September 20th, 2012 By Emory Heart & Vascular Center
Saint Joseph’s Hospital patient and triathlete, Joe Michalak, narrowly missed a heart attack by listening to the risk factors of heart disease. On Father’s Day weekend, he felt some tweaks in his chest and instead of ignorning his symptoms, he went to the hospital right away. Luckily, Joe listened to his body. In hindsight, he had a 95 percentage blockage in his left anterior artery and 80 percent blockage in another one.
Learn more about Joe’s symptoms and what prompted him to make a trip to his local E.R. at Saint Joseph’s Hospital.
Joan Jahnke, Emory Clinic patient and patient of Emory Heart & Vascular physician, Dr. Habib Samady, shares her journey through her diagnosis and treatment of Cardiac Microvascular Endothelial Dysfunction with Vasopastic Angina.
I have led an active life and thought I was doing everything possible to keep my heart healthy – eating right, exercising and not smoking, and trying to maintain a relatively low stress life. I was also a cardiac nurse and knew what it meant to be healthy, and why I wanted to remain healthy. So when I closed in on retirement age, I was surprised when I started clutching my chest first, with shortness of breath then with chest pain.
I was diagnosed with Cardiac Microvascular Endothelial Dysfunction (MVD) with Vasospastic Angina in 2008 during a drug challenge catheterization test at Emory Healthcare after two and one-half years of chest pain. My case was very severe and I had a cardiac arrest during the procedure. Each episode of an angina attack is like having an individual heart attack and I was barely able to keep up activities of daily living. I had attacks multiple times during a day, for days on end, with few periods of pain–free stability.
MVD is a form of heart disease found predominantly in women of a certain age. The etiology, or cause, is unknown and each woman with MVD can have different degrees of heart attack-like symptoms. I have had chest, arm, axilla, jaw, ear and back pain, and just simple fatigue with this MVD.
Treatment is dependent on symptoms and presenting complaints. The first important treatment step is opening up the affected small heart muscle microvessels with nitroglycerine. This allows oxygenated blood to flow freely through the heart muscle to supply it with oxygen and then out to the body’s general circulation. This relieves the angina pain greatly and reduces the shortness of breath that occurs. Nitroglycerine can be in sublingual, oral spray, patch or in a pill form.
The second important treatment is with a medication called a Calcium Channel Blocker that greatly reduces the irritability of the affected vessels and again, reduces pain.
To help these microvessels from developing plaque, I am very careful about keeping my cholesterol numbers low both by diet and medication.
The heart-sensible treatment for MVD is to attempt a regular exercise regime. In my case the endothelium doesn’t open up when I try to increase my heart’s rate, so I cannot exercise and it has been three and one-half years since I have had any exercise. However, my lipid numbers are wonderful and my weight has not ballooned out of control.
Most of the medications I take for MVD are the same ones given for hypertension, and I may have days when my BP is low so I am careful about sudden changes in position. Further treatment can also include pain management.
Although I have stabilized nicely after treatment at Emory, I am dependent on many medications 24/7 and still have frequent episodes of vasospasm with crippling angina. I visit Emory every few months to monitor the disease. My Emory cardiologist and my local cardiologist both follow my changing symptoms carefully. Emory takes the lead in any changes or additions in medications and both doctors follow my blood work for cholesterol issues. I recently had my first change in three years with my nitroglycerine medication. Initially, I started at a very low dose and gradually worked up to a higher dose sufficient to make me as close to pain free and without chest tightness and shortness of breath. This also allowed me to return to some low level of exertion.
I have learned that these vasospasms can occur by some demand I have caused, like attempting a flight of stairs too quickly or by some other unknown to me demand when I am resting or asleep. The daily calcium channel blockers keep the vasospasms away most of the time so this has greatly helped reduce chest pain from the painful spasms. Over the years as I have developed tummy, feet and leg swelling, my Emory doctor has been careful to prescribe not only medication to help with that sign, but also advising me of simple things as watching salt in my diet and elevating my legs. I also have not been subjected to the many tests or additional heart caths that many physicians might request. I have been tested for sleep apnea and use a CPAP which helps my heart rest at night.
I am very healthy and have developed no other health complaints in six and one-half years. The most wonderful part of having this odd dysfunction is having the Emory doctors who not only understand this dysfunction, but also know how it should be treated for each individual patient as their symptoms develop. They also understand that this difficult, exhausting ailment impacts the very simplest of daily functions, social interactions and normal exercise activities. Dr. Samady listens when I tell him how I must change my lifestyle, stop all exercise and avoid those activities or emotions that could cause a demand on my heart and cause me pain or discomfort.
A big frustration with many MVD patients is that our complaints and symptoms often bring us to an urgent or emergent care setting where none of our signs show on any EKG, echocardiogram, ultrasound or stress test. We look well, present with chest pain and shortness of breath – perhaps anxious – but the tests are generally negative, even the cardiac enzymes. We understand that we may have to rule out other causes with GI and pulmonary tests, but we repeatedly return seeking help, knowing that it is our heart but we repeatedly fail the best current technology tests.
My care at Emory from first contact was relatively pleasant as each physician I saw was confident of my diagnosis. And I am confident in my care because of my doctor’s confidence and superb care in an area of cardiology with so many unknowns.
About Joan Jahnke
Joan Jahnke is now a retired RN. She has enjoyed many career opportunities and great jobs traveling around the world with her husband, who is in the Navy. She is an Emory Clinic patient and sees Emory Heart & Vascular Physician Dr. Habib Samady.
November 1st, 2011 By Emory Heart & Vascular Center
Emory patient, Donna Fielding, a healthy looking 41 year old mother of two is sure that stress and her high-intensity type A personality lead to her heart attack at 37. Her heart attack taught Donna to “take a step back, take a deep breath, and make a decision.” She doesn’t let the “little things” in life ruin her days any longer.
Emory physicians are doing research to study the connection between stress and heart attack risk. According Emory physician, Dr. David Sheps, when you get stressed your heart rate and blood pressure go up.
View Donna’s story and learn about the research Emory is doing in a video from Fox 5 Atlanta, below:
Take control of your stress and potentially reduce your risk for heart disease!
October 27th, 2011 By Kathy Lee Bishop MS, PT, CCS; Manager, Emory HeartWise Risk Reduction Program
We hope having a heart attack on Stone Mountain is not something you will never have to worry about, but for one Emory Heart & Vascular Center patient, he had to take quick action to save his life. Luckily Howard Dean survived to tell the story and is now participating in the Emory HeartWise Heart Disease Risk Reduction program. He has even returned to hike Stone Mountain since that crazy day. View this Fox 5 Atlanta piece on Howard’s story:
To help keep your heart healthy, register to join us this Saturday, October 29th for the American Heart Association’s Metro Atlanta Heart Walk! If you don’t have a team, you can join our Emory team!
October 24th, 2011 By Malia Veator, Emory Heart & Vascular Patient
Nine years ago I was diagnosed with cardiomyopathy and heart failure. I was very weak, but I improved with medication and diet. At this point, I decided to get a second opinion at Emory Healthcare based on Dr. Andy Smith’s recognition in the heart failure community. I quickly felt very comfortable with Dr. Smith and his staff at the Emory Heart Failure Clinic.
My husband and I concluded that we had met the best doctor to manage my progressive illness. Due to our confidence in Dr. Smith, we followed his advice to have a defibrillator implanted in 2006 to help manage my arrhythmias. In 2007, I became symptomatic again because my mitral valve was leaking significantly. Dr. Smith and my local cardiologist in Macon, Dr. Thomas Terry, advised that I have valve surgery. In 2008, Dr. Robert Guyton, at Emory, performed a mitral valve repair on my heart. A few weeks after surgery, I began having more arrhythmias that could not be controlled. As a result of this new challenge, I had a cardiac ablation in Macon by Dr. Felix Sogade. My heart continued to weaken over the next two years, and I was placed on the heart transplant waiting list in February 2010.
Living with advanced heart failure has been challenging at times. Before my heart transplant in March 2010, there were the days when I couldn’t grocery shop, vacuum or even walk for five minutes. I even dreaded having to wash and dry my hair because I would get exhausted and had trouble breathing.
Life has changed for my family over the last nine years but my husband and I believe that these changes have been beneficial to improving our way of approaching life. Due to my illness, we were unable to have children and our greatest gift has been our beautiful son that we adopted in 2008. We now appreciate each day that we are given and feel very blessed that I have been given a second chance at life.
Waiting for a new heart can be a difficult challenge. But, my family was blessed when we received a phone call about a new heart only 10 days after being placed on the waiting list. Having the heart transplant was such an exciting time for me. When I first came off the ventilator after the surgery, I could already feel an improvement. I noticed my chronic cough was gone and my husband quickly told me I had color in my cheeks again. Four days after surgery I was walking the hospital halls. In fact, I was walking faster and further than I had in the previous two years. I have been exercising ever since: walking, running, light weight training and tennis. These are activities most people take for granted; activities I used to take for granted. Not any more, now I appreciate all activities of daily living. I even enjoy working again!
Since having my transplant, I am followed at the Emory Transplant Clinic and I am proud to say I have met many more remarkable doctors and nurses. I call my clinic doctors, typically Dr. Book, Dr. Laskar or Dr. Cole, my biopsy buddies since I have to have heart biopsies on a regular basis to check for rejection of my new heart. They are great at their jobs, but I would not expect anything less from such a superb hospital. My confidence in Emory, my faith in God and my support from my family give me the courage to continue living life to the fullest each and every day. I could not ask for anything more.
There is no doubt that I was able to benefit from the research and advances made possible by organizations like Emory Healthcare and the American Heart Association, and receive a heart transplant – when 50 years ago there would not have been any options for me!
I am proud to be participating in the 2011 Metro Atlanta Heart Walk! The American Heart Association has made huge advances in the treatment of heart disease resulting from funding heart research, and I want to give back so that others can benefit and hopefully we will one day find a cure for heart disease. I am also walking to honor my family, my heart donor and their family, and the many staff at Emory Healthcare who have been with me on my journey from heart failure to heart transplantation.
Malia Veator, Emory Heart & Vascular Center patient and 2011 Atlanta Heart Walk Participant
My name is Donna Seaman, and I’d like to share my story of Peripheral Artery Disease with you.
First—a little background for you: I’m from Massachusetts, and I’ve lived in Atlanta for over 35 years now. I attended Emory University and majored in business before becoming a buyer for Rich’s (now Macy’s). I enjoyed the best of both worlds in that I spent several years as both a working Mom, and several as a stay-at-home Mom. I live in Dunwoody, and I have two children—a 26-year-old daughter, and a 23-year-old son.
I’ve been playing tennis now for over 20 years, and once I hit my late 40s I began to notice some leg pain and swelling. At the time, I attributed it to normal wear and tear, and assumed it was also due to all of the years I spent on my feet working in the retail industry. When the pain worsened after about a year or so, I knew it was time to seek medical help.
When Dr. Niazi asked me if I was experiencing any other symptoms, I shared the fact that my tennis game had been really “off”, and that I had noticed that I was stumbling around more and feeling clumsier in general. I would also pick up items and unintentionally drop them. I didn’t think much of these particular symptoms, but the folks at Emory really took notice when they heard me mention them, and decided to run some more tests.
After the tests, Emory called me with the results and informed me that not only did I have peripheral artery disease in my legs, the carotid artery in my neck was 97% blocked. (My neck artery blockage was what was causing the stumbling and clumsiness.) Dr. Niazi immediately warned me not to have any neck rubs or massages, and to exercise caution when I was getting my hair washed at the salon or bending my neck. With 97% of the artery blocked, I was dangerously close to experiencing a stroke.
Initially, I had less invasive procedure that involved the physician going through my groin area and then up into my neck in order to place a stent. However, after reviewing the results of the procedure, Dr. Niazi realized that my condition was worse than he anticipated. He recommended that I undergo total carotid artery surgery, which was necessary given my younger age and the severity of the blockage.
A week later (in October of 2009), I was back at Emory for the carotid artery surgery that would clean out the build-up of plaque. I was in the hospital for three days for the procedure. I left Emory with a scar on my neck and the knowledge that I’d come dangerously close to having a potentially fatal stroke. In my mind, it’s a sort of miracle that my condition was discovered the way it was—if it weren’t for Dr. Niazi’s proactive treatment of my PAD, I’m not sure I’d be here to tell you my story today.
About a month later, I was treated for the PAD that was present in my legs. This was a much simpler procedure—and was practically right in and out of the hospital for it.
Since the surgery, I started taking medication for cholesterol and high blood pressure, and I have yearly checkups to the doctor. I no longer feel any pain in my legs when I exercise. My walking is better, and my balance has improved greatly.
I can’t say enough good things about Dr. Niazi and the team at Emory who treated me. They’re personable, professional, and top-notch, and they took a personal interest in me and carefully listened to me speak about my concerns and symptoms. I feel very fortunate that I was in such good hands and that I escaped the life-threatening repercussions of PAD.
My name is Andrew Sawyer, and I’m 25 years old. Believe it or not, before I was 2 years old, I had 4 open-heart surgeries. I spent the first day of my life being transported by helicopter from Douglas, GA to Children’s Healthcare of Atlanta at Egleston for emergency surgery. It was there that Dr. Willis Williams performed 3 open-heart surgeries on me as he attempted to fit the right sized shunt into my heart. I was born without a pulmonary valve (a condition called pulmonary atresia), which prevented the normal flow of blood from my heart to my lungs from being replenished with oxygen.
I spent my first birthday in the hospital, where I underwent my 4th surgery. The surgeons had to place a patch over the area of my missing valve, allowing blood to flow through.
Surgery number five took place when I was in the sixth grade. The existing patch was beginning to fail, so this procedure involved the placement of a pulmonary cadaver valve, restructured my tricuspid valve, and repaired the lining of my right ventricle. Memory is a funny thing—I’ll never forget waking up from the surgery and learning that the Braves were losing to the Yankees in the World Series.
The surgeons predicted that my new pulmonary valve would last for 8-10 years, but remarkably, it lasted for 13. Once a year, I’d go in for my yearly check-up appointment and wonder if this would be the visit that the doctors told me that it was time for another surgery. Every year I heard the welcome words, “see you next year”—until the fall of October of 2009.
That fall, Dr. Book learned through my echocardiogram results that my pulmonary valve was damaged, and it was time for another surgery. I was amazed that the doctors were able to discover this through a simple echo, but technology had advanced since my last surgery, and a catheterization process was unnecessary this time around. Dr. Book and Dr. McConnell recommended that I see Dr. Kogon, a cardiothoracic surgeon specializing in adults with congenital heart defects.
From the start, I knew that I was in great hands with Dr. Kogon—he immediately made me feel at ease, and he was very clear in how he presented my options. I’m not sure I can accurately describe how surreal it was to have a conversation with Dr. Kogon about whether to go with a pig or a cow valve for my surgery. According to Dr. Kogon, there had been great advancements with animal tissue valves. He explained that this would be a better option than a human or mechanical valve—animal valves, for whatever reason, seem to last longer and yield better results. Dr. Kogon estimated that my new bovine valve would last 20-30 years.
Many people ask me if I was discouraged, or scared in reaction to the news of another surgery, but I can honestly say that I wasn’t. I’ve always had an extremely positive attitude throughout my life—this, coupled with my religious conviction carries me through tough times. Strange as it may sound, I compared the pain of my recovery period to one particularly tough summer job I had as a door-to-door salesman. That was one of the harshest, most emotionally taxing periods of my life, and it changed me somewhat. Being told “no” time and time again, and having to get up and hit the road again the next day requires strength and resilience. I realize I’m talking about two completely different types of pain here—but when I was lying in bed in pain post-surgery, that’s exactly what I thought about. I figured, “if I made it through that gut-wrenching summer of door-to-door sales, I can make it through this.”
When I think back to my 6th and most recent surgery, a few things come to mind: first, I couldn’t believe the level of service I experienced at Emory. The nurse technicians were incredibly kind and knowledgeable. I always had baths and a clean bed, and the overall level of care was just phenomenal. Even months after the operation, Dr. Kogon would stop by to visit me during my check-ups with Dr. Book and Dr. McConnell. Knowing I was in such good and capable hands was a comfort in itself.
My recovery experience as a 25-year-old was much different from my experience as a 12-year-old. The doctors explained the difference to me, saying that a 12-year-old body is made up of quite a bit of cartilage, as opposed to a 25-year-old, whose body is made up primarily of bone, causing recovery to be more painful. Even so, I was only in the hospital for 6 days, and I was able to get back to school (medication-free) within 30 days of the surgery.
Aside from being a student, I’m a musician, and over the years, my experiences have inspired me to write several songs, one of which is called “South Georgia Pine”—this video shows footage of me leaving Emory a few months after my last surgery.
I’m incredibly grateful to my family, and to all of the Emory doctors and nurse technicians who have supported me and helped me along on this journey to recovery.
My name is Peggy Adams. I’m a retired schoolteacher, and I live with my daughter and grandson in Pensacola, Florida. I am 76 years old, and I’ve been living with congestive heart failure for years. In May of this year, I came to Emory to undergo valve replacement.
I suffered from aortic stenosis for three years, and because of my heart problems I entered stage IV renal failure. Unfortunately, I have several other health problems, including diabetes, COPD (chronic obstructive pulmonary disease), and arthritis. Over this past year, I reached the point where I was in the emergency room every three weeks. The slightest exertion would send my system into major fatigue. Typically, I’d get out of bed, walk out the door and down the ramp to the car, and by the time I reached my car I’d have to take 10 minutes before I could stop panting. I was just so tired all the time; my eyelids would close in mid-conversation.
When I was in the hospital last December, my primary heart doctor informed me that my valve would eventually stop working completely, and that she didn’t think I had more than six months left to live. She sent me to another doctor who did a workup and predicted that it was closer to three months. He told me that I needed to have my aortic valve replaced, but that he wasn’t willing to perform the surgery due to all of my other illnesses. He believed there was no way I’d survive it.
I wasn’t willing to accept the fact that this was the end. So we started researching and heard about the program at Emory with Dr. Block and Dr. Thourani. They were performing percutaneous valve replacement, where the incision is just six inches below the breast. With this procedure, they wouldn’t have to split my chest open, so the recovery would be much easier. I have a fighting spirit, so I decided that I wanted to go for it.
It was then that we traveled to Emory to take part in an interview to participate in the study. There were all these young doctors in the room who proceeded to ask me many, many questions. I had just one question that I wanted to ask them: “How many times have you done this operation?” They replied that they had performed the surgery 35 times, and I would be number 36. When I asked them about their rate of success and failure, they said that it was 100 percent, and that they hadn’t lost any patients. This was very reassuring, and it gave me a lot of confidence.
So, we came back home to Pensacola to wait for them to call. They told us to prepare to wait eight weeks fro their decision, but after only about three weeks they called and told me I needed to get back up to Emory as soon as possible. I was there by 8 o’clock on a Tuesday morning, and they had me in surgery the next day.
The doctors were very concerned that I’d go into renal failure, or that they wouldn’t be able to wean me off of the ventilator after the surgery. But I surpassed everyone’s expectations. Not only did I not go into kidney failure, but after only three or four days after surgery, I was walking the hallways to show the nurses how well I was doing. Now, here’s the amazing thing about this surgery: On the fifth day, I no longer needed a bandage at all. It healed that quickly and that perfectly. I was feeling good. On Friday, just nine days after surgery, I was back in the car headed home.
When we went back for a follow-up five weeks after the surgery, they gave me an echocardiogram, and my heart pressures were normal. For the first time in years, I had normal heart pressures. My new valve is functioning wonderfully. I sure wish everyone with valve problems could have this procedure instead of having open-heart surgery.
Now, I can go to the movies, I can go to church on Sunday, and I can visit my sisters. Even better, I’m not sleeping through life. It’s amazing. I’m very grateful to the doctors at Emory for giving me a second chance at life.
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