Bukenya recalls. Taken individually, each symptom did not seem serious. Grouped together, they pointed toward heart attack.

He sought medical care in Uganda and was diagnosed with high blood pressure. His condition worsened, with chest pains that came and went, so Bukenya’s daughter arranged for him to see Kyobe. The church took a collection to help defray his expenses.

That was in the spring of 2010. Bukenya went home with medication. His condition grew worse and in September, he returned to the United States in September with his wife, Christine.

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Syracuse New York

Focus on Women

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any women delay seeking care for heart attack because they miss the subtle warning signs, and this raises their risk of death or grave disability.

Melanie Kalman PhD, an associate professor in Upstate’s College of Nursing, is working to change that. In collaboration with a researcher at Binghamton University, she has created acronyms — CURB and FACTSS — to help women remember the warning signs and common symptoms of heart attack. Their project, called “Matters of Your Heart,” looks at whether teaching women about the early warning signs of heart attack can help improve their response to symptoms.

“Women have chest pain,” Kalman says, “but usually not the crushing chest pain. It’s usually more of an ache. They will get unusual fatigue, and pain radiating to the back, jaw, shoulder or arm.

“Women tend to get symptoms six months to a year ahead of time, and they are nebulous symptoms of being tired or short of breath, indigestion or having trouble sleeping.”

Kalman and Pamela Stewart Fahs DSN, a professor in rural nursing at Binghamton, developed a questionnaire to measure a woman’s knowledge of heart attack symptoms and warning signs. They created a pilot version of an educational program. Using an intramural research grant

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B e a l e rt f o r t H e S e Sy m p t o m S: The heart attack symptom of crushing chest pain is classic for men, but uncommon for women, whose symptoms are liable to be more vague.

Researchers from Upstate’s College of Nursing and Binghamton University collaborated on acronyms to raise awareness of the common heart attack symptoms for women:

f a C t S S

Fatigue Anxiety Chest discomfort Tummy troubles (indigestion) Shortness of breath Sleeping difficulty

and the early warning signs of heart attack for women:

C u r B

Chest discomfort Unusual fatigue Radiating pain Breathing difficulties

from Upstate, they held smallgroup sessions with 141 post-menopausal women. They gave them the questionnaire, presented the program, and then gave them the questionnaire a second time.

“The overwhelming majority of them did learn the symptoms.

Most of the women did remember,” Kalman says.

The next phase of the project relies on funding from grants from the Rural Nurse Organization and the Raymond Marsh

Up s tat e He a rt & Vas c ul a r Ne w s

Melanie Kalman PhD

Pamela Stewart Fahs DSN

Fund and will compare an education program that uses the CURB and FACTSS acronyms with a program that does not.

The researchers will also study whether women retain the information two months after they learn it.

Kalman expects this work to take place this spring in the rural areas around Binghamton and in Syracuse, and to involve her colleague, assistant professor Margaret (Meega) Wells.

Eventually, the researchers want to study whether education can improve the way women respond when they experience signs of a possible heart attack. Stewart Fahs says, “having knowledge doesn’t necessarily change your behavior. But if you don’t have the knowledge, you’re unlikely to change.”

Kalman says once the educational program is perfected, the researchers will explore methods of sharing the information. Three years ago when they embarked on the research, they envisioned CURB or FACTSS on refrigerator magnets. Now they like the idea of internet or mobile telephone apps. ™

Winter 2012

Focus on Women

C l o g g e d a rt e r i e S S e n d w o m e n S u Bt l e S i g n S

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ennifer Denton and Karol White have never met, but they have lots in common. Neither seemed a likely candidate for a heart attack. Each was stunned to learn she needed heart bypass surgery. Both have recovered nicely.

Their stories are not uncommon, says Kristen Iglesias, a nurse in Upstate’s Heart & Vascular Center. Symptoms of a heart attack are different for women, more subtle than those for men. “Women tend to overlook symptoms. I think they’re so busy

Jennifer Denton, 57, of Brewerton works part time as an office manager for a construction company, and she teaches Zumba exercise classes.

No one in her family has had heart trouble, but Denton was a smoker. She started to get out of breath during her Zumba class but thought that meant she was working harder than normal. She would reduce her intensity and power through the class.

By May 2010, the shortness of breath troubled her enough to mention it to her doctor, who sent her to a cardiologist. Denton had a heart catheterization and learned that three of her vessels were severely blocked, which

taking care of everything else and everyone else that they tend to put themselves last.”

Iglesias says many of her female patients have a difficult time relaxing and focusing on themselves.

“I lay it out straight: I tell them ‘in order for you to be there for your family, you need to take care of you right now,’ ” — and she says that usually works.

Denton and White agreed to share their stories:

can often lead to a fatal heart attack.

Early the next morning, Dr. Gregory Fink operated on Denton to bypass the diseased vessels.

Within six months, she was back to teaching Zumba. And she managed to conquer cigarettes.

“I have to attribute that to my faith to my God, because I did pray about it,” she says. She tried quitting multiple times. Just before her stress test, she quit for good.

Karol White, 46, of Baldwinsville was familiar with heart attack symptoms in women. She works in the health

care field as a branch manager for GENEX, a national company that provides cost-containment and care management services.

But the odd sensation in her chest that developed in October made no sense. “She felt a thickening on her sternum, as if a piece of Styrofoam was there. It wasn’t painful, just odd.

White couldn’t understand it.

She was healthy. She ate right, took no medications, walked five miles a day and had no risk factors for heart disease.

If she rested, the sensation usually went away. Later it would return. This went on for several days. When she danced continued on page 4

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Focus on Women S u Bt l e S i g n S

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at a friend’s wedding the sensation returned. “I said ‘OK, something’s not right.’”

She went to her doctor. He looked at her EKG and sent her to cardiologist Timothy Ford MD, who looked at the tracing and used a sonogram to examine White’s heart. He told her she needed to go to the hospital.

All she could think of was, “I have to cook dinner… I have a

dog to walk… I have these reports...” Once admitted, she quickly learned that one vessel was 100 percent blocked, a second was 95 percent blocked and a third was 60 percent blocked.

Surgeon Charles Lutz MD did a triple bypass on White. She says she went home from the hospital with Lutz telling her that “My heart should last another 50 years.”

Three months after surgery, White says her life is pretty much back to normal. She’s walking a couple of times a week and slowly building back to five miles.

“It’s so surreal to me that it happened,” White says. “I have to remind myself that I had heart surgery.” ™

We’ve Got You Covered!

3 Accredited Chest Pain Care 3 Heart Failure Program — Silver Achievement

3 Open Heart Surgery 3 Minimally Invasive Heart Surgery 3 Robotic-assisted Heart Surgery 3 Valve Replacement and Repair 3 Vascular Surgery & Endovascular Services

3 Arrhythmia Center with Magnetic Navigation Expertise

Knowing changes everything SM www.upstate.edu/hvc

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Winter 2012

Pat i en t s Fi rs t

pa C e m a k e r pat i e n t C a l l S u p S tat e ‘ t o p o f t H e l i n e ’ isa Montanaro, 50, of Liverpool has been a patient in several hospitals across Central New York and the United States because she has been pacemaker dependent since age 28. She came to Upstate for the first time this fall.

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patient. “I’ve been in Massachusetts General. I’ve been in Long Island hospitals, the Cleveland Clinic, CommunityGeneral, St. Joe’s, Crouse.” She won’t return to some hospitals, but she plans to come back to Upstate.

Montanaro says problems with the sinus node in her heart surfaced in her 20s. She underwent ablation, which at that time was an experimental procedure to destroy tissue that triggered the irregular rhythm.

The node was damaged beyond repair during the procedure, and she had a pacemaker implanted in 1989.

Charles Lutz MD operated on Montanaro with just three incisions. In previous operations, Montanero was left with eight incisions, more pain and a longer recovery.

Leads sewn to the outside of Montanaro’s heart have to be replaced periodically, requiring surgery, and her pacemaker battery also requires changing.

So she is a frequent hospital

“This was top of the line,” she says of her care at Upstate. “Dr. Lutz, you can talk to him. He’s gentle, he’s understanding. And the nurses were phenomenal.”

She was impressed by the Heart and Vascular Center, and the way beds are situated around a nursing station in the postoperative area. “They sit right there, and they look at you. If

Small world

Lisa Montanaro raves about the care she received at Upstate.

you grimace or you moan or you groan, they’re right there asking ‘can we help you?’”

Montanaro offers a three-word critique: “Keep it up.” ™

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A stress test and catheterization that revealed blockages of 70 percent and 90 percent in two vessels. “I realized I was looking at death, right at death itself,” Bukenya says.

Charles Lutz MD operated the next day. u g a n da

Bukenya is feeling much better and healing fast. His recovery includes a plan for losing weight and trimming his diet of salt and sweets. He says he believes in the power of prayer in healing. “I also believe that God works through doctors, that He gives them the brilliancy to see things and do things well.” ™

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Good To Know

a B d o m i n a l a o rt i C a n e u ry S m : t H e S i l e n t k i l l e r

By Michael J. Costanza MD, Division of Vascular Surgery and Endovascular Services

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he aorta is the body’s main artery, carrying blood from the heart to all the vital organs and throughout the body.

An abdominal aortic aneurysm — written in medical shorthand as AAA — is a weakening in the wall of the aorta that causes a widening or "ballooning" of a portion of the artery itself, much like a blister of an oldfashioned rubber inner tube.

Aneurysms may enlarge and rupture or break open. Severe and often fatal internal bleeding results.

A family history is of special concern. Seek a screening exam from your health care provider if one of your family members has had an AAA.

Symptoms Usually no symptoms precede an AAA. Most are found by chance during routine examination, over the course of treatment or testing for other ailments.

Ruptured aneurysms are the 10th leading cause of death in men older than 55 and the 15th leading cause of death overall. Although ruptured AAAs kill more than 15,000 people per year, most deaths are preventable.

Occasionally, a person may experience low back pain or abdominal pain that could signal an enlarging or rupturing AAA. This requires urgent medical attention.

risk factors

diagnosis

You are at greatly increased risk if you are: over the age of 60 smoke have a family history suffer from high blood pressure.

AAAs may be found when your health care provider examines you by feeling for a prominent pulse on your abdomen (belly).

Imaging studies such as an ultrasound, CT scan, or MRI can help to confirm the diagnosis and get a more accurate picture of the aneurysm and its size.

• • • •

Although AAAs are more common in men than women, aneurysms tend to rupture at a smaller size in women. It is

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therefore just as important for women to determine if they are at risk.

treatment Medication alone cannot make

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an aneurysm go away or prevent an AAA from rupturing. Small aneurysms can be closely watched over time and pose little to no risk of rupture. If an AAA grows, the risk of rupture goes up and it should be repaired.

Surgery is a safe, effective, and durable procedure. Surgeons replace the weakened portion of the aorta with an artificial graft made of strong textile or polymer material. The graft is carefully matched to the aorta and sewn in place with permanent sutures.

Advances in technology now allow vascular surgeons to repair AAAs by delivering stent grafts inside the blood vessels. These procedures can be performed through needle punctures or very small groin incisions which are minimally invasive ways to treat AAA and are associated with a faster recovery and a lower risk of complications and blood loss. Endovascular AAA repair is not appropriate for everyone, however. The decision depends on the patient and the anatomy of the aneurysm.

prevention If you smoke, quit.

Keep your blood pressure under control.

If you are at increased risk or have a family history of aneurysms, talk to your health care provider about a screening exam. ™

Winter 2012

Good to Know

C l i p - a n d S aV e

keeping yourSelf Safe in tHe Sun

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By Jackie Fredericks, PharmD. coronary intervention, which is emergency treatment that reduces the amount of heart muscle permanently damaged by heart attack.

To become accredited, Upstate had to: 1. reduce the time from the patient’s onset of symptoms to the diagnosis and treatment; 2. treat patients more quickly during the critical window of time when the integrity of the heart muscle can be preserved; and 3. monitor patients when it is unclear whether they are having a heart attack, to make sure they are not sent home too soon.

You may be aware of the dangers of sunburn, but did you know certain medications increase your risk? And this is not simply a summertime issue. The sun shines (ok, maybe not brightly) year-round, so your protection must continue through all seasons.

A variety of medications can increase your skin’s sensitivity to the sun by increasing the skin’s absorption of ultraviolet light, which releases energy and damages cells. Of course, this will occur in the area most exposed to the sun and can result in exaggerated sunburn, with or without blistering.

Multiple classes of medications — including certain antibiotics, anti-inflammatory pain relievers, antiarrhythmics, hormones, and antipsychotics — are known for causing this type of reaction.

Always check with your doctor or pharmacist if you have questions about prescription or over-the-counter medications, and use an effective form of sunscreen for protection.

Also, make sure to read your medication’s recommended storage instructions. You may be asked to keep a medication in the refrigerator, at room temperature or even in the freezer. Not following the instructions can mean your medication loses its effectiveness. ™

“People tend to wait when they think they might be having a heart attack, and that’s a mistake,” says Gregory Fink MD, chief of cardiac surgery at Upstate. “The average patient arrives in the emergency department more than two hours after the onset of symptoms, but what they don’t realize is that the sooner a heart attack is treated, the less damage to the heart and the better the outcome for the patient.”

The accreditation process begins with a document that details key elements of optimal care. Its content is derived from peerreviewed medical journals, professional society guidelines and the body of clinical insight of participating clinicians.

Accreditation through the society is more collaborative than other traditional certification models.

At Upstate, when someone arrives complaining of chest pain that may be signaling a heart attack, he

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or she goes directly to the “Cath Lab” for a cardiac catheterization.

Doctors determine if any blockages in the arteries that feed the heart need to be stented, or if bypass surgery is required. This all happens within the first 60 to 90 minutes of arrival — by a hospital staff so skilled and knowledgeable about treating chest pain that it earned status as an Accredited Chest Pain Center. ™

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Center News

™

LOV E YO HEA UR RT

H e a rt - H e a lt H y Va l e n t i n e C H o C o l at e !

H e a rt a rt

By Danielle Stegman, RD, CDN

Artist Ludwig Stein, a professor at Syracuse University, donated his series of Valentine paintings to Upstate University Hospital, in memory of his wife, Dr. Nancy Jermanovich, and their 22 years together.

Indulge your sweet tooth this season and treat your heart well! This dessert is packed full of antioxidants, vitamins and minerals, fiber, and even has omega-3 fatty acids from walnuts. The dark chocolate contains flavonoids from the extract of the cocoa bean. These flavonoids have been linked to improved heart health in some studies!

INGREDIENTS: 1 bar dark chocolate 1 orange 4 strawberries pineapple air popped popcorn walnuts almonds

PREPARATION: Finely chop walnuts and almonds. Melt chocolate on low in sauce pan. Dip fruit and popcorn into melted chocolate and set on wax paper. While chocolate is still soft, sprinkle nuts and cinnamon on top as desired.

Refrigerate to cool and serve.

cinnamon wax paper

NUTRITION:: Complete nutritional data will depend on the food you choose for dipping. One 1.45-ounce dark chocolate candy bar contains 228 calories, 13 grams of fat, 2 milligrams cholesterol, 2 milligrams sodium, 25 grams of carbohydrates, 3 grams of fiber, 19 grams of sugar and 2 grams of protein.

B ro CCo l i S o u p From Wegmans Food Market

INGREDIENTS: 1 Tbsp pure olive oil 1 pkg (8 oz) chopped onions 1 cup (4 oz) leeks, thinly sliced 1 cup (4 oz) celery, thinly sliced 1 Tbsp garlic,chopped 2 Bay leaves Salt and pepper to taste 3 Tbsp pan searing flour 2 lbs broccoli florets, chopped 2 cartons (32 oz each) chicken stock 1 container (6 oz) plain Greek yogurt Wegman’s Italian Classics Bruschette toasts Mild white cheddar, shredded

12.018 0112 300 UBC

PREPARATION:

NUTRITION: Each 1-cup serving contains 130 calories, 10 grams carbohydrate, 3 grams fiber, 8 grams protein, 6 grams fat, (including 3 grams saturated fat), 15 milligrams cholesterol, and 460 milligrams sodium.

On their second Valen tine’s Day, Stein presented Jermano vich with a painting which featured a stylized heart.

When she asked “For Your Collection” is one of the where her 22 painting Ludwig Stein donated to Upstate University Hospital. painting was the next year, an annual tradition was born. Until Jermanovich’s death in 2000, Stein presented her with a new painting every Valentine’s Day. This one is called “For Your Collection.”

The collection of 22 works is displayed in Upstate’s Heart & Vascular Center. ™

You will need a stockpot and a blender or stick blender.

newsletter Staff

Heat olive oil in stockpot on medium. Add onions, leeks, celery, garlic and bay leaves; season with salt and pepper to taste. Cook, stirring often, about 10 minutes, until soft but not browned. Stir in pan-searing flour; cook 1 minute.

Editors: Karen A. Gibbs MSN, RNC, Nurse Practitioner, Cardiopulmonary Surgery

Add broccoli and stock; bring to simmer on high. Reduce heat to low; continue to simmer until tender, about 10 minutes.

Amy Tetrault RN, Head Nurse, Cardiac Catheterization Lab

Remove soup from heat. Discard bay leaves. Add soup and yogurt to blender, working in batches, and add to another pot. Or, puree soup in stockpot with a stick blender until smooth. Taste and adjust seasonings.

Melanie Rich, Director Amber Smith, Senior Editor Marketing and University Communications

Garnish each serving with toast and cheese.

www.upstate.edu

Up s tat e He a rt & Vas c ul a r Ne w s

Karen A. Gibbs

Amy Tetrault

Designed by Upstate Marketing and University Communications

Winter 2012