January/February 2013 by West Suburban Living Magazine

Health & Wellness

By Denise Linke

Taking Preventive Cardiac Care to HEART Thanks to greater public awareness and better, more proactive treatment procedures, the death rate for heart disease has actually dropped 28 percent in the last 10 years.

EMEMBER WHEN A HEART ATTACK inspired the same terror

as a death sentence? Even 20 years ago, nearly one third of heart attack victims who made it to the hospital still ended up dying in the emergency room or shortly thereafter. Those who survived usually suffered serious damage to their hearts that made them “cardiac cripples,” unable to resume their normal lives and living in fear that a second attack would kill them — which it often did. What a difference two decades make. Today, heart attack victims who receive prompt, state-of-the-art treatment stand a 98 percent chance of walking out of the hospital within a week or 72 JANUARY/FEBRUARY 2013 | WWW.WESTSUBURBANLIVING.NET | WEST SUBURBAN LIVING

two, and many of them live normally for decades without a second cardiac crisis. In December, the American Heart Association announced that the death rate for heart disease has dropped 28 percent since 2002. “No disease comes close to dropping its death rate as far as the heart disease death rate has dropped,” asserts Dr. Mark Goodwin of Midwest Heart Specialists in Downers Grove. “We’ve made tremendous advances on multiple fronts in the last 15 years.” “It used to be that if you had a heart attack at age 45, you were probably going to die by age 55 and you wouldn’t be able to do much in between,” adds Dr. Edgar Carell, director of Illinois

Heart and Vascular in Hinsdale. “Now we process, which is very inefficient in a high treat people for heart attacks at age 45, we risk situation,” notes Dr. Peter Kerwin of Today, heart attack Advocate Good Samaritan Hospital in don’t see them back in the hospital and Downers Grove. “The patient had to wait they live to be 80.” victims who receive for the ambulance to arrive, then to get to Many people avoid their first heart prompt, state-of-the-art the emergency room and sign in before attacks by undergoing routine screenings treatment stand a 98% undergoing tests to diagnose the attack. that spot clogging arteries long before they Then they often had to wait for the on-call get blocked. “In the 70s and 80s, we waited chance of walking out cardiologist to arrive. The standard ‘doorto see people until they came in with a of the hospital within a to-balloon time’ between the patient’s heart attack,” Goodwin recalls. “Today, arrival in the ER and getting an angioplasty people come in for stress tests and quick week or two, and many to reopen the blocked artery was 105 CAT scans that catch problems before of them live normally minutes. A severe blockage can start they become dangerous. Fifty percent of damaging the heart in 15 minutes and heart attacks occur without warning or for decades without a can destroy it in two hours.” previous symptoms, so screening makes a second cardiac crisis. These days, the diagnosis process huge difference.” Most heart attack victims seek medical starts as soon as the ambulance arrives. help sooner than they did 10 or 20 years Paramedics now administer EKGs in the ago because they better know how to recognize the symptoms of ambulance and wirelessly transmit the results to interventional an attack. “We’ve been working to raise public awareness in the cardiologists who staff heart trauma centers 24/7. By the time the community about the signs and risk factors of heart attack. Now, ambulance reaches the hospital, doctors and nurses are waiting to when someone’s having an attack, we’re seeing them sooner whisk the patient to the trauma center’s CT scan machine, then because they know what’s happening and what to do about it to the catheterization lab for an angioplasty. The standard doorrather than just assuming they’ve got indigestion or are coming to-balloon time now stands at 60 minutes, and several area hospitals down with something,” explains Dr. Imran Ahmad of Central report achieving 30- to 40-minute times on a regular basis. DuPage Hospital. “Lowering the mortality rate from heart attacks isn’t about omen are finally catching up to men in heart attack spending a lot of money on new technology. It’s about changing awareness, says Dr. Fred Leya of Loyola Medical the process for treating patients to make it more efficient,” Center. “For the past 25 years men’s heart attack Kerwin asserts. mortality rates have shown a nice, steady downward slope, but Once the crisis has passed, cardiologists can offer a large spectrum of medicines and therapies to restore and maintain cardiologists have been quite concerned that women’s heart patients’ heart functions as much as possible. attack mortality rate drops were lagging behind,” he observes. “When I started practicing, we had only a couple of cholesterol“But the last two years the women’s rate decrease has caught up lowering medications and no standards for what cholesterol to the men’s, thanks to the recent emphasis on women’s heart levels people should have,” Goodwin says. “Now we have multiple health education.” “Educating women about their risk factors and symptoms has medications to lower cholesterol and guidelines for what levels patients should shoot for.” improved their knowledge base and helped more of them survive heart attacks,” agrees Dr. Santosh Gill of Rush-Copley Medical mprovements to statin-based drugs have made them more Center in Aurora. “But there’s still a disparity between affluent, effective in preventing clogged arteries, especially for people well-educated Caucasian women and financially disadvantaged diagnosed with sclerosis — hardening of the arteries or veins women and women of color. We need to help them learn about — without ever having a heart attack. “If you could only take their risks, too.” one medication for your heart, statins would be the one,” Even five years ago, a heart attack victim who called 911 imAhmad asserts. mediately still had to wait nearly two hours for diagnosis and The number of different medications available let doctors treatment. “Until recently, treating heart attacks was a sequential tailor drug regimens to their patients’ unique systems. “People

WEST SUBURBAN LIVING | WWW.WESTSUBURBANLIVING.NET | JANUARY/FEBRUARY 2013 73

Health & Wellness | CARDIAC CARE

The Next Step In Combatting Heart Disease: Reversing the Spread of Diabetes



IF YOU’RE IN GOOD HEALTH, a slight, but

The extra fluid volume raises the diabetic’s

persistent tightness across your chest might be

blood pressure, which over time damages

a sign that you shouldn’t have drunk espresso

blood vessels in much the same way as a

with that big plate of spicy ribs.

rubber hose rated for 10 pounds per square

If you’re diabetic, it could mean that you’re

inch of water pressure will deteriorate when it

in the middle of a potentially fatal heart attack.

consistently fills with liquid at 20 psi. The body’s

“Diabetics often lose their perception of

attempts to strengthen the damaged blood

pain, due to nerve damage from the disease,”

vessels thicken them, which narrows their

explains Dr. Fred Leya of Loyola Medical Center

inner diameters. A small clot that otherwise

in Maywood. “What other people experience

would have passed through easily can then

as a crushing pain, they might feel as just a bit

get stuck in a narrowed blood vessel, causing

of pressure. They can be walking around with

a heart attack.

a silent heart attack and not know it until they

Sugar can also crystallize along capillary

die or experience symptoms of heart damage.”

because it stops producing enough insulin

walls in the hands and feet, making them too

Many people don’t understand the

to break down the sugar or it becomes resistant

rigid and narrow to accept blood flow. To

connection between diabetes and heart disease,

to insulin’s attempts to deliver processed

compensate, the heart tries to beat harder to

primarily because they associate diabetes with

glucose to tissue cells. Left in the blood, the

force the blood through the blocked capillaries,

excess sugar intake and heart disease with too

sugar crystallizes around nerve sheathes,

which — you guessed it — also boosts blood

much fat intake. But there is a strong link

making them brittle and unresponsive to

pressure and damages veins and arteries that

between the two illnesses because chronic

neurochemical signals – which is why diabetics

send and receive blood directly from the heart.

diabetes, especially left untreated, damages the

often lose sensations or develop false sensations

cardiovascular system enough to make it easy

called neuropathy.

U.S.,” notes Dr. Santosh Gill of Rush-Copley

prey for clots or valve-damaging infections.

When the brain detects excess sugar still

Hospital in Aurora. “We can’t bring the heart

Diabetes develops when the body can’t

in the bloodstream, it orders the body to flush

disease rate down much further until we reverse

process all of the sugar it takes in, usually

it out through the liver and kidneys with water.

the spread of diabetes.”

react differently to different types of medication,” Gill states. “We’re using a systematic plan to make sure patients get the drugs that work best for them. That makes their recoveries much easier.” ardiologists also not only press patients to exercise after a heart attack or other heart disease diagnosis, they find ways to make it easier for patients to stick to a fitness plan. Most area hospitals offer fitness clubs with trainers who can help patients safely exert themselves, as well as walking paths where even extremely fragile heart patients can keep their cardiovascular systems in shape. “The days when doctors told heart patients to sit on the couch and not stress their hearts are long gone,” Kerwin declares. “Regular exercise is essential to a good recovery.” “If I can get someone to exercise more often and eat better, he won’t have to take as many medications,” Ahmad adds. One long-term therapy for heart attack victims will soon become, well, not so long-term. In 1993, doctors began implanting small

74 JANUARY/FEBRUARY 2013 | WWW.WESTSUBURBANLIVING.NET | WEST SUBURBAN LIVING

“The diabetes epidemic is still rising in the

metal tubes called stents in formerly blocked blood vessels to support the weakened tissue and keep them from collapsing. While stents help keep blood vessels open, the early versions were hard to implant in the right place and often became clogged themselves, requiring patients to come in and have blockages removed. Today, stents are more flexible, making them easier to implant. They are also coated with drugs that slowly dissolve into the surrounding tissues to inhibit re-blockage. But they still cause long-term side effects that can make life difficult for patients. “Stents stiffen the blood vessels, which helps keep them open, but they create other issues,” Leya explains. “Blood vessels are not like pipes. They can widen and narrow, reacting appropriately to the environment of the cardiovascular system as it changes. When there’s a rigid metal pipe in the way, they can’t help the heart speed or slow the flow of blood passing through them.” Labs across the U.S. are testing bioabsorbable stents made from corn-based polymers that dissolve over time, allowing the

Health & Wellness | CARDIAC CARE



Lowering Your Risk for Heart Disease

OKAY. YOU’VE STAYED IN SHAPE, hit the gym at least three times a week, passed up cheeseburgers with salty French fries more times than you can count, and munched a garden’s worth of fruits and veggies. Is there anything else you can do to lower your risk of contracting heart disease? Yes, say area cardiologists. While some popular heart attack preventives are more hokum than helpful, a few good habits can keep your ticker in tip-top shape. Assuming you’ve quit smoking or, better yet, never started, the single best thing you can do for your heart is to avoid secondhand smoke, asserts Dr. Edgar Carell, director of Illinois Heart and Vascular in Hinsdale. Fortunately, that’s easy to do around here, since Illinois banned smoking in public places. “Every state that has banned smoking in public has seen a significant lowering of heart disease death rates compared to states that haven’t banned it,” he observes. Swallowing an aspirin a day can help you avoid heart attacks, even if you’ve never shown signs of clogging arteries. “Aspirin works on platelets to prevent blood clots that can travel to the heart and block arteries,” explains Dr. Fred Leya of Loyola Medical Center in Maywood. “That converts something that would have been a major heart attack into something that just causes a mild, momentary chest pain without any damage.” Other supplements don’t live up to their reputations as heart guards. “Fish oil, Vitamin E and folic acid have all been advertised as improving heart health, but tests show they don’t have any real effect on the heart,” Leya advises. While coffee, red wine and dark grape juice have shown some heart-protecting properties in the laboratory, their effect is too small to outweigh the health hazards of the alcohol, caffeine and sugar that come along with those foods' positive antioxidants, doctors maintain. While getting a flu shot every winter won’t help prevent a heart attack, it will help heart attack survivors and other people with heart conditions stay on their feet. “Flu or any other type of upper respiratory infection can overload a heart that’s already operating marginally,” notes Dr. Raminder Singh of Sherman Hospital in Elgin. “The added stress on the heart of fighting the infection can tip the balance and put the patient in the hospital.” That’s why Dr. Peter Kerwin of Advocate Good Samaritan Hospital recommends that cardiac patients get regular pneumonia vaccinations as well as flu shots. “If your heart’s already damaged and you get a serious infection, your heart could sustain even more damage trying to keep up with the extra work of fighting the infection,” he says. Finally, get regular screenings to check for plaque buildups in your veins and arteries. “The more people we can screen," says Dr. Mark Goodwin of Midwest Heart Specialists in Downers Grove, "the more effectively we can treat them before they actually have a heart attack.”

76 JANUARY/FEBRUARY 2013 | WWW.WESTSUBURBANLIVING.NET | WEST SUBURBAN LIVING

healed blood vessel to resume its normal function. The new stents should become available to the public within the next two years, doctors agree. “After the vessel is restored, the stent disappears and there’s nothing foreign left in the body to cause complications later,” Ahmad explains. Patients can then typically stop taking blood thinners once the stents have dissolved. While doctors are happy that they’re saving so many more heart attack victims than before, they’re now wrestling with a new problem: how to help attack survivors with long-term heart damage recover as much as possible so they can live happy, productive lives. “Because so many people are surviving heart attacks that would have killed them 20 years ago, we now have a large population with chronic heart disease,” notes Dr. Raminder Singh, an interventional cardiologist at Sherman Hospital in Elgin. “Heart failure is now the number one problem we face.” Heart failure, often called congestive heart failure, results when the heart becomes too weak to keep blood circulating throughout the body. Early warning signs include shortness of breath; swelling in the legs, feet and hands; and trouble recovering from exertion or exercise. If left untreated, heart failure will make other organs and muscles shut down from lack of oxygen, eventually killing the patient. hile lifestyle changes such as eating a low-fat, low-salt diet, not smoking and doing mild exercise can slow the disease’s progress, cardiologists can offer several new high-tech options to bring heart failure patients’ lives back to near-normal. A biventricular pacemaker keeps both ventricles pumping in rhythm with each other, maximizing blood flow while preventing ventricular fibrillation, Singh says. Even standard pacemakers have become safer to use long-term, thanks to wireless technology. The leadless pacemaker replaces the wire that runs through a blood vessel to connect the device to its power source with a tiny ultrasonic pulse generator implanted just beneath the skin. The pacemaker converts the ultrasonic pulses into electrical energy, which it then uses to shock the heart back into proper rhythm when needed. “It’s a huge advance because over time, the leads can get entrenched in the wall of the blood vessel, scarred into it, and have to be removed by laser surgery,” Ahmad explains. “This technology eliminates that complication and helps keep patients out of the hospital.” Patients whose hearts need more help can get an auxiliary pump installed inside their chests. Called a left ventricle assist device (LVAD), it attaches to the left ventricle and to the aorta. When the ventricle contracts, it pushes blood into the LVAD, which repumps it at a higher pressure into the aorta. Powered

 by a battery pack worn by the patient, the patient and they can be done with elderly and Improvements to LVAD can increase blood flow throughout frail patients who might not survive statin-based drugs the body, oxygenating organs and muscles traditional surgery.” so that they can function properly. Stem cell research might produce the have made them more “LVADs keep people alive longer and next far-reaching advance in cardiology, effective in preventing improve their quality of life,” says Goodwin. doctors agree. Researchers are experimenting clogged arteries, atients whose aortic heart valves wear with ways to implant stem cells into damaged out or sustain damage from infections heart tissue to restore it with freshly-grown especially for people no longer need to brace for risky, cells. “We have huge hopes for stem cell diagnosed with sclerosis, therapy,” Ahmad asserts. “Potentially it can painful and expensive open-heart surgery to replace them. These days most west suburban replace scar tissue with living cells and restore or the hardening of hospitals can offer trans-catheterization full heart function without a transplant or arteries or veins. procedures that don’t require a chest an assist device.” incision at all. A compressed artificial valve That hope, however, doesn’t mean fits into the tip of a catheter that the surgeon inserts into the femoral residents should drop their gym memberships, light up cigarettes artery, then guides through the artery into the aorta. When the and plop onto the couch with beer and beef jerky. “Even though surgeon reaches the damaged valve, he releases the replacement we are excited about the new advances and technologies on the valve, which expands to compress the original valve and fill the horizon, we should not forget that the basic rule to cure heart opening. The new valve starts working immediately. disease is prevention,” Gill warns. “It sounds boring, but basic “I think trans-cath valve replacements will become more things like diet, exercise and screenings are very important to keep common," predicts Gill, "because they pose less risk to the the cardiac death rate going down.” n

WEST SUBURBAN LIVING | WWW.WESTSUBURBANLIVING.NET | JANUARY/FEBRUARY 2013 77