Posts Tagged ‘emory heart and vascular center’

Takeaways from the Peripheral Arterial Disease (PAD) Treatment Options Live Chat

pad-260x200Thank you to everyone who attended and participated in our Peripheral Arterial Disease (PAD) live chat on Tuesday, January 24th with the Emory Heart & Vascular Center’s Chief of Vascular Surgery, Dr. William Jordan. Peripheral Arterial Disease (PAD) affects 8 to 12 million people in the United States, especially those over 50. Those who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

Dr. William Jordan was able to answer all of your questions about PAD and the various treatment options available. We received a lot of awesome questions which you can find in the full chat transcript here. Below are some highlights from our live chat.

 

Question: How do I get tested for PAD?

Dr. Jordan: A thorough physical exam would be the first test. Non-invasive testing with blood pressure cuffs on the legs along with low-grade treadmill walking can usually confirm the diagnosis. It is best to see a vascular specialist to be tested.

Question: Are there clinical trials for PAD?

Dr. Jordan: Yes, Emory participates in the BEST-CLI study which is an NIH sponsored study to compare open vs. endovascular treatment for PAD. We also are constantly evaluating new treatment modalities as new devices become available.

Question: What do you think the best way to treat PAD is?

Dr. Jordan: The first line would be medical therapy, including lifestyle changes such as exercise, diet and nicotine cessation. If there is not improvement from medical therapy, we will consider the patient for reconstruction- bypass or stent.

 

Thank you again to everyone who joined us for our PAD live chat! You can learn more about the Emory Heart & Vascular Center here.

Peripheral Arterial Disease (PAD) Treatment Options Live Chat: January 24, 2017

pad-260x200Peripheral Arterial Disease (PAD) affects 8 to 12 million people in the United States, especially those over 50. Those who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

Join us on Tuesday, January 24th at 12pm when the Emory Heart & Vascular Center’s Chief of Vascular Surgery, Dr. William Jordan,  will answer all of your questions about PAD and the various treatment options available. All are welcome to attend this open chat with our physicians.

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Takeaways from the Atrial Fibrillation (A-Fib) Live Chat

afib-email260x200Atrial fibrillation, or A-fib, is the most common irregular heart rhythm in the United States, affecting over two million Americans. We hosted a live chat on Tuesday, November 15th at 12pm EST about atrial fibrillation with Mikhael El-Chami, MD, of the Emory Heart and Vascular Center where we received a lot of great questions about symptoms, treatments, and more.

Dr. El-Chami was able to answer these questions and provide insight on this condition that affects so many people. Below are some highlights from this live chat.

 

Question: Are there different types of a-fib? Is one more serious than another?

Dr. El-Chami: There are typically two different types of a-fib. The first type is persistent a-fib (always in a state of a-fib) and the other type paroxysmal a-fib (a-fib that comes and goes). One type is not more dangerous than the other. The most devastating complication of a-fib is related to the predisposition to stroke. If that is treated appropriately with blood thinners, then the risk is reduced significantly. At times, a-fib is also associated with weakening of the heart muscle, and if that is the case physicians are usually very aggressive at trying to keep patients out of a-fib.

 

Question: What are some risk factors for a-fib?

Dr. El-Chami: That is a very good question. Common risk factors for a-fib include hypertension, obstructive sleep apnea, obesity, aging and structural heart disease (patients with valve problems, weak heart muscle or thick heart muscle). A-fib could occur in a younger patient without major health issues, but this is not the norm.

 

Question: Am I more likely to have a stroke if I have a-fib?

Dr. El-Chami: A-fib is typically associated with a 5 fold increase in the risk of stroke. There is a clinical scoring system (CHADSVaSC score) that will better determine the risk of stroke in patients that have a-fib.

 

Thank you to everyone who participated in our live chat! You can view the full chat transcript here.

What’s Causing Your Fainting Spells?

fainting spellsMany people have experienced what is commonly called “passing out” or “fainting.” The medical term for this is syncope.

Syncope happens when, for short periods of time, there is a sudden drop in blood pressure and there is reduced blood flow to the brain. The most common cause of syncope, especially in healthy young people, is vasovagal syncope. The good news is that, even though vasovagal syncope sounds scary, most of the time it is nothing to worry about.

Vasovagal syncope is due to slow heart beat or expansion of blood vessels. This allows the blood to accumulate in your legs, which lowers your blood pressure and reduces blood flow to the brain. There are certain situations that can provoke these responses, for example pain, fear, standing for too long, being over tired or over heated. It could even be an unusual reaction to coughing, having a bowel movement or urinating. Before you faint you might experience lightheadedness, nausea, cold sweats, a feeling of warmth or blurry vision.

The diagnosis of vasovagal syncope can be made without further testing or by excluding other causes, but sometimes tests like blood work, electrocardiogram, exercise stress test or tilt table test are performed. In most cases, treatment for vasovagal syncope is not necessary. Your doctor might recommend that you increase your liquid and salt intake, wear compressions stockings or avoid prolonged standing, especially in crowded or hot places. Occasionally, medication to increase your blood pressure is needed.

Other less frequent causes of syncope are problems in the brain or in the valves, muscles or the electrical system of the heart. All of these causes will be considered by your doctor or nurse when evaluating your case. Because the causes may vary, it is important that every person who faints is evaluated by a healthcare professional.

To make an appointment with an Emory Healthcare physician, please call 404-778-7777.

About Dr. Gongora

Carolina Gongora, MDDr. Gongora is a Board certified cardiologist at the Emory Heart and Vascular Center and Assistant Professor of Medicine (Cardiology) at Emory University School of Medicine.

Dr. Gongora went to medical school in Bogota, Colombia, where she is from originally. She moved to Atlanta in 2005. Before starting her training in Internal Medicine and Cardiology at Emory University, Dr. Gongora did a post doctoral research fellowship in hypertension and renal disease. Her research was partially funded by the American Heart Association. During this time she published in recognized journals like the Journal of American College of Cardiology, Hypertension and Circulation. Also, she presented in nationally renowned meetings, like the American Heart Association, the American Society of Hypertension and the American Physiology Society meetings, among others. She has been a member of the American College of Cardiology, the American Physiological Society and the American Heart Association-Council for high blood pressure. She is board certified in Cardiology, Internal Medicine and Echocardiography.

Stem Cell Research Reveals Promising Data for Heart Attack Patients

Stem Cell Research for Heart PatientsDuring a heart attack, every minute counts, especially when the type of heart attack is a STEMI (ST segment elevation myocardial infarction). STEMI is the most fatal type of heart attack and is caused by a prolonged blockage of blood supply in the heart, which weakens or deadens the heart muscle.

In a recent clinical trial named PreSERVE AMI, research investigators from 60 different sites conducted one of the largest studies using bone marrow cell therapy for heart attack in the United States. The study treated 161 patients following a STEMI heart attack using their own bone marrow cells in hopes of improving their recovery process.

“For cardiologists, our key goal is to keep patients from progressing to worsening heart muscle function and death after a major heart attack,” said Dr. Arshed A. Quyyumi, professor of medicine at Emory University School of Medicine, co-director of the Emory Clinical Cardiovascular Research Institute and lead principal investigator of the PreSERVE AMI study. Heart attack patients are usually at high risk of downstream adverse events, including chronic heart failure, recurrent heart attack, significant arrhythmias, premature death or acute coronary syndrome.

About the PreSERVE AMI Clinical Trial

The PreSERVE AMI study, sponsored by NeoStem, Inc., produced promising results that will allow stem cell researchers to continue making progress in determining the cell type and dose that benefit patients. After receiving the standard of care following a heart attack, which is stenting, participating patients were enrolled if their ejection fraction, a measure of the heart’s pumping capacity and indicator of the severity of the attack, was less than 48 percent.

After trial enrollment, patients had bone marrow cells extracted, sorted and then re-injected into the heart. Bone marrow contains rare cells which are believed to promote healing and recovery of blood flow. In this study, extracted bone marrow cells were shipped to NeoStem’s facility where sophisticated stem cell technology sorted and selected the rare cells called CD34+ cells before they were returned for re-injection into the patient.

The stem cell study was randomized and not all patients received the same dose of cells — some received the minimum of 10 million cells while others received up to 40 million — and a half of participants received placebo.

Discovery and Results of the PreSERVE AMI Clinical Trial

Recovery and outcomes of PreSERVE AMI were assessed in several ways: MACE (major adverse cardiac events, ranging from hospitalization for chest pain to death), ejection fraction and blood flow in the heart. Cardiac imaging was performed six months after treatment and MACE reported from an average of twelve months of follow-up.

Highlights of initial trial results include:

  • A statistically significant mortality benefit in patients treated with CD34+ as compared to the placebo group. Mortality was 3.6 percent in the control group, and zero in the treatment group.
  • A statistically significant dose-dependent reduction in serious adverse events.
  • MACE occurred in 14% of control participants, in 17% of subjects of who received less than 14 million CD34+ cells, in 10% of subjects who received greater than 14 million CD34+ cells, and in 7% of subjects who received greater than 20 million CD34+ cells. Therefore, it appears that the numerical decrease in MACE is dependent on cell dose size.
  • Patients treated with a dose of greater than 20 million CD34+ cells were seen to have a statistically significant improvement in their ejection fraction compared to the placebo group.
  • No significant effects on improvement in blood flow, measured by SPECT imaging, between the treatment and the control group based on 6 months of data.**

According to Dr. Quyyumi, the U.S. Food and Drug Administration (FDA) officials have told stem cell researchers using cell therapy that MACE (clinical outcomes) are the important measure of success and SPECT imaging is not, although imaging provides insightful information on the heart and therapy being issued.

Summary of PreSERVE AMI phase II Clinical Trial

In the treatment group that received the largest dose of CD34+ cells, the MACE rate was half that of control group, which is a good indicator that cell dose impacts MACE outcomes. But comparing that measure to the placebo group (versus the entire treatment group), bone marrow cell therapy did not have a significant effect on MACE.

One positive, NeoStem has reported that because of this phase II trial, they are now able to standardize their procedures so that in the future, every patient should be able to receive 20 million CD34+ cells.

“It is encouraging to see clinically meaningful results this early in the study, and I look forward to future data readouts,” says Dr. Quyyumi. He is hopeful that additional follow-up trials should continue to make the effect of cell therapy treatment on clinical outcomes more clear.

“Research and discovery are important components to delivering exceptional patient care,” states Dr. Quyyumi. “Clinical trials are an iterative process that allows us to gain answers to the many questions we have about disease and treatment therapies, regardless of whether the clinical trial produces the outcome we want or expect.”

**Worthy to note, some patients who received cell therapy treatment had delays in getting stents (average 931 vs. 569 minutes), which puts the treated group at a disadvantage in terms of the heart’s recovery. This happened by chance resulting from the randomization of participants to placebo vs. treatment and not because of the treatment process since all bone marrow-related treatment procedures occurred after stenting.

About Emory Heart & Vascular Center

The Emory Heart & Vascular Center is comprised of four major areas of cardiovascular care– cardiology, vascular surgery, cardiothoracic surgery, and cardiac imaging. Each area is committed to providing superior cardiac and vascular patient care, promoting overall heart health, pioneering innovative clinical cardiovascular research, and training the best heart specialists and cardiologists in the world.

About Arshed Quyyumi, MD

Arshed Quyymi, MDDr. Arshed A. Quyyumi has been involved in clinical translational research in cardiovascular diseases for over 30 years. Dr. Quyyumi received his undergraduate degree in Pharmacology and medical degree from the University of London, England. He completed his residency at Guy’s and Royal Free Hospitals in London, and cardiology fellowships at National Heart Hospital, London; Massachusetts General Hospital, Boston; and the National Institutes of Health. After completion of his residency and fellowship, he served in several capacities in the Cardiology Branch of National Heart Lung and Blood Institute, NIH in Bethesda, MD, including Senior Investigator and Director of the Cardiac Catheterization Laboratory. In 2001 he was appointed Professor of Medicine in the Division of Cardiology at Emory University School of Medicine, and in 2010 he was named Co-Director of the Emory Clinical Cardiovascular Research Institute (ECCRI). Since 2005, Dr. Quyyumi has been awarded more than $9 million in research funding. He serves on the Editorial Boards of several national journals, is a member on several Scientific Advisory Boards, and is a reviewer for the NIH-NHLBI Study Sections. Dr. Quyyumi has authored more than 250 peer-reviewed publications and has been an invited speaker and session chair at numerous National and International scientific meetings and conferences.

Dr. Quyyumi’s research focus includes vascular biology, angiogenesis, progenitor cell biology, mechanisms of myocardial ischemia, the role of genetic and environmental risks on vascular disease, genomics, and metabolomics. Other interests have spanned the fields of personalized medicine and disparities in cardiovascular diseases. During his academic career, Dr. Quyyumi has carried out more than 50 NIH, industry-funded, or investigator-initiated projects, including numerous clinical trials. Dr. Quyyumi is a member of NeoStem’s advisory board. This relationship has been reviewed and approved by Emory University School of Medicine.

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Cutting-Edge Therapies for Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is the most common monogenetic cardiovascular disorder occurring in about 1 per 500 people in the general population. Approaches to the treatment of HCM vary considerably depending on how the patient is affected. At Emory Healthcare, we are fortunate to have true experts capable of providing state-of-art therapies which range from genetic counseling or simple life-style adjustments to cardiac transplantation. Patients at risk for sudden cardiac death receive life-saving cardiac defibrillators. Those with drug-refractory symptoms due to obstruction of outflow from the heart receive septal reduction either by open heart surgery or by catheter ablation. The Emory Hypertrophic Cardiomyopathy Center is a regional and national center of excellence capable of addressing the full range of challenges in the patient with HCM.

For more information about programs that make up the Emory Heart & Vascular Center, visit emoryhealthcare.org/heart.

About John Douglas, MD

John Douglas, MDDr. John Douglas is an interventional cardiologist at the Emory Heart & Vascular Center. He is also a Professor of Medicine at Emory University School of Medicine and Director of the Interventional Cardiology Fellowship Program. He is one of the most tenured Emory cardiologists, beginning his career in 1974. He has been recognized in America’s Top Doctors, Atlanta’s Top Doctors and The Best Doctors in America.

Advancing Patient-Centered Cardiac Care

Patient Centered Cardiac CareOne of the chief goals of quality healthcare, as defined by the Institute of Medicine, is to provide patient-centered care. Doing so requires “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001). As patients know, this kind of care doesn’t always happen. Providing patient-centered care requires effective communication and a trusting relationship. It also requires high-quality evidence regarding what forms of treatment are most likely to advance patients’ goals.

Emory has placed patient and family centered care at the top of the list of priorities and is taking important steps to make this happen. The Patient and Family Advisor program, for example, has created a way for patients and families to be “at the table” in important discussions about the way that care is delivered within our system. The clinicians at the Emory Heart & Vascular Center are active participants in helping to transform care at Emory and are committed to working with our patients to provide them with care that is most consistent with their goals. My colleague Dr. Cassimatis, for example, recently wrote on this blog a very helpful set of tips that will help patients to get the most out of their visit and ensure that their questions are answered. Emory cardiologists are committed to answering these questions and to working with patients and their family members to make decisions that are often complex.

Emory cardiologists are also actively conducting research to advance the mission of patient-centered care. Emory physicians are studying how our patients want us to communicate with them about research studies for which they might be eligible. Emory physicians are studying what information is most important to patients undergoing evaluation and treatment for severe heart failure. And Emory physicians are studying the role of new tools for communicating with patients about the risks and benefits of cardiac procedures. These are just a few examples of the ways that Emory physicians and researchers are helping to improve communication and facilitate the kind of trusting relationship that is essential to effective patient-centered care.

Because no decision can adequately reflect patients’ values without evidences, Emory doctors are also at the forefront of conducting clinical research studies that are essential to address many of the pressing problems that patients face. It is only through well-done research that we will have the information our current and future patients need to make decisions that are consistent with their goals.

In all of these ways, the clinicians at the Emory Heart & Vascular Center are committed to ensuring, and to helping other doctors ensure, that patients’ decisions match their values as much as possible.

If you have feedback or suggestions on how to improve patient-centered care at Emory Healthcare, please let us know by leaving a comment below. To make an appointment with an Emory cardiologist or cardiovascular specialist, please call 404-778-7777.

About Dr. Dickert

Neal Dickert, MD, PhDNeal Dickert, MD, PhD is Assistant Professor of Medicine in the Division of Cardiology. He also holds a secondary appointment in the Department of Epidemiology at the Rollins School of Public Health and is a senior faculty fellow at the Emory Center for Ethics. He also serves as associate program director for the cardiology fellowship program. Dr. Dickert received his MD from the Johns Hopkins University School of Medicine and PhD from the Johns Hopkins Bloomberg School of Public Health. Dr. Dickert is board-certified in cardiology and internal medicine. Clinically, Dr. Dickert practices in the Emory University Hospital and Atlanta VA Medical Center Cardiac Care Units. Dr. Dickert’s research focuses on ethical issues relevant to cardiology practice and clinical research.

How To Get the Most Out of Your Doctor’s Visit

Doctor VisitsGoing to the doctor takes time, often comes at some expense and can raise your anxiety level – especially if you are worried that something bad could be discovered. Excellent communication between you and your doctor is essential to a meaningful visit.

Here are a few brief tips to help you get the most from your visit with an Emory Heart & Vascular Center provider:

  1. Think about your top concerns ahead of time. Jot down your top 3 questions/concerns on a piece of paper and bring them in. Show this to the doctor or nurse when they first come in to the room.
  2. Don’t be afraid to ask for something to be repeated if you didn’t understand it.
  3. Make sure you leave the office with a clear understanding of what we know already regarding your health concerns, what the next steps are and what the possible outcomes of any testing are.
  4. Make sure you understand how to take any new medicines and why you were prescribed these medicines.
  5. Consider bringing a relative or friend with you who can listen and ask questions on your behalf – they won’t be as anxious and can help you remember what is said during the appointment.

I am honored to be one of the doctors at Emory. It is our goal here to treat YOU, not just your symptoms or condition. If you have a concern that you want to discuss with us, we are here to help you. Just call 404-778-7777 to make an appointment with an Emory physician near you.

About Dr. Cassimatis

Dimitri Cassimatis, MDDimitri Cassimatis, MD, is Assistant Professor of Medicine at Emory University and Director of the Coronary Care Unit at Emory University Hospital Midtown. He divides his clinical time between Emory University Hospital Midtown and Grady Memorial Hospital. He is also co-director of the first year medical student cardiovascular pathophysiology module at Emory’s School of Medicine. Dr. Cassimatis received his MD from Harvard University and then spent 11 years in the United States Army before joining Emory in 2010.

Emory Expansion Update: Emory Cardiovascular Specialists and the Emory Heart and Vascular Center at Saint Joseph’s are On the Move!

on-the-move-300x114To provide a better patient care experience and align demand with available capacity, many Emory Clinic and Emory Healthcare practices are relocating to redesigned clinical space and/or new locations. The new spaces will be more inviting for patients and more accommodating to the needs of our physicians as well.

As of April 28, 2014, Emory Cardiovascular Specialists and the Emory Heart and Vascular Center at Saint Joseph’s are moving to a new and shared location at 5671 Peachtree Dunwoody Rd, Suite 300, Atlanta, GA 30342, on the third floor.

Beginning April 28th, the patients of the following providers will be seen at the new location:

Emory Cardiovascular Specialists:

Emory Heart and Vascular Center at Saint Joseph’s:

For more information, call 404-778-6070 or get details online, at: http://emoryhealthcare.org/expansion/moves.html