November 12th, 2012 By Emory Heart & Vascular Center
Emory University Hospital Midtown and Emory University Hospital in Atlanta are among the first hospitals nationwide and the only hospitals in Georgia to have access to the world’s first and only commercially available subcutaneous implantable defibrillator (S-ICD) for the treatment of patients at risk for sudden cardiac arrest (SCA).
Emory has been a part of the clinical trials to get this device approved and was the third highest enrolling center nationwide. Electrophysiologist Michael Lloyd, MD will be performing the procedure for the first time since the device has been approved on the open market on November 12, 2012.
The S-ICD System, produced by Boston Scientific, is designed to provide the same protection from SCA as transvenous implantable cardioverter defibrillators (ICDs); however the S-ICD System sits entirely just below the skin without the need for thin, insulated wires – known as electrodes or ‘leads’ – to be placed into the heart itself. This leaves the heart and blood vessels untouched, offering physicians and patients an alternative treatment to transvenous ICDs.
Sudden cardiac arrest is an abrupt loss of heart function. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation. Recent estimates show that approximately 850,000 people in the United States are at risk of SCA and indicated for an ICD device, but remain unprotected.
Emory Electrophysiologists Mikhael El Chami, MD, Michael Hoskins, MD, Angel Leon, MD, David DeLurgio, MD, Jonathan Langberg, MD and Michael Lloyd, MD have been instrumental in getting this device approved and will be performing this procedure.
About Michael Lloyd, MD:
Dr. Lloyd began practicing medicine at Emory in 2007—he specializes in Cardiology and Cardiac Electrophysiology. His areas of clinical interest and research include arrhythmias, electrophysiology lab, and pacemaker. Dr. Lloyd’s organizational leadership memberships include the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society.
Thank you for those who were able to participate in the Emory Heart & Vascular Live Chat on Cardiac Arrest in Young Athletes. I was very impressed by many of your questions on the topic of cardiac arrest, and happy to be able to answer them. If you were not able to join me, you can view the Sudden Cardiac Arrest chat transcript here.
In the chat, we covered a variety of important topics pertaining to cardiac arrest symptoms, warning signs, and risk factors. All parents, coaches, and supporters of young athletes should be aware of these warning signs and know how to respond when they present themselves. There are a few key takeaways from last week’s chat that I would like to reiterate:
Children and adults can survive sudden cardiac arrest if parents and others in the area act quickly.
We encourage all coaches and parents learn CPR.
In addition, we recommend obtaining an AED for all sports facilities. The equipment can be costly, but can save the life of a young athlete.
During the chat, there was also a question regarding what sports/activities were deemed too strenuous for those with heart disease. Please refer to the chart below that outlines the classification of competitive sports. The acceptable competive sports for those patients who have been diagnosed with hypertrophic cardiomyopathy and most other types of heart disease are:
Please note that if you think you could be at risk for HCM you should visit your primary care physician for an evaluation. If the physician clears you or your child you do not need to limit activity based on the above chart.
If you have additional questions about sudden cardiac arrest in general, or cardiac arrest in young athletes, please use the comments section below. Please also feel free to use the comments section to let us know if you have other heart and vascular topics you would like to cover in future live chats!
Cardiac arrest, once thought to be rare in young athletes, is becoming increasingly prevalent. According to some experts, a high school student dies of cardiac arrest as often as every three days. A young person’s cardiac arrest could stem from a structural defect in the heart, or a problem with its electrical circuitry. But the most frequent cause of cardiac arrest among young athletes—making up nearly 40 percent of all cases— is the Hypertrophic Cadriomyopathy (HCM) which is a thickening of the heart muscle.
Fortunately, there are warning signs of both hypertrophic cardiomyopathy and cardiac arrest. To ensure good health during healthy competition among young athletes, parents and guardians need to be aware of the symptoms of both.
Join Emory Heart & Vascular Center cardiologist and director of the Hypertrophic Cardiomyopathy clinic, B. Robinson Williams III, MD onThursday, August 9, 2012 at 12:30 p.m. for an interactive online Q & A web chat on the topic of sudden cardiac arrest in young athletes. Dr. Williams will be available to answer questions and discuss various topics about cardiac arrest in young athletes including causes, symptoms, and how to quickly treat, if it occurs.
Chandan Devireddy, MD, Cardiologist at the Emory Heart & Vascular Center discusses young athletes and heart attacks after an Olympic Swimmer from Norway dies of sudden cardiac death. The 26 year old world class swimmer, Dale Oen, died after a swimming workout.
In this CNN interview, Dr. Devireddy mentions one cause of sudden cardiac death is a cardiac disease called Hypertrophic Cardiac Myopathy (HCM) which affects one in 500 people. Emory has one of the few dedicated HCM Centers in the US. The center aims to treat people who are at risk for sudden cardiac risk. Watch the CNN interview in the video below:
Emory Heart & Vascular Center cardiologist Chandan Devireddy, MD recently sat down with the team at CNN to discuss what likely happened to English soccer player, Fabrice Muamba, when he collapsed from sudden cardiac arrest during a game earlier this month.
In the CNN interview, Dr. Devireddy also the cautions and guidelines athletes need to take to diagnose and prevent sudden cardiac death. To get Dr. Devireddy’s full take on cardiac arrest and athletes, check out his interview with CNN here.
Emory’s Heart & Vascular Center is consistently recognized by U.S. News & World Report as one of the top heart health centers in the nation. The Emory Heart & Vascular Center offers services that cover the entire continuum of care, from prevention and early detection to the latest in cardiovascular treatment. In fact, Emory has one of the few dedicated hypertrophic cardiomyopathy clinics (HCM) in the US. Emory’s specialized HCM center offers comprehensive care (surgery, interventional cardiology, genetic testing, etc.), as well as greater experience and expertise.
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.
December 15th, 2011 By Emory Heart & Vascular Center
Emory physicians are conducting research on how to use heart stem cells to help regenerate heart muscle in individuals who have experienced a heart attack. This effort is looking at ways stem cells can replace damaged heart cells and restore cardiac function.
Heart attack survivor Don Robinson was involved in a phase I clinical trial at Emory to test if his own stem cells would help regenerate his heart. For this, stem cells were taken from his body during a bone marrow transplant.
Clinicians involved in the trial are working to find cells that are likely to enhance blood vessel formation and protect the heart muscle from further damage. Mr. Robinson was given 10,000,000 cells after the heart attack, but before the scaring could take place. Scans performed as part of the study now show that Mr. Robinson’s heart has regenerated.
Emory is continually leading the way for advanced new treatments for heart disease. The phase I trial was testing safety of this procedure, but a phase II trial will soon begin at Emory to test this procedure further.
This Web site is provided as a courtesy to those interested in Emory Healthcare and does not constitute medical advice and does not create any physician/patient relationship. Also, Emory Healthcare does not endorse or recommend any specific commercial product or service. This Web site is provided solely for personal and private use of individuals accessing this information, and no part of it may be used for any other purpose.