heart conditions

What is Aortic Dissection?

Aortic Dissection

An aortic dissection is a severe heart and vascular condition where there is a tear in the inner layer of the aorta, a large blood vessel that branches off the heart. Although aortic dissections are rather uncommon, this is a condition that anyone can develop. It is important to learn how to prevent them and when it is necessary to see a physician. Aortic dissections most commonly occur in men between 60 and 70 years old. Sometimes aortic dissection symptoms, outlined below, can be mistaken for other cardiovascular disease.

Aortic Dissection Symptoms

Symptoms of aortic dissection include:

  • Sudden chest of upper back pain that radiates down the neck or back
  • Fainting
  • Stroke
  • Sweating
  • Shortness of breath
  • High blood pressure
  • Weakness or paralysis

Aortic Dissection Risk Factors

Some of the risk factors associated with aortic dissection include:

  • An aortic valve defect
  • Uncontrolled high blood pressure
  • Hardening of the arteries
  • Weakened and bulging arteries
  • Constriction of the aorta

Aortic Dissection Prevention

The best way to prevent an aortic dissection is to follow your physician’s advice and:

  • Maintain a healthy blood pressure
  • Do not smoke, or try to quit smoking
  • Maintain a healthy cholesterol level
  • Maintain a healthy body weight

When Should I See My Physician?

If you have any of the symptoms listed above contact your physician or emergency medical assistance. You may not have an aortic dissection, but it would best to get it checked out as you may have other heart or vascular disorders.

Aortic Dissection at Emory Heart & Vascular

Emory Heart & Vascular Center cardiologists, cardiothoracic surgeons and vascular surgeons work together to treat patients with aortic dissections. If detected early, a patient’s chance of survival is improved. We believe that if you can maintain a healthy heart if you pay attention to the keys to prevention, understand symptoms and work closely with your physician.

About Ravi Veeraswamy, MD

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Learn About Atrial Fibrillation (A–Fib) in new Physician “Ask the Expert” Video Series

Atrial Fibrillation Ask the ExpertsAs we have discussed in previous blogs on the topic of arrhythmias, atrial fibrillation, also referred to as A – Fib, is the most common irregular heart rhythm in the United States.  It is so prevalent that over 2 million Americans suffer from it. Even though it is not directly life threatening, it can lead to other heart problems such as congestive heart failure and stroke, as well as shortness of breath, dizziness, chest discomfort and palpitations.

The physicians in Emory’s Arrhythmia Program talk about various arrhythmia topics and how to best manage your condition in our new “Ask the Expert” video series.

You can also view past blogs about arrhythmia including:

If you have further questions or think you may have A- Fib after viewing our atrial fibrillation videos, please call Emory HealthConnection℠ 404-778-7777 to speak with a nurse.

Do you have questions about this procedure or about A-Fib in general? If so, please let me know in the comments section.

About Angel Leon, MD:

Dr. Leon is a Professor of Medicine and the Chief of Cardiology at Emory University Midtown. His specialties include electrophysiology, cardiology, and internal medicine, and his areas of clinical interest include arrhythmia ablation, electrophysiology lab, and pacemaker. Dr. Leon holds organizational leadership memberships with the American College of Cardiology and the American Heart Association. He has been practicing with Emory since 1991.

Coronary Artery Disease Treatment – A Patient Story

Michael Halkos, MDMichael Armstrong joined the gym to get some aerobic exercise and lose some weight. One day, he was walking on a treadmill when he noticed pain in his chest as well as pain that went up into his throat. The pain then began radiating down his left arm.

Michael has worked in the health care industry for many years, so he quickly realized what he was experiencing could be signs of a heart attack, and he consulted his primary care physician. Michael told his physician about the symptoms and the physician quickly referred him to me at Emory University Hospital Midtown for an innovative procedure called hybrid coronary revascularization.

As I mentioned in my previous blog post about hybrid coronary revascularization, this procedure is typically performed on a patient who has blockage in the artery in the front of the heart and one other blood vessel with disease in it. This unique approach is a best of both world’s strategy where we combine durability of surgery with the minimally invasive nature of a procedure called stenting. Optimal therapy with this minimally invasive approach translates into shorter recovery time, potentially fewer complications and a quicker return to work. Emory is one of only a few centers in the nation offering this procedure.

Michael Armstrong sums up his experience:

“I didn’t know what to expect, this was my first hospitalization in my life but I was comfortable getting my heart care at Emory University Hospital Midtown. Dr. Halkos had done more than 100 robotic surgeries so I was very impressed with that. Dr. Halkos knows the road you are about to take together is treacherous and comes across as very knowledgeable while still friendly and empathetic.  Now shortly after the surgery, I am back to full exercise, I walk around the neighborhood with my wife, and even last weekend I walked to the top of Stone Mountain with a friend. That made me feel good. I know Emory talks about quality patient and family centered care, but actually experiencing it was pretty wonderful.”

Watch Michael’s story in this video.

Do you have questions or feedback? If so, please leave them in the comments section below.

About Michael Halkos, MD
Dr. Halkos is a cardiothoracic surgeon at the Emory Heart & Vascular Center. He specializes in minimally invasive adult cardiac surgery. He is leading the innovative Emory work with the hybrid coronary revascularization procedure being performed at Emory University Hospital Midtown. He finished his Medical School, Residency and Fellowship at Emory University School of Medicine and is a member of the American Medical Association.

New Treatment for CAD – Hybrid Coronary Revascularization

hybrid revascularization treatment for CADIn our last blog, Dr. John Douglas discussed Coronary Artery Disease (CAD). Now, we will cover a new procedure to treat CAD, called Hybrid Revascularization, that we are performing at the Emory Heart & Vascular Center.

Currently, Emory is one of the few centers in the country offering this procedure. Standard guidelines call for patients with blockages in the left main artery (the artery that provides most of the blood to the heart) to undergo bypass surgery.

Hybrid revascularization’s advantage is a combination of coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Emory physicians are leaders in performing these procedures “off-pump” in a minimally invasive fashion, without breaking open the chest.

The minimally invasive CABG procedure uses robotic-assisted techniques that allow surgery to be performed using small incisions between the ribs rather than through a midline incision dividing the sternum.

The recovery from robotic assisted CABG is shorter and expected to have fewer complications. Impressively, most patients are able to leave the hospital within three to four days and return to full activity, including work, in two to three weeks rather than the two-month recovery generally required following traditional CABG.

This approach is a “best of both worlds strategy”- minimally invasive off-pump left internal mammary artery (LIMA) graft plus a stent placed via ultrasound from the left main to the left circumflex artery.

For more a case study about this procedure view the March issue of The Chamber, our heart and vascular e-newsletter.

About Dr. Halkos
Dr. Halkos is a cardiothoracic surgeon at the Emory Heart & Vascular Center. He specializes in cardiovascular disease, coronary artery bypass surgery and valve repair/replacement. He finished his Medical School, Residency and Fellowship at Emory University School of Medicine. He is a member of the American Medical Association.

The Emerging Role of Fenestrated & Branched Aortic Endografts in the Treatment of Complex Aortic Aneurysms

Dr. RicottaAs Dr. Kasirajan mentioned in the last blog about aortic aneurysms, this condition can cause serious medical issues or even death. For patients with large complex aneurysms, there is a new procedure that we are performing at the Emory Heart & Vascular Center called a fenestrated and branched stent graft. This procedure is a viable option for patients who may have once been considered inoperable. These grafts are now used in select high-risk patients with complex aneurysms that are located throughout the entire length of the aorta.

In addition to being a safe and effective option for high-risk patients, fenestrated and branched endograft implantation provides patients with a number of benefits including:

• No incisions
• Shorter hospital stays (one or two days vs. 10 to 14 days for open surgical repair)
• Quicker recovery

Unfortunately, these devices are not yet commercially available in the United States. In countries where they are available, the grafts must be customized for each patient, a process that can take up to 12 weeks. During this time patients are at risk for a rupture in their aneurysm. As an alternative since 2007, several vascular surgeons in the United States have been custom-making fenestrated and branched stent grafts using available components.

Emory currently is one of only a few institutions in this country and the only one in the Southeast that offers these investigational procedures.

Fenestrated and branched endografts appear destined to play a key role in the management of complex aortic aneurysms. Research results have shown that these devices are both safe and effective in treating carefully selected patients, with low incidence of complications. Although additional research is needed to substantiate these results, Emory is poised to participate as a primary site in proposed clinical trials of these innovative devices.

You can learn more about Emory’s fenestrated and branched aortic stent graft program at www.emoryhealthcare.org/vascular

Do you have questions about fenestrated and branched aortic endografts? If so, feel free to ask away in the comments section.

About  Joseph J. Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases.  He has authored several journal articles and book chapters on the topic of fenestrated and branched endografts, and holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery and the Society for Vascular Surgery.

Coronary Artery Calcium Scoring: What Does it Involve?

As we’ve mentioned in previous blog posts, atherosclerotic plaque is made up of a combination of fat, cholesterol, and calcium beneath the inner layer of the arteries. The coronary arteries supply oxygen-rich blood to the heart, and the presence and severity of calcified plaque in these vessels is an indirect way to assess the presence of atherosclerosis. The sudden rupture of one of these plaques can cause a heart attack, which is why it’s crucial to know if an individual has accumulated large amounts of atherosclerosis.

An easy way of accomplishing this is through a cardiac CT scan—with this non-invasive method we obtain information on the level of calcified plaque build-up. If calcified plaque is detected, atherosclerosis of the coronary arteries (coronary artery disease: CAD) is present. Two-thirds of heart attacks aren’t caused by the narrowing of the coronary artery, but as I mentioned—by plaque rupturing within the artery wall.

With CT scanning we calculate a calcium score, which measures the extent of plaque burden on your arteries. We report 3 pieces of information with the calcium score: 1) your own absolute score 2) your percentile of calcium score, which tells you how you rank in comparison with people of the your age, sex and race, and 3) your estimated “vascular age”; this is an estimation of how healthy (i.e. young) or diseased (i.e. older) your coronary arteries are compared to people with similar backgrounds, and therefore gives you an indication of your relative risk.

Other components of our Heart CT scan screenings include:

Blood Pressure

If your blood pressure measures over 140/90 mm Hg, it is considered to be at a high level. Some people refer to high blood pressure as “the silent killer” because it can cause severe damage on the body with little to no symptoms.  In fact, it can cause strokes, heart disease and damage to your kidneys or eyesight if left untreated.

Fasting Glucose

The fasting glucose test measures your blood sugar level for the presence of early diabetes. While diabetes is a treatable condition, it may not manifest for years, and can cause damage to your heart and vessels without you realizing it.

Framingham Risk Score

The Framingham Risk Score indicates your risk of experiencing a heart attack within ten years, and is based on a combination of factors such as your age, sex, your blood pressure and cholesterol level.

Overall Cardiovascular Risk

This measurement results from the combination of your Framingham Risk Score and calcium score.

Emory’s comprehensive cardiovascular screening is very reasonably priced at $150, and includes all of the components listed above.

If you have any questions about our Heart CT scans, please let me know in the comments.

About Paolo Raggi, MD:

Dr. Raggi specializes in Internal Medicine and Cardiology, and has been with Emory since 2006. His areas of clinical interest include cardiac CT and MRI, echocardiography, nuclear cardiology, arteriosclerosis and lipids, cardiovascular disease, hypertension, and valvular disease. Dr. Raggi is fluent in Italian, Spanish, and French, and holds Organizational Leadership Memberships at the American College of Cardiology and the American College of Physicians.

Treatment Options for Peripheral Artery Disease

In this post, we’ll continue our blog series by examining the various treatments for treating peripheral artery disease (PAD).

Lifestyle

Before we delve into the various medical treatment options for PAD, we must point out the importance of taking control of your own health. If you’re suffering from diabetes, this means that you must carefully monitor your blood sugar levels. If you’re a smoker, we cannot stress the importance of doing everything in your power to quit the habit. PAD is very common among smokers, and smoking only exacerbates the effects of the condition.

Additionally, we strongly encourage regular exercise as a means of treatment—it increases blood flow to your legs and can actually alleviate symptoms. For some, exercise may be painful; however, you can often work your way up to a level of exercise that’s extremely beneficial as well as tolerable.

Medication

Medication may be necessary to offset the effects of PAD and lower the risk of heart attacks and stroke.

Antiplatelets affect blood platelets, causing them to be less likely to stick together to form blood clots. One of the most common antiplatelets is aspirin.

Anticoagulants prevent blood clotting, but must be monitored carefully for side effects. Two examples of anticoagulants are heparin and warfarin.

Cholesterol-lowering drugs have also proven to be effective in preventing heart attacks and stroke. Additionally, they can improve atherosclerosis and alleviate painful symptoms resulting from claudication. Statins and niacin are both examples of cholesterol-lowering drugs.

Angioplasty & Surgery

Many times, PAD patients require treatments such as angioplasty or surgery. As we described in our last blog post, angioplasty involves the insertion of a catheter into the groin area and then into the narrowing arteries. Partially blocked arteries can be opened through the insertion of a tiny stent or balloon.

For patients with more severe instances of PAD, more invasive means of surgery may be necessary, such as endarterectomy, which removes the buildup of plaque within the affected arteries. Bypass surgery may also be performed, which involves the replacement of blocked arteries with a graft. This encourages blood flow to move around the narrowed or blocked arteries.

If you have questions on any of these procedures or treatments, please be sure to let us know in the comments.

About Gregory Robertson, MD:

Dr. Robertson specializes in Cardiology and Internal Medicine, and is an Assistant Professor of Medicine at Emory. Some of his areas of clinical interest include atherosclerosis, cardiac catheterization, cardiovascular disease, valve disease, and peripheral artery disease. Dr. Robertson holds an organizational leadership membership at The American College of Cardiology, and has contributed to multiple publications in his field.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Dr. Veeraswamy had major or recent publications in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Diagnosing Peripheral Artery Disease

In previous blog posts, we’ve discussed patient stories and described symptoms of peripheral artery disease (PAD). Today, we’ll focus on what types of patients are candidates for screening and treatment, and the types of screening methods available.

Risk factors for PAD include people who are over the age of 70, over the age of 50 and suffering from diabetes, and smokers. In some cases, people under the age of 50 may be at risk, particularly if they’re obese, suffering from diabetes, or if they have high blood pressure.  High cholesterol or a family history of the disease also increases the risk of developing PAD.

If we suspect that you have PAD, we’ll perform one or more of the following tests:

General physical exam:

Here, we’ll examine your body in an attempt to pinpoint any potential signs of PAD. This typically includes checking the pulse (particularly below the suspected weakened artery), listening for sounds over your arteries, checking your blood pressure, and tapping areas of your body to assess the level of fluid in your organs.

Doppler Ultrasound:

The Doppler Ultrasound test gauges the blood flow within the arteries in your arms and legs. It can diagnose arteriosclerosis, blood clots and artery blockages, and venous insufficiency or occlusion.

Angiography:

With angiography, we insert a dye into your blood vessels, which enables us to view the flow of blood though your arteries. During the procedure, X-rays are taken, or MRA (magnetic resonance angiography) may be used to follow the flow of the dye. Additionally, a catheter may be used (this is referred to as catheter angiography), and inserted into the groin area and into the area of the body being examined. While this particular method is a bit more invasive, it’s also beneficial in that we can treat the area in question while we examine it by inserting medication or opening partially blocked arteries with a stent or balloon.

Ankle-brachial index:

The ankle-brachial test measures the blood pressure at your ankle and compares it to the blood pressure in your arm. Your blood pressure is measured before and after you walk on a treadmill to determine whether PAD is present. The ABI test is considered to be one of the most reliable for determining the presence of PAD.

These are the main tests that we typically perform in order to diagnose and evaluate PAD; however, additional tests may be necessary.

Do you have questions about how we diagnose PAD? If so, feel free to ask away in the comments section.

About Dr. Joseph Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases. He holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery, and the Society for Vascular Surgery.

What Are the Symptoms of Peripheral Artery Disease?

As we pointed out in our previous Peripheral Artery Disease (PAD) post, nearly half of people with this condition are unaware of their diagnosis because they experience no symptoms or are unaware that their complaints are due to PAD.  PAD can develop slowly over one’s lifetime so that symptoms may not present until arteries are severely blocked.

One of the major symptoms associated with this disease is referred to as claudication, which involves pain or cramping in the arms or legs during exercise or merely walking.  Every patient is different and some may experience it as heaviness, burning, or numbness.  The pain typically diminishes with rest, and may be severe, depending on the blockage of the artery.  When involving the legs, this symptom occurs most commonly in the calf muscle, but can often involve the buttocks or thighs.  Claudication may occur in one or both legs.  Discomfort is often worse when walking up stairs or uphill.

In severe cases, PAD can also cause symptoms that involve intense pain at rest. This is due to insufficient amounts of blood or oxygen reaching the legs even in the resting state.  Patients may find that they have severe pain at night relieved by hanging the foot down from the bed.

Other symptoms of PAD include:

-       Numbness of the limbs/extremities

-       Sensation of coldness in the legs or feet

-       Ulcers in the toes

-       Redness or discoloration of the skin

-       Foot and toe sore that will not heal

-       Loss of hair on the legs and changes in nail growth

Our next post will discuss which patients and/or candidates should be treated for PAD. If you have questions on the symptoms of PAD, or about this condition in general, please be sure to let me know in the comments.

About Chandan Devireddy, MD:

Dr. Devireddy specializes in Interventional Cardiology and Cardiovascular Medicine, and has been practicing with Emory since 2005. He actively participates in the Interventional Cardiology research department, which has been a significant enroller in several multi-center clinical trials. His individual research interests include acute coronary syndromes, novel coronary and peripheral technology, and medical and interventional treatment of peripheral vascular diseases.

Emory Heart Valve Study Featured on Fox 5 News

As we’ve pointed out in past blog posts, aortic stenosis refers to the narrowing of the aortic valve. This is most commonly caused by the simple wear and tear of aging. As people age, calcium builds up in the valve, causing it to narrow and restrict blood flow from the heart to the body. Recently, Fox 5 News featured Emory on a news piece describing our work with a new, minimally invasive procedure that is showing great promise in the treatment of this condition.

For more details, you can view the news clip here:

About Vasilis Babaliaros, MD:

Dr. Babaliaros specializes in Internal Medicine and Cardiology, and his areas of clinical interest are cardiology-interventional, valve disease, and valve repair/replacement. He received his Biomedical Engineering degree at Duke University (1992), his MD degree at Emory University (1996), and completed his training in Internal Medicine and Cardiology at Emory (2003). In 2004, he completed fellowship training in Interventional Cardiology at Emory University and then continued sub-specialty training in Valvular Interventional Cardiology under Alain Cribier MD at the University of Rouen, France (2005). He joined the faculty working with Peter Block MD as the Associate Director of the Emory Center for Valvular Intervention and Structural Heart Disease Treatment in 2006.