Do you want to make more time to exercise? Do you want to cut out the excess sugar and sodium in your diet? Do you wish you had more energy throughout the day? If you answered yes to any of these questions, then you are on the right path to keeping your heart healthy.
The statistics surrounding heart disease are staggering. It’s the leading cause of death in the United States, with almost six million hospitalizations each year. Heart attack, stroke and other cardiovascular diseases are responsible for about one third of the deaths in Georgia, but researchers and physicians are working hard to change this. In honor of American Heart Month, Best Self Atlanta has turned to the experts in some of Atlanta’s top facilities to find out what they’re doing to stay on the cutting edge of heart health.
Treating Cardiovascular Disease
The goal in treating cardiovascular disease is often to open narrowed arteries that cause symptoms like chest pains and shortness of breath. Depending on the severity of the blockages in your arteries, treatment may include medications, surgery or a combination of these. But first and foremost, your doctor will recommend a low-fat, low-sodium diet. Get at least 30 minutes of exercise three days a week, and of course, quit smoking and limit how much alcohol you consume.
“Obesity and physical inactivity are endemic to our culture,” says Dr. Andrew Kobylivker, cardiologist at Kaiser Permanente’s Southwood Specialty Center. “Our communities are not often walkable, and our lifestyles are often heavily dependent on cars. Add to this a hectic workday, and it is often difficult to find time to stay active. It will take a shift in mentality, but obesity and physical activity must be addressed.”
If these lifestyle changes aren’t enough, your doctor may prescribe drugs to control your heart disease. These could include medications to lower your blood pressure, such as diuretics, beta-blockers, blood thinning medications or cholesterol-lowering medications such as statins or fibrates. “Several new blood thinners have gotten FDA approval very recently and many more are expected in the upcoming year,” says Dr. Kimberly Champney, a cardiologist at Northside Hospital. “Dabigatran is a new anticoagulant that is used to prevent stroke in patients with an underlying irregular heart rhythm called atrial fibrillation. This drug, for many patients, has replaced Coumadin, which required frequent lab tests to monitor the level.”
If you are someone who swears by supplements, you may want to think twice. “One of the newest trials shows that vitamins and supplements don’t do much good, and they may in fact be harmful,” says Dr. Charles Brown, III, interventional cardiologist and medical director of Piedmont Heart Institute. “Listen to your physician’s recommendation on what medications to take instead of piling on the supplements.”
Minimally Invasive Treatments
The United States Food and Drug Administration (FDA) recently approved a new transcatheter heart valve that is expected to revolutionize the treatment of cardiovascular issues. “The device - called the Sapien valve - offers a new, non-surgical option for individuals experiencing failing aortic valves,” says Dr. Susmita Parashar, assistant professor of Medicine (Cardiology) at Emory University School of Medicine. “The procedure provides an option for patients who are too frail or have other high-risk conditions that will not allow for open heart surgery.”
An alternative to this is a ventricular assisted device (VAD), a battery-operated mechanical pump (MCS) that helps a weakened heart pump blood throughout the body. It is most commonly used in patients whose medical therapy has failed, and for those who are hospitalized with end-stage heart failure. Most recently, the VAD has provided an alternative to a heart transplant, and it offers a near normal quality of life, with most patients returning home with their families.
Another big advancement in cardiology is percutaneous valve procedures that treat older patients with aortic stenosis. “The only treatment for aortic stenosis until very recently was aortic valve replacement, which requires open heart surgery,” Dr. Champney explains. “It is now possible to treat aortic stenosis with a minimally invasive percutaneous procedure.”
A percutaneous valve procedure is done all through a catheter that is placed in a leg artery, so it does not require cardiopulmonary bypass. “This procedure is typically easier on the patient from a recovery standpoint because it does not require an incision in the chest wall,” Dr. Champney says. “However, valve surgery has been around for a long time, and in the correct patient, is still the preferred way to correct valve problems.”
The Latest Innovations
Fortunately there are a number of technological advances that keep Atlanta’s top cardiologists on the cutting edge of heart health, and more importantly, help patients avoid the operating table. “For certain types of holes within the chambers of the heart, our interventional cardiologists can place a closure device to help seal the hole,” Dr. Kobylivker says. “Other procedures, such as robotic surgery on the mitral valve, have good success in repairing the mitral valve without opening the chest.”
Similarly, cardiologists can perform robotic surgery with a single vessel bypass of the heart with the use of drug-coated stents. This is a method of revascularization that Dr. Mindy Gentry, a cardiologist at WellStar Cardiovascular Medicine, calls a “hybrid procedure.” “With these hybrid procedures, both the surgeon and the interventional cardiologist are in the room,” she explains. “The surgeon doesn’t open the chest, but just uses small incisions to keep the patient from potentially having open heart surgery. The recovery time is better, and there are less complications.”
Hybrid coronary revascularization is typically performed on a person who has a blockage in the artery in the front of the heart and at least one other blood vessel with disease in it. “This approach is a best of both worlds strategy,” Dr. Parashar adds. “We combine the durability of surgery with the minimally invasive nature of stenting. It is optimal therapy with a minimally invasive approach.”
Another innovative strategy is LDL apheresis, a treatment option for patients with dangerously high cholesterol. This procedure is similar to kidney dialysis, as it targets the “bad” cholesterol containing LDL. During a session of LDL apheresis, the patient’s blood is continually removed from their veins and run through a machine that separates out the plasma. While the rest of the blood is passed back to the patient through a different vein, the plasma is run through another part of the machine that removes the LDL in the plasma. As a result, the blood is “cleaned” of the bad cholesterol. The procedure takes between two and four hours and must be repeated every two to three weeks.
In addition to these advances, Emory University Hospital is participating in a clinical trial called Simplicity-2 for treatment of patients with drug-resistant hypertension. The procedure is called renal sympathetic denervation, and it is a catheter-based approach that may have a role in treating select patients with uncontrolled hypertension.
As researchers and cardiologists continue to develop aggressive prevention programs, there is a strong push to screen for coronary disease. “There is a tremendous amount of cardiac disease that occurs without any symptoms, so we are screening a large part of the population who are at risk,” Dr. Brown says. “We perform a simple test that looks at coronary artery calcification. We call it ‘the mammogram of heart disease.’” If you are a smoker, overweight, over a certain age or have any other symptoms that would identify you as high risk, your physician will likely recommend having a calcium score done. In addition to screening for the prevention of heart disease, this often puts patients into the best treatment pathways.
The Emory Division of Cardiology has also established the Women’s Heart Program to provide cardiac risk assessment, diagnosis and heart disease care specifically for women. “Many people don’t realize that more women than men die from heart disease every year,” Dr. Gentry says. “As a woman in this country, you are about 12 times more likely to die of cardiovascular disease than breast cancer. Heart disease is different from other diseases like cancer because we know a healthy lifestyle can significantly prevent it.”
Caring For Your Own Heart
While certain conditions like congenital heart defects can’t be prevented, many forms of heart disease can be avoided or treated with healthy lifestyle choices. “The number one thing we’re dealing with as a country is weight,” Dr. Brown says. “There isn’t a day that goes by that I don’t tell a patient they need to lose 40 or 50 pounds. Obesity has an effect on everything. It changes tendencies toward sleep apnea, which is a direct contributor to coronary disease. You’d be amazed at how many diseases go away when weight is reduced. Diabetes and high blood pressure often resolve themselves when people get closer to their ideal body weight.”
Emory Women’s Heart Care program, www.emoryhealthcare.org
Kaiser Permanente of Georgia, www.kp.org
Northside Hospital, www.northside.com
Piedmont Heart Institute, www.piedmontheart.org
WellStar Cardiovascular Medicine, www.cvmed.com
Dr. Parashar’s top ways to keep your heart healthy
By exercising regularly for at least 30 minutes a day, you can significantly improve your heart health. You don’t necessarily have to join a gym to get exercise. Engage in fun activities such as brisk walking, swimming, dancing, jogging or running. Find something you enjoy and do it regularly.
Eat a Heart-Healthy Diet
A heart healthy diet consists of low-fat and low-cholesterol foods, plenty of fresh fruits and vegetables high in fiber, and low salt intake. The recommended sodium per day is no more than 2,300 mg per day for a healthy adult, and no more than 1500 mg for those with any of the following hypertension risks: more than 51 years of age, African American, those who have diabetes, and of course, those who already have high blood pressure.
Reduce Your Stress
Stress reduction by doing yoga, meditation and/or exercise is important in today’s hectic world.
For regular smokers, this can be a lot easier said than done. Try talking with a doctor first to understand your best course of action. You might need to wear a nicotine patch, chew gum or try an alternative route like hypnotherapy.
Dr. Susmita Parashar
Assistant Professor of Medicine (Cardiology)
at Emory University School of Medicine
Jean Whittenberg: New Life with Advanced Technology
Jean Whittenberg of Fayetteville is a decorated air force veteran who took part in one of the last atmospheric atom bomb tests in the early 60s and was exposed to massive amounts of ionized radiation. Although he recovered, it wasn’t until later that heart disease began to take a toll on his body.
No longer a candidate for open heart surgery, he was basically waiting to die until a team of specialized cardiologists at Piedmont Hospital offered a type of heart catheterization procedure (commonly referred to as a “CTO catheterization” or “CTO procedure”) that repaired a total occlusion in his coronary arteries. He no longer needs nitrate pills and can finally exercise and walk his dog.
“Maintaining a healthy lifestyle is what keeps you healthy in the long run. But if you find yourself in trouble, seek professional help. Remember to be persistent, because new things happen all the time in medicine,” says Whittenberg. “I believe the best thing that ever happened to me is getting Dr. Anna Kalynych at Piedmont as my cardiologist. She is a superb physician and without her, I would not have gotten this procedure and my second chance.”
More about CTO
As a minimally invasive procedure, doctors enter the body through an artery in the leg to approach the heart. Using guide wires the size of a human hair and with the help of live X-ray imaging, they advance through the coronary blockage. Once through, a balloon is inflated allowing for the placement of very small, specialized metal stents. Embedded within the artery wall, the stents serve as a scaffolding to help hold the artery open and prevent recurrent blockage.